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THREE CASE STUDIES IN DEMENTIA CARE IN THE COMMUNITY IN JAPAN

FROM COMMUNITY NURSE’S PERSPECTIVES

Chie Katayama*, Dai Kiuchi*, Hirotoshi Niikawa*, Junichiro Toya*, and Yuko Takahashi**

*Sakurashinmachi Urban Clinic, Tokyo, Japan * * Preventive Long-term Care & Community Support Division, Elderly Welfare Department, City of Setagaya


The Orange Plan: Japan’s National Dementia Strategy

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The Orange Plan( 2012 )

The New Orange Plan ( 2015 )

“Five-Year Plan for Promotion of Measures Against Dementia” for a period from 2013 to 2017

One of the features is:

the establishment of the Initial-Phase Intensive Support Team (IPIST)

“Comprehensive Strategy to Accelerate Dementia Measures” – revision of the Orange Plan with 7 priorities

One of 7 priorities is:

the expansion of the IPIST

Reference: Ministry of Health, Labour and Welfare (2012, 2015)


IPIST’s role:• Making an initial assessment by outreach to subject’s home• Planning for a comprehensive and intensive support• Liaising with local healthcare and social care services• Facilitating early diagnosis of dementia • Promoting social care involvement

Initial-Phase Intensive Support Team of dementia (IPIST)

• IPIST is one of the key policy priorities in the national dementia strategy.• A specialist team consisting multidisciplinary professionals in dementia

(nurses, health visitors, occupational therapists, GP and psychiatrics).• A targeting population: People who are suspected to have dementia,

but have no medical or care intervention.

Home visit to a patient Multidisciplinary team meeting


Aims and objectives

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1. To outline a local IPIST in Setagaya, Tokyo, Japan, to present three case studies to illustrate current situations surrounding people with dementia

2. To examine the effects of the IPIST, particularly from the community nurse's point of view, on people with dementia


Case 1: Pearson A with cluttered house

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History

Issues

Actions

• 80 year old female• Living with her son, but her son was not regularly working and usually at home• The house was built about 50 years ago• Rubbish was scattered throughout the house

• It was difficult to enter the living room • Rubbish was overflowing in the bathroom and out of the house

• Complaints were made to the Regional Comprehensive Support Centre.• She was, then, referred to our IPIST.

• Most social and life history was taken from the family• Confirmation of cognitive dysfunction after learning disability was ruled out• Itching skin conditions• Financial difficulty – not having enough foods• Difficulty in:

• Communication• Making phone calls• House chores

• Skin conditions• Helped her to make an appointment with dermatologist• Got support from her sons and daughter regarding putting ointment

• Financial difficulty• Applied financial benefits to the local authority

• Other health issues• Helped her to register with a family physician in her local area• Liaised with a care manager regarding coordinating social care


Case 2: Person B with son with mental health issue

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History

Issues

Actions

• 80 year old female with son and daughter• Living with her son, and her daughter lived away• Memory impairment for several years• A diagnosis of Alzheimer’s disease • Verbal aggression and refusal of care gradually increased, resulting in arguments with her son.• Neighbours reported to the Regional Comprehensive Support Centre on a number of

occasions that her son was physically and verbally aggressive towards her.• She was, then, referred to the IPIST.

• Mental health issues of her son• Her son was schizophrenic, controlled by medications for a long time• Due to her dementia and lack of her supervision of his medication intake, his delusion

and physical violence got worsened.• At the same time, her son’s mental health issues made her conditions worse.

• Her son’s refusal to let her live with her daughter due to her son’s financial dependent on her

• Implementation of living away from her son• Took time to get to know her and her son• Provided dementia education to her son – to make him understand her conditions

getting worse due to his presence• Suggested staged separation from her son

• Agreed to initially live in a nursing care home near her daughter’s• Managed eventually to live with her daughter


Case 3: Person C with refusal of the IPIST’s involvement

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History

Issues

Actions

• 80 years old female with a son• Living alone since her eldest daughter committed suicide more than 20 years ago. • A number of wandering incidences and troubles with neighbours• A warden on her accommodation referred her to the Regional Comprehensive Support Center • She was then referred to the IPIST.

• Increased incidences in wandering outdoors• Lack of support from her son• Refusal of the IPIST’s involvement

• A number of home visits were made by nurses• Her trust toward nurses and IPIST was gradually gained• Assessment revealed she had difficulty in IADLs as well as ADLs, such as:

• buying foods, dressing and financial management

• Involvement of IPIST and then other social care services• Gained consent from her• Allocated her to a care manager and developed her care plan • Introduced services such as care visits and a day centre during daytime• As a result, reduced wandering and increased nutrition intake

• Consultations with her son• No change in his attitude, but agreed to let her live in a group home near his• Her son gradually increased the visits to the home

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Conclusion

• Community nurses can play a key role in dementia care in Japan.

• They are involved with dementia care not only for those with dementia, but also for people who care for those with dementia.

• It is vital to work in a collaborative multidisciplinary team in the community to fulfil the role of community nurses in dementia care.

• As part of the multidisciplinary team:• They can provide expertise in nursing while working closely

with other healthcare and social care professionals.• They can be more effective in enabling those with dementia

live in their familiar environment as long as possible and helping to developing dementia friendly communities in the community.

adi2017 chie katayama

Healthcare