Features of the Japanese national dementia strategy in comparison with international dementia policies: How should a national dementia policy interact with the public health- and social-care systems?
ABSTRACT The Ministry of Health, Labour, and Welfare of the Japanese national government announced a "Five-Year Plan for Promotion of Measures Against Dementia (Orange Plan)" in September 2012. This article described features of the Japanese dementia strategy in comparison with international dementia policies.
An international comparative study was implemented on national dementia policies to seek suggestions for Japanese national strategy. The study consisted of a bibliographical survey, a field survey, and an online case vignette survey in several countries.
The Japanese health- and social-care system had multiple access points in the dementia care pathway, as did Australia, France, South Korea, and the Netherlands. Contrary to Japan, a simplified access point was observed in Denmark, England, and Sweden. The Orange Plan aimed to establish specific health-care services, social-care services, and the coordination of agencies for persons with dementia. However, fragmentation remains in the dementia care pathway.
The national government should examine fundamental revisions in health, social-care services, and advocacy in joint initiatives with Alzheimer's Association Japan to improve the national dementia strategy.
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ABSTRACT: Background: The Japan Geriatrics Society published a guideline on the decision-making process for health care for the elderly in June 2012, noting that withholding or withdrawing feeding tubes are treatment options that should be discussed during the decision-making process. Arguments against the guideline posit that the insertion of a percutaneous endoscopic gastrostomy (PEG) tube feeding may improve quality of life (QOL) for elderly adults and their relatives. Objectives: The aim of the present study was to explore (a) expected outcomes with PEG tube placement and (b) outcomes from PEG tube feeding in long-term care settings among elderly adults with advanced dementia in Japan. Design: This study was conducted using a cross-sectional study design. Setting: A total of 381 hospitals and 985 long-term care facilities provided sets of completed questionnaires. Participants: There were 1 199 hospital patients and 2 160 long-term care patients aged 65 years or older with PEG tube placement included in the analysis. Measurements: The nurses or physicians at each hospital provided information on the level of dementia at the time of PEG tube placement and on the expected outcomes of PEG tube feeding for elderly hospital patients. The nurses or other direct care workers at each facility provided information on the level of dementia and outcomes from PEG tube feeding for the long-term care patients. Results: In the hospital patient group, 62.9% of patients had advanced dementia. PEG tube feeding was expected to prolong survival for 51.1% of hospital patients with advanced dementia. Improved QOL was expected for 39.1% of them. In the long-term care patient group, 61.7% of patients had advanced dementia. The rate of patients enjoying their own lives was lower in long-term care patients who had advanced dementia (4.2%) than in the other patients (16.4%). Approximately 60% of relatives reported satisfaction with the QOL of the patients, both in the long-term care patients with advanced dementia and the other patients. Conclusion: Our results question the assumption that PEG tube feeding may improve QOL among elderly adults with advanced dementia. The national health policy should explore an approach to help patients, relatives, and practitioners make decisions about feeding options.The Journal of Nutrition Health and Aging 05/2014; 18(5):503-509. DOI:10.1007/s12603-014-0011-9 · 2.66 Impact Factor
Article: Epigenomics of Alzheimer’s Disease[Show abstract] [Hide abstract]
ABSTRACT: Alzheimer’s disease (AD) is a large and growing public health problem. It is characterized by the accumulation of amyloid-β peptides and abnormally phosphorylated tau proteins that are associated with cognitive decline and dementia. Much has been learned about the genomics of AD from linkage analyses and more recently, genome-wide association studies. Several but not all aspects of the genomic landscape are involved in amyloid-β metabolism. The moderate concordance of disease among twins suggests other factors, potentially epigenomic factors, are related to AD. We are at the earliest stages of examining the relation of the epigenome to the clinical and pathologic phenotypes that characterize AD. Our literature review suggests that there is some evidence of age-related changes in human brain methylation. Unfortunately, studies of AD have been relatively small with limited coverage of methylation sites and microRNA, let alone other epigenomic marks. We are in the midst of two large studies of human brains including coverage of more than 420,000 autosomal cytosine-guanine dinucleotides (CGs) with the Illumina Infinium HumanMethylation 450K BeadArray, and histone acetylation with chromatin immunoprecipitation-sequencing. We present descriptive data to help inform other researchers what to expect from these approaches in order to better design and power their studies. We then discuss future directions to inform on the epigenomic architecture of AD.Translational Research 05/2014; DOI:10.1016/j.trsl.2014.05.006 · 4.04 Impact Factor
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ABSTRACT: The World Health Organization's report, Dementia: A Public Health Priority, noted that the number of people worldwide affected by dementia is significant and will continue to increase. The report called on nations to address dementia by developing national plans and undertaking public health initiatives. Special mention was made of the situation of people with intellectual disability, some of who manifest high risk for dementias. In the United States, the National Task Group on Intellectual Disabilities and Dementia Practices (the “NTG”) was created to ensure that the needs and interests of adults with intellectual and developmental disability who are affected by Alzheimer's disease and related dementias—as well as their families and friends—are taken into account as part of general-population dementia health and public policy efforts, particularly as noted in the U.S. National Plan to Address Alzheimer's Disease. To this end, the NTG's multifaceted advocacy efforts have included (1) identifying best practices for providing care and services to affected adults with intellectual disability; (2) developing and identifying a functional workable administrative dementia early detection and screening instrument; (3) producing educational materials useful to families, adults with intellectual disability, and nongovernmental organizations; and (4) furthering public policy initiatives on dementia as they affect adults with intellectual disability. This article describes the origins of this group, its functions and accomplishments, as well its role with respect to national dementia advocacy, as a prototype for other national efforts that can be used to promote the interests of adults with intellectual disability affected by dementia and improve the quality of their lives. Suggested are means for replication of such an effort in other national environments.Journal of Policy and Practice in Intellectual Disabilities 09/2014; 11(3). DOI:10.1111/jppi.12085 · 0.97 Impact Factor