IPA Bulletin

PSYCHOGERIATRICS AROUND THE WORLD: PSYCHOGERIATRICS IN JAPAN 
JIMMEIKAI Research Institute for Mental Health and the Gold Plan

KOHO MIYOSHI

The life expectancy of Japanese is now the longest in the world. The average life span of Japanese men and women are 77.64 and 84.62 years respectively. The population aged 65 years and over have increased rapidly in Japan from 7.0 percent in 1970 to 17.2 percent in 2000. Currently, 18.9 percent of the general population is aged. And, it is estimated that a population of the old will be at 19.6 percent in 2005, 22.0 percent in 2010 and 32.3 percent in 2049. Additionally, the population of the old-old, 75 years and over, is estimated to increase persistently, from 7 percent in 2000 to 8.7 percent in 2005,10.5 percent in 2010, and 13.4 percent in 2020.

The increase of the aged among the general population causes a serious problem for society. In Japan, rate of prevalence of dementia in the elderly over 65 years was 7 percent in 2000, and is estimated to be 8.5 percent in 2020. That means that people with dementia are at approximately 1.55 million in 2000 and will be 2.91 million in 2020 in Japan.

The most common cause of dementia is now Alzheimer’s disease (AD) in Japan. In the 1970s vascular dementia (VD) was reported to be the commonest cause of dementia. However, the recent incidence rate of VD has been reduced remarkably. The VD/AD ratio decreased from 2.9 in 1973 to 0.7 in 1996. The reason for this decrease is that the prevalence of VD is still not fully known.

In 1989 the Ministry of Health and Welfare predicted the serious problems of the aging society and started a comprehensive 10-year project, called the Gold Plan, in order to cope with the aging problems. In 1994, the project was slightly modified (New Gold Plan) to accelerate the program. The Project aimed to establish a network system to support the aged in the society.

There are three types of Nursing Homes, namely “Special Nursing Home for the Elderly” (34,000 beds) for the persons who are severely disturbed in daily life with physical or mental illness, including dementia, but not needing hospitalization, “Nursing Home for Elderly People” (95,000 beds) for persons without disabilities, and “Health Service Facility for the Elderly” (283,000 beds) for those with a mild physical or mental disorder, including dementia. Besides these institutions, there are 2,200 group homes for the mildly demented people.

Now, as one of the results of the projects, 142 Medical Centers for Dementing Disorders, affiliated with the General Hospital or Hospital of Medical University, are functioning as clinical and research centers for the dementing disorders in the elderly. There are 1,058 Mental Hospitals with approximately 335,000 inpatients in Japan in the year 2002. According to the governmental statistics, the numbers of elderly patients in Mental Hospitals were approximately 103,000 in the year 2000. That means elderly patients occupy approximately one-third of the wards of the mental hospitals. The numbers of inpatients with AD, VD and other organic mental disorders in mental hospitals were 10,612; 22,773; and 61,624 respectively at the end of June, 2000.

The insurances, managed mainly by Government and Municipalities, may lighten financial burdens of the families of the demented patients. We have an obligatory “Health Insurance,” which all citizens must join. Most of the expenses for treatments of physical and mental disorders, including dementia, are inpatient and outpatient in hospitals and are covered by the Health Insurance. Since the year 2000, Government started another insurance system, “Longterm Care Insurance,” which is also obligatory for the elderly in Japan. Municipalities, like Cities, Towns and Villages, manage this insurance system with support by Prefectures and Government. All Japanese, over 45 years of age, pay the premium for the insurance. And, people over 65 years of age, have a right to receive care services in their homes or in institutions, if approved by the Operating Committee, consisting of physicians, psychiatrists, case workers, lawyers, and local government staffs. The Care Service Insurance covers the expenses of institutional care of the demented. For in-home care, nurses or helpers who assist the daily living of the aged are sent to the home. Day Care or temporary stays for a few days in institutions is arranged with insurance to reduce the burden on the caregivers in the home.

The Japanese Psychogeriatric Society

The Japanese Psychogeriatric Society (JPGS) was founded in 1986. JPGS had 2,519 members in the year 2002. The number of psychiatrists in Japan is estimated at 8,800 this year. Thus, 28.6 percent of Japanese psychiatrists are members of JPGS.

Dr. Masaaki Matsushita has been president of JPGS since 2000. Past presidents are Dr. Kazuo Hasegawa (1986-1996) and Dr. Tsuyoshi Nishimura (1996-2000). The society’s first meeting was held in Kawasaki near Tokyo in 1986. Since then, annual meetings have been held for 17 years. The 17th meeting was held in Kanazawa City this year. Two symposia were held—“Manual of Diagnosis and Treatment of AD” and “Prevention of Vascular Dementia”—and 101 papers were submitted to the meeting.

Two papers received the JPGS Research Award this year: “No Association Between Presenilin I Intron Gene or butyryolcholinesterase K Variant and Alzheimer’s Disease in Japanese Population” by Dr. T. Yamamoto, Kobe University Graduate School of Medicine; and “Effect of Aging on Gene Expression of Metabrotropic Glutamate Receptor 5 and Glutamate Transporter-I in the Prefrontal Cortex of Schizophrenia” by H. Shimada, Juntendo University School of Medicine.

Two journals are published by JPGS. The Japanese Journal of Geriatric Psychiatry (Rounen-Seishin Igaku Zassi, monthly, in Japanese), started in 1986. Original and review papers are contributed to the Journal. The chief editor is Dr. Masaaki Matsushita.

Prior to 1999, Dr. Koho Miyoshi edited the Journal. The quarterly journal, Psychogeriatrics (in English) was started in 2001. Dr. Masatoshi Takeda (Osaka) is editor in chief. Original as well as review papers, written in English, are published in this journal. In 2001, JPGS published Manual for the Diagnosis and Treatment of dementia of the Alzheimer Type (in Japanese), as a guideline for the treatment of dementia.

In 1999, JPGS established a system to approve experienced doctors as specialists in Psychogeriatrics. This enables families of demented patients to find geriatric psychiatrists in the community. Clinical practice for seven years, including the training in geriatric psychiatry under the supervisors who are also certified by JPGS, is essential for certification. Scientific contributions are also necessary for approval. The number of certified specialists in psychogeriatrics is 385 in the year 2002. Contact information for these specialists is located on the JPGS Website (www.rounen.org).

JPGS has been closely collaborated with IPA for many years and has been affiliated with IPA since 1988. The 3rd International Congress of Psychogeriatrics was held in Tokyo in 1989. It was certainly a good chance for Japanese Geriatric Psychiatrists to establish close relations with colleagues in the world. Since then, many contributions to IPA have been made by Japanese doctors, including Kazuo Hasegawa (the past-President of IPA), Akira Homma (past-Treasurer of IPA) and Tsuyoshi Nishimura (retired BOD). Currently, Masatoshi Takeda and myself are the members of the IPA BOD.

Members of JPGS are pleased to again be the host society of the 13th International Congress in 2007. The Congress will be held in the second largest city in Japan, Osaka. We hope many of you visit Osaka and enjoy the Congress in the year 2007.

Koho Miyoshi is the director of Jinmeikai Institute for Mental Health, Nishinomiya, Japan.

Reprinted from IPA Bulletin Volume 19 Number 4