The EconomistAugust 29th 2020 Special reportDementia 71I
n a two-storeybuilding in a suburb of Tokyo, eight old people
are sitting around tables in a spotless living room with a kitchen-
ette attached. They are enjoying a quiz game, which entails shout-
ing out the word that completes a well-known phrase or saying.
One woman is first to all the answers, with nobody else getting a
look-in. But, say staff at this care home, one of 280 run by Nichi
Gakkan, a medical-services company, she forgets what happened
ten minutes ago. The residents’ spartan rooms, with just a few
keepsakes from home, have their photographs on the door, to
make it easier to go to bed in the right one.
The house has 18 beds. All residents have dementia—mostly
Alzheimer’s, but some cases of vascular dementia and one of the
rarer fronto-temporal sort. The youngest is 69; half are over 90.
They are encouraged to help with chores, such as folding their own
laundry. Volunteers teach ikebana(flower arranging) and origami
(paper folding). They watch, or sit through, a lot of television.
Most have families. But some never visit. To be honest, says
one of the staff, it makes little difference. Residents often do not
recognise loved ones. The best that can be hoped for is to offer a
“safe and ordinary everyday life”. This is a top-of-the-range facili-
ty, with a lower ratio of residents to staff than in many other care
homes: four people on duty in the day and two from 5pm to 8am.
The cost is met by public insurance, residents’ pensions and sav-
ings, or by their families. Occasionally a resident has to leave for acheaper home. Mostof them are here till they die.
Japan has the world’s oldest people, with 28% of the population
aged 65 and over and 2.4m people over 90, including more than
70,000 centenarians. (In America, with a population two and a
half times as big, 16% of the population are 65 or over, and there are
97,000 centenarians.) Japan also has the highest percentage of
people with dementia of any country: about 4%, or 5m people.
Since life expectancy at birth is high (81 for men, 87 for women),
birth rates low (seven births per 1,000 people in 2019) and immi-
gration tiny, this percentage is only going to grow.
Just behind Japan demographically are greying western Euro-
pean countries such as Italy and Portugal, and the Asian tigers:
Hong Kong, Singapore, South Korea and Taiwan. These trends of
longer lifespans and lower fertility rates will, barring disaster, be
followed by the rest of the world. So how Japan copes with a pro-
blem that every country will have to confront is instructive.
It has advantages—notably prosperity, but also traditions of so-
cial cohesion and respect for the elderly, and sophisticated compa-
nies alert to the business opportunities in ageing. Nichi Gakkan,
for example, was founded in 1968 to focus on medical administra-
tion and education. It moved into long-term care, which now ac-
counts for 60% of its business, in 1996, ahead of a new insurance
scheme that the government launched in 2000. Its home in Tokyo
is a fine example of humane, dignified care for people with demen-
tia, of whom it houses 130,000 across Japan. However, as the coun-
try’s demographic imbalance worsens, the shortage of places for
the infirm elderly and those with dementia will become more
acute. In 2018 Tokyo was reckoned to be short of 140,000 residen-
tial places for old people. Across Japan it is estimated that the num-
ber of care workers will need to increase sevenfold by 2030 from
today’s 1.5m. On this basis, more than a tenth of the workforce will
be working as carers.
This is a global phenomenon. Around the world, similar pro-
blems are sure to develop. In America in 2017, 1m sufferers from de-God’s waiting rooms
The big question about dementia care is who is going to do itCare