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Japan is far from alone. Dementia is increasing across the globe - 47 million people already live with the disease, with more than 130 million projected by 2050. But the first waves have crashed over Japan. When it comes to dementia - a group of disorders affecting memory and cognition, for which there is no known cure - age is the greatest risk factor. No country has gotten older faster than Japan, the world's first "super-aged" nation. In the early '60s, Japan was the youngest of today's G7 countries. Now, it is the oldest - a dramatic shift fuelled by plummeting birth rates and the world's highest life expectancy, according to the World Health Organization, with an average of 84 years (in Canada, it's 82).

A quarter of Japan's 128 million people are already elderly, meaning over 65. By 2060, the elderly will make up 40 per cent of the population. Many will spend their dying days addled by dementia, which already affects 4.62 million Japanese. Ten years from now, an estimated 7.3 million people in Japan will have dementia - more people than live in Hong Kong, Rio de Janeiro or the entire GTA. "The impact will be so huge," said Dr. Koji Miura, director general of the Ministry of Health, Labour and Welfare's bureau for the elderly. "The burden on younger people is very rapidly increasing. If we don't do anything, society will be in trouble." Last year, more than 10,700 people with dementia went missing in Japan. The vast majority were found - some dead - but 168 were not. Violent crimes fuelled by kaigo jigoku, the Japanese term meaning "caregiver hell," are increasingly making headlines.

In July, 83-year-old Kyuji Takahashi was accused of stabbing his wife. He allegedly told police: "My wife has dementia and I am worn out from looking after her." Right now, these stories are still the exception, but Japan's challenge is to stop a public health crisis from unspooling - while battling the world's highest debt.

There is little any government can do about changing the course of dementia. The only thing Japan can change is Japan. "We see the crisis point as 2025," said Mayumi Hayashi, a research fellow with the Institute of Gerontology at King's College London. "And to cope with that crisis point, Japan is trying to create a society where everybody contributes and people with dementia have a better experience and quality of life." Grassroots efforts play a leading role in building this new society, with volunteers spearheading efforts to increase awareness and to form networks to find wanderers - those who go missing after becoming disoriented or confused.

Over the past 15 years, Japanese policy-makers have also changed everything from the social welfare system to the very word for "dementia." Before, the commonly used term was chiho, meaning "idiocy" or "stupidity," even in medical literature. In 2004, the government made an unusual announcement: chiho would know be known as ninchisho, meaning "cognitive disorder." "After the change of the name, the knowledge and acceptance of dementia has spread widely all over this country," said Dr. Takashi Asada, a psychogeriatrician who was a member of the renaming committee.

Japan's all-hands-on-deck dementia strategy - introduced in 2012 and revised last year - involves not just the health ministry but 11 other ministries and agencies. The strategy funds research but also prioritizes early detection, training front line health workers, support for caregivers and creating "dementia-friendly" communities. But the single most important - and radical - change Japan has made to improve dementia care came in 2000, when the government introduced mandatory long-term care insurance.

A primary goal was to help seniors live more independently and reduce the burden on relatives - particularly women, who are often the caregivers. So unlike long-term care insurance in countries like Germany, which offer cash, Japan's system offers services - and consumer choice. The scheme works like this: at age 40, every Japanese resident pays a monthly insurance premium. When they turn 65 - or get sick with an aging-related disease - they become eligible for a range of services: everything from dementia daycare to lunch delivery and bathing assistance. Depending on income, users also pay a 10- or 20-per-cent service fee - a measure that discourages overuse. This system also created something crucial in the field of long-term care: a market.

"Lots and lots of services developed very rapidly," said John Creighton Campbell, a University of Michigan professor emeritus and expert on Japan's long-term care system. "Without the long-term care insurance system, they wouldn't be conceivable." Campbell believes Japan is "better than any other place in the world for dementia care." Of course, Japan's unique and complicated system won't necessarily translate in other countries and significant issues remain, particularly when it comes to financial sustainability; the number of Japanese using long-term care has more than doubled since the program began, with 5.6 million people accessing it in 2013. Japanese families also continue to demand institutionalized care for their relatives and caregiver burnout is still a growing problem. But Japan's trials and errors are instructive for other nations, marching their own paths toward the destination of super-aged. The country is already living the future that countries like Canada are bracing for.

In September, national anxiety followed Statistics Canada's announcement that, for the first time ever, Canada's elderly population had surpassed its population of children. Japan hit this same milestone - in 1997. Clearly, there is good reason to keep an eye toward the Land of the Rising Sun, the Lancet medical journal recently suggested. "How Japan addresses the challenges - and opportunities - posed by a rapidly aging society will become a model for other countries facing their own demographic time bombs."

Dementia by the numbers 61,568 Japanese centenarians today 153 Japanese centenarians in 1963 1 in 5 Elderly Japanese who will have dementia in 2025 1 million

Nurses and care workers needed by 2025 to deal with dementia 40% Percentage of Japan's population that will be over 65 in 2060 15,731 Number of over-65 Japanese abused by families or relatives, according to a 2013 survey 14.5 trillion yen

Cost of dementia on the Japanese economy in 2013 6.2 trillion yen Estimated cost of informal care for de

24.3 trillion yen Estimated cost of dementia in 2060

Elderly people work out with wooden dumbbells in Tokyo to celebrate Japan's Respect for the Aged Day in September. A quarter of Japan's 128 million people are over 65. By 2060, that figure will be 40 per cent. • Nobuko Tsuboi runs a seniors daycare, covered by Japan's long-term care insurance. • Tomofumi Yamamoto is staying fit in hopes of warding off dementia.

£7 an hour, receives an extra £1 an hour for a night shift and £2 an hour for weekends.

"The NHS encourages you to have these NVQs, all this training, improve your knowledge, and then they [private care companies] come along and it all comes to nothing.

Care UK expects to make a profit "of under 6%" by the end of the three-year contract

£700,000 operating profit in the six months between September last year and March this year,

In 1993 the private sector provided 5% of the state-funded services given to people in their homes, known as domiciliary care. By 2012 this had risen to 89% – largely driven by the local authorities' need for cheaper ways to deliver services and the private sector's assurance that they could provide the answer. More than £2.7bn is spent by the state on this type of care every year. Private providers have targeted wages as a way to slice out profits, de-skilling the sector in the process.

1.4 million care workers in England are unregulated by any professional body and less than 50% have completed a basic NVQ2 level qualification, with 30% apparently not even completing basic induction trainin

Today 8% of care homes are supplied by private equity-owned firms – and the number is growing. The same is true of 10% of services run for those with learning disabilities

William Laing

report on private equity in July 2012

"It makes pots of money.

Those profits – which are made before debt payments and overheads – don't appear on the bottom line of the health firms' company accounts, and because of that corporation tax isn't paid on them.

Some of that was in payments on loans issued in Guernsey, meaning tax could not be charged. Its sister company, Silver Sea, responsible for funding the construction of Care UK care homes, is domiciled in the tax haven of Luxembourg

Bridgepoint

.voterDiv .ob_bctrl{display:none;} .ob_pdesc IMG{border:none;} .AR_1 .ob_what{direction:ltr;text-align:right;clear:both;padding:5px 10px 0px;} .AR_1 .ob_what a{color:#999;font-size:10px;font-family:arial;text-decoration: none;} .AR_1 .ob_what.ob-hover:hover a{text-decoration: underline;} .AR_1 .ob_clear{clear:both;} .AR_1 .ob_amelia, .AR_1 .ob_logo, .AR_1 .ob_text_logo {display:inline-block;vertical-align:text-bottom;padding:0px 5px;box-sizing:content-box;-moz-box-sizing:content-box;-webkit-box-sizing:content-box;} .AR_1 .ob_amelia{background:url('http://widgets.outbrain.com/images/widgetIcons/ob_logo_16x16.png') no-repeat center top;width:16px;height:16px;margin-bottom:-2px;} .AR_1 .ob_logo{background:url('http://widgets.outbrain.com/images/widgetIcons/ob_logo_67x12.png') no-repeat center top;width:67px;height:12px;} .AR_1 .ob_text_logo{background:url('http://widgets.outbrain.com/images/widgetIcons/ob_text_logo_66x23.png') no-repeat center top;width:66px;height:23px;} .AR_1:hover .ob_amelia, .AR_1:hover .ob_logo, .AR_1:hover .ob_text_logo{background-position:center bottom;} .AR_1 .ob_org_header { border-top: 10px solid #D61D00; display: block; font-family: georgia,serif; font-size: 14px; font-weight: bold; padding-bottom: 10px; padding-top: 5px; } More from the guardian Rogeting: why 'sinister buttocks' are creeping into students' essays 08 Aug 2014 Theatre's decision to ban Jewish film festival is 'thin end of wedge' 09 Aug 2014 Sir Paul Nurse: 'I looked at my birth certificate. That was not my mother's name' 09 Aug 2014 Adventures in contraception: eight women discuss their choices 10 Aug 2014 Child prison deaths 08 Aug 2014 [?] .voterDiv .ob_bctrl{display:none;} .ob_pdesc IMG{border:none;} .AR_2 .ob_what{direction:ltr;text-align:right;clear:both;padding:5px 10px 0px;} .AR_2 .ob_what a{color:#999;font-size:10px;font-family:arial;text-decoration: none;} .AR_2 .ob_what.ob-hover:hover a{text-decoration: underline;} .AR_2 .ob_clear{clear:both;} .AR_2 .ob_amelia, .AR_2 .ob_logo, .AR_2 .ob_text_logo {display:inline-block;vertical-align:text-bottom;padding:0px 5px;box-sizing:content-box;-moz-box-sizing:content-box;-webkit-box-sizing:content-box;} .AR_2 .ob_amelia{background:url('http://widgets.outbrain.com/images/widgetIcons/ob_logo_16x16.png') no-repeat center top;width:16px;height:16px;margin-bottom:-2px;} .AR_2 .ob_logo{background:url('http://widgets.outbrain.com/images/widgetIcons/ob_logo_67x12.png') no-repeat center top;width:67px;height:12px;} .AR_2 .ob_text_logo{background:url('http://widgets.outbrain.com/images/widgetIcons/ob_text_logo_66x23.png') no-repeat center top;width:66px;height:23px;} .AR_2:hover .ob_amelia, .AR_2:hover .ob_logo, .AR_2:hover .ob_text_logo{background-position:center bottom;} .AR_2 .ob_org_header { border-top: 10px solid #D61D00; display: block; font-family: georgia,serif; font-size: 14px; font-weight: bold; padding-bottom: 10px; padding-top: 5px; } /* updated via mysql on 2014-04-08 */ .AR_2 .ob_what { display: block; } /* added via mysql on 2014-06-20 */ .OUTBRAIN:hover .ob_what a { text-decoration: underline; } .ob_box_cont.AR_2 { padding-bottom: 5px; } /* end mysql add */ /* added via mysql on 2014-07-14 */ .AR_2 .ob_org_header span { color: #999; font-family: arial; font-size: 11px; font-weight: normal; display: block; } /* end 2014-07-14 */ More from around the webPromoted content by Outbrain http://paid.outbrain.com/network/redir?p=0iZOm4XuGW6R5uuT6ZFciNevzJlIfmxs0SRwpiMrH7gWrMXoPie4vIA9PlhaEW%2BXNi57pCgl9j8yOE3HuJT75pwCLNj4n18v3EKQDEV0YFQjOBxc46mOs

NDP MP and health critic Libby Davies said the problem is a lack of health-care resources aimed at wellness, disease prevention and assistance for caregivers, she said. “All of the resources are aimed at the acute care system but we know that there’s so many gaps and holes that create really enormous difficulties for people,” said Davies.

Even seeing the halls decked for the holidays -- multicoloured strings of lights, glittering decorations and a Christmas tree -- can be anxiety triggers for a person with dementia, especially as the disease progresses and memory loss becomes more prominent.

"What happens is for people who have memory loss, they don't quite understand what the decorations are for sometimes," says Rubinstein.

"Now all of a sudden you've got this tree in the living room. And it's a tree that wasn't there yesterday ... And because it is something new and it is out of their ordinary, it can cause anxiety: How did this get here? What's next?"

"Memory encompasses logic, knowledge, concentration and judgment," so its progressive diminishment can lead to some unexpected behaviours.

"Still continue to involve the person (with dementia). Especially in the early stages, this is so important because quite often what happens is the person with dementia is quite aware of what's happening to them and still quite able to do a lot of things.

"And oftentimes, people around that person will start to step back from them or not include them because of the diagnosis," Hickman says. "That can be really, really difficult for the person with dementia to feel as if they're not being included and not an important part of the family in the gathering."

Finkbeiner's advice to others caring for a loved one with dementia is to recognize the signs that things are not going well for the person and to be prepared to alter plans.

Here are some tips from the Alzheimer's Society to help make the holiday period more enjoyable for everyone involved.

Talk to staff in advance; they usually know best what residents can handle. Make celebrations simple; it's your presence that counts. Bring a favourite book or piece of music; read and sing together. Reminisce about past holidays or events to help trigger happy memories. Don't prolong your visit if the person seems tired or distressed.

Recent reports from the Health Service Ombudsman,3 the Care Quality Commission,4 and the Equality and Human Rights Commission5 have also shed light on some appalling practices in care.

47% of patients admitted were incontinent, 49% needed help with feeding, and 44% needed major help with transfers

a quarter of patients over 70 undergoing acute admission have dementia.7

A more recent prevalence study conducted in a general hospital found that 50% of people over 70 years admitted to hospital had cognitive impairment, 27% had delirium, 24% had possible major depression, and 8% had definite major depression, 8% had delusions, and 9% were agitated or aggressive.9

However, the 2011 national audit of dementia care in general hospitals showed that only 6% of 210 hospitals had a care pathway for people with dementia, only 6% of those with dementia were administered a test of cognition on admission and discharge, a quarter of hospital notes did not include an assessment of pain, and only 5% of hospitals required staff to be trained in the care of patients with dementia.8

The Preventing Abuse and Neglect in the Care of Older Adults (PANICOA) study

found that older patients often described acute hospital wards as “confusing and inaccessible”

A Royal College of Nursing project that undertook several surveys of more than 700 professionals and almost 1500 family carers, supporters, and people with dementia, found that older people with dementia have more complications and stay longer in hospital than those without dementia.11

152 residents

A compact, self-contained model village on a four-acre site on the outskirts of town, half of it is open space: wide boulevards, cosy side-streets, squares, sheltered courtyards, well-tended gardens with ponds, reeds and a profusion of wild flowers. The rest is neat, two-storey, brick-built houses, as well as a cafe, restaurant, theatre, minimarket and hairdressing salon.

low, brick-built complex, completed in early 2010

suffering from severe or extreme dementia

250-odd full- and part-time staff

six or seven to a house, plus one or two carers, in 23 different homes. Residents have their own spacious bedroom, but share the kitchen, lounge and dining room.

25 clubs, from folksong to baking, literature to bingo, painting to cycling

encourages residents to keep up the day-to-day tasks they have always done: gardening, shopping, peeling potatoes, shelling the peas, doing the washing, folding the laundry, going to the hairdresser, popping to the cafe

seven different "lifestyle categories"

One is gooise, or Dutch upper class

a house in ambachtelijke style, for people who were once in trades and crafts: farmers, plumbers, carpenters

Huiselijke is for homemakers: neat, spotlessly clean, walls hung with wooden display cabinets for dozens of brass and porcelain ornaments

No doors – apart from the main entrance, with its hotel-like reception area – are locked in Hogewey; there are no cars or buses to worry about (just the occasional, sometimes rather erratically-ridden, bicycle) and residents are free to wander where they choose and visit whom they please. There's always someone to lead them home if needed.

Other houses are designated christelijke, for the more religious residents; culturele, for those who enjoy art, music, theatre (and, says Van Zuthem, "getting up late in the morning"); and indische, for residents from the former colony of Indonesia (rattan furniture, Indonesian stick puppets on the walls, heating two degrees higher in winter, and authentic cuisine).

urban, for residents who once led a somewhat livelier lifestyle

By the time Hogewey was finished, it had cost ¤19.3m (£15.1m). The Dutch state funded ¤17.8m, and the rest came from sponsors and local fundraising.

anyone can come and eat in the restaurant, local artists hold displays of their work in the gallery, schools use the theatre, businesses hire assorted rooms for client presentations

Nor is the cost per resident of this radically different approach to dementia care much higher than most regular care homes in Britain: ¤5,000 a month, paid directly to Hogewey by the Dutch public health insurance scheme

Some residents also pay a means-tested sum to their insurer. There is a very long waiting list.

You don't see people lying in their beds here. They're up and about, doing things. They're fitter. And they take less medication.

we've shown that even if it is cheaper to build the kind of care home neither you or I would ever want to live in, the kind of place where we've looked after people with dementia for the past 30 years or more, we perhaps shouldn't be doing that any more."

Researchers think the symptoms result in part from brain damage as the disease eats away at nerve centres that regulate mood, perception, motor skills and the ability to control impulses.

More important than flagging the warning signs is having home-care workers and CCAC case managers act on any identified symptoms

With the new computer tool, case managers are automatically alerted to clients who might need closer medical attention and given concrete steps for followup. They include contacting a client's family doctor and, if needed, coaching a physician to refer patients to the appropriate community supports or medical specialists such as Molnar.

nearly 20 per cent of the 31,000 seniors who receive home-care services in Eastern Ontario have diagnosed dementia. That translates to more than 6,300 seniors a year

He said an NDP government would also focus its efforts to improve health-service access in communities and neighbourhoods facing doctor shortages. Later in the day, in the southeastern B.C. community of Cranbrook, Mr. Mulcair rolled out a $40-million strategy to deal with Alzheimer's and dementia.

The dementia money would be spent on screening, early diagnosis and treatment to slow the advance of the devastating condition, as well as on helping families access care for afflicted family members. Funding would also go to research. "Stephen Harper has left important health issues like dementia and Alzheimer's disease without resources or leadership, just as the number of Canadians living with the conditions is expected to double," the NDP Leader said in a news release. A year ago, the Conservatives announced a $31.5-million plan to partner with public and private sector groups over five years to tackle dementia.

The Alzheimer Society of Canada says 747,000 Canadians had the disease in 2011 - about 15 per cent of people over 65. The figure is projected to rise to 1.4 million by 2031. Ottawa has been increasing health transfers to the province and territories by six per cent per year since 2004. The Conservative government announced in 2011 that after 2016-17, future increases would be tied to the growth in the nominal gross domestic product - a measure of real GDP plus inflation.

All three main political parties are jostling for position in advance of Thursday's Globe and Mail leaders' debate on economics in Calgary. The NDP will release a full costing of its platform on Wednesday to get out ahead of the debate. But before it rolls out its numbers, the party is announcing key details in its health-care platform - a central theme of NDP campaigns for decades.

And in Vancouver on Sunday, the NDP Leader announced plans to invest $1.8-billion over four years to expand home care for 41,000 seniors, create 5,000 additional nursing beds and improve palliative-care services. Party officials say they intend to focus on health care all week, suggesting there is more to come. Still, questions remain about how or when Mr. Mulcair will make good on a long-standing promise to use a budget surplus to preserve the six-per-cent annual increase in health-care transfers to the provinces. Monday was the second straight day for Mr. Mulcair in British Columbia, where the NDP hopes to double its seat count to at least 24.

Hogewey has a grocery store, a theatre and a barber shop. The only twist is that many of its 152 residents live unaware that their orderly community is actually a nursing home for people with severe dementia.

Rhonda Desroches, who helped create a smaller-scale Hogewey in Penetanguishene, Ont., says relatives of the residents are pleased with how happy their family members seem to be in the new facility.

Last August, Georgian Bay Retirement home in Penetanguishene, Ont., opened a section designed to recreate the look and feel of the 1950s and '60s.

All the doors in the theme rooms look like bookshelves, so residents won't recognize them and stray.

In Florida, a company called Miami Jewish Health Systems wants to create a program that reflects Hogewey's philosophy "to really make living as normal as possible within the scope of the disease," says Marc E. Agronin, the company's vice-president of behavioural health and clinical research.

Georgian Bay Retirement home opened a memory care centre unit based on the Hogeway model last April. The facility is built to remind residents of the '50s and '60s. (CNW Group/Georgian Bay Retirement Home)

Some nursing homes have built fake bus stops outside their facilities, Hughes says. When patients want to leave the facility and go home, health-care workers take them to the bus stop. After a while, caregivers can distract the person, presumably taking advantage of the fact that they have forgotten where they were going, and bring them back inside.

There are nurses on staff, but the amenities are operated by real cooks, waiters and other employees who aren't health-care professionals. They're just trained to deal with dementia patients.

These are not 311 new beds - certainly not in the longterm care facility where our mother has been a resident for the past six years. To achieve this target, the very people who already occupy those beds are being displaced. So if there are no new beds, where are these displaced long-term patients supposed to go?

When I received the phone call from my mom's facility, I was immediately asked if there was another facility where we'd like her to go. Which mythical long-term care facility might that be? Our mother does not respond well to change. After the last room move, this delicate woman was sick for two months from the stress and ended up in hospital.

She was already in our facility of choice, so moving her elsewhere is out of the question. In recent weeks, we've watched as residents in her wing have been moved - some into rooms in a different wing after other residents there have died; others upstairs into the dementia unit. So now precious beds for dementia patients are being taken away to accommodate other residents who should not even be in that unit in the first place.

The facility where our mother resides is supposed to provide 11 beds for restorative care. Administration had managed to displace enough people to offer up nine beds. By Monday, it was down to the last two, both in private rooms and difficult to place - a gentleman who has called the facility home for more than a decade after suffering from a stroke, and our mother.

At a meeting with the care manager, we were told a private room had come available, but it was not in the wing where other longterm care residents had been moved. It was in the dementia unit. By the end of a stressful morning of discussions with the manager, among family and a consultation with our mother's doctor, it was clear that if we didn't take this room, then regardless of our wishes and what was in the best interest of our mother's physical and mental health, AHS would likely transfer her elsewhere. Whatever it took, AHS would get those 11 beds, at least four of which came at the expense of dementia patients.

Like a captive sentenced to death and offered the choice of beheading, hanging or electrocution, the outcome for my mother is still the same: She's still going to move, and it will be devastating. We've been down this road all too often before. The forced move has not been easy for the other residents either. I'm told one elderly woman keeps returning to her old room whenever she needs to use the bathroom. Disorientation is a common thread. At my mom's facility, the introduction of restorative care was carried out with much secrecy. It's also been rushed, chaotic, highly disruptive to residents, their families and staff. I've been informed that staff found out about the addition of the restorative care program not from their administration, but through a news story.

This debacle demonstrates a profound lack of caring, compassion and common sense, as well as a total disregard for the well-being of elderly, vulnerable patients who have been displaced. To Mandel and AHS, these people are only numbers; pawns in a shell game of shuffling beds. And to what end? Certainly this has not resulted in the creation of new beds. Rather, the result is a loss of beds and the heartless displacement of seniors in need of long-term care and dementia care. There is a human cost. Shame on you, Stephen Mandel and the Alberta government. Cheryl Croucher is an Edmonton broadcast journalist working in digital, radio and print media.