Category Archives: Dementia: International Policies

Japan offers us many lessons in embracing longevity

Japan offers us many lessons in embracing longevity

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With a quarter of the population aged over 65, Japan has had to be innovative in catering for their wants and needs.
Martyn Jones, Author provided

Marco Amati, RMIT University; Marilena Kavoura, RMIT University; Martyn Jones, RMIT University, and Robin Goodman, RMIT University

Japan is famous for the longevity of its citizens. A quarter of its population is older than 65. That is a proportion that Australia is likely to reach only by 2056. Japan’s experience makes it an interesting example to learn from in the area of aged care.

In 2000, following a decade of stagnant growth, mounting public debt and skyrocketing hospitalisation, Japan introduced the Long-Term Care Insurance Scheme (LTCIS). This universal and compulsory scheme provides support to assess and deliver care through institutional or community-based services for all people over 65. It provides sufficient funds to allow everyone to age in place – even those in public housing and with late-onset dementia.

The scheme represents one of the boldest social democratic experiments in aged care policy in the last 30 years. Yet with bold experiments come surprises.

To the chagrin of the scheme’s designers the LTCIS has been too successful. Cheaper to implement than the policy it replaced, it is still oversubscribed and contributing to Japan’s public debt (230% of GDP).

Happy Active Town in Kobe is a public housing estate where more than 50% of residents are older than 65.
Photo: Martyn Jones

The universal acceptance of the scheme contributes to a paradox: while Japan has the largest ageing population in the world, it is difficult to make a business of providing aged care, as the collapse of Watami, the food chain-cum-nursing home provider, demonstrates. So what can this experience teach Australia’s aged care sector?

Care happens within the community

The first set of lessons concerns community-based integrated care. Here, the LTCIS, following 2012 reforms, mobilises support through community general support centres.

Australia is seeking to improve integration of multi-level care. The support centre in “Happy Active Town”, Kobe, provides an example. This public housing estate houses many refugees from the 1995 Great Hanshin Awaji earthquake. Its proportion of residents over 65 is more than 50%.

The LTCIS, with the local government, provides a care hub for volunteers, social workers and health professionals to provide services and respite care free to all residents on and off the estate. Community hubs such as these are designed to support a range of needs from intense support to community and family engagement in care across the life course.

Happy Active Town in Kobe houses many aged survivors of the devastating 1995 earthquake.

Harnessing technological innovation

The second lesson comes from watching and observing the Japanese experience of integrating technology in care provision. Dense, multistorey buildings of small units are typical in Japan. New, so-called “Platinum” housing integrates universal design and new technologies to ensure safe independent living for the elderly.

Retrofitting large areas of public housing to this standard is complex and expensive. A limited number of exemplary regeneration projects where the local municipality, private providers and the LTCIS work together guide the way. One example is Toyoshikidai, a public estate built for young families in the 1950s in Kashiwa to the north of Tokyo.

Alongside these urban changes a generational change is afoot. As the digitally literate generation reaches old age, smart home devices and new security and communication technology assume increasing importance. The business opportunities alone could amount to US$1 trillion by 2035.

The Japanese government supports this shift with its “Silver ICT” agenda. This includes a raft of e-strategies to bridge the digital divide between “active and inactive” elderly populations.

Yet in the nation where the development of robotic assistive technologies enjoys vast sums of research and development support, there is little sign of this in daily life. In Japan, applying technology in aged care is fraught with ethical, personal and logistical challenges. The solution, for now, centres on the involvement of humans.

The ConversationThe Japanese experience of ageing is unique and varied, but presents a foretaste of the future for many post-industrial societies. The “Happy Active Town” of Kobe, 20 years after a major natural disaster, is one example of a place where public policy, housing and technology converge to create solutions for an ageing society. Its mechanisms to support the passion and commitment of the people working and living there can teach Australia how to age with dignity.

Marco Amati, Associate Professor of International Planning, Centre for Urban Research, RMIT University; Marilena Kavoura, Manager Industry Linkage, RMIT University; Martyn Jones, Associate Professor of Social Work, RMIT University, and Robin Goodman, Professor of Urban Planning, Deputy Dean, Sustainability and Urban Planning, RMIT University

This article was originally published on The Conversation. Read the original article.

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Ageing in Place? Yes, we can!

Article: Why it’s good to be old in Wakabadai estate, where nearly half the residents are elderly

Read about a community that has come together to age together at the Wakabadai public housing estate.

Recently Channelnewsasia did a piece on the Wakabadai housing estate in Yokohama, Japan. It’s a really interesting estate and the means in which the estate has been configured bears many similarities to the high rise housing estates found in the big cities where we all live a wall away from our neighbours. However, despite living in the same building for 30 to 40 years a lot of us may just be acquaintances, saying the passing “hi” and “hellos” as we greet each other at the elevator or when we pass each other along the corridors.

A few years ago, I visited a couple who lived alone in a little apartment with two bedrooms, their children had moved out and the husband was caring for his wife with dementia. She is very quiet and apathetic. His greatest worry was that he may suffer a stroke or a heart attack and is unable to get help in time and both of them may pass away in their apartment despite being surrounded by hundreds or thousands of people living in the building. He cited a neighbour living a few floors below them, who had passed away without anyone noticing until a number of days later. He talked about the need for services for families like them, and many services assume that because they have children, there would be someone watching out for them. However, with the busy lives that his children lead, looking after their families and juggling work, they could only call in on the weekends and rightly so with the changing landscape of the economy.

His son offered to have them stay with him but leaving their much familiar neighbourhood might be too much for his wife. Even now she would get agitated if they left the vicinity. For them this is home, this is where they had built their lives, house their memories, thrived in their love, and they wouldn’t want to live anywhere else.

Why is it that when we grow old, we have to move away? We have to sell our home, move into a retirement village and start all over again. I want to live in a place that will evolve and age as I age, that grows old as I do.

Back to Yokohama, the Wakabadai public housing estate is just that, with slightly less than half of the residents 65 years and older, the people living in the estate are ageing in place together. To date, there is a total of 14,658 residents living in the estate in 6,304 units. To ensure that they needs are met, they have come together with organisations and council to organise a range of services.

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Map of Wakabadai

Social Engagement for Older Adults:

The Wakabadai Non-Profit Organisation enables social activities such as health, music, cultural and sporting events to be held in the vicinity. Himawari provides a space for volunteers to interact with older adults over a cuppa. Residents are also keenly aware of “kodokushi”, which refers to people who are living alone and have passed away and their deaths have gone unnoticed by the community. In Wakabadai, residents band together and keep a keen eye out for the sudden build up of mail or newspaper in the mailboxes of older residents and the mail continues to be left unattended with no notice that the resident might be away.

A paid service is also available at the Himawari Community Centre where they can have a staff to ring their phones to ensure they are alright. They can also have a spare key stored at Himawari for approximately 500 yen.

In addition, celebrations during festive periods are arranged by the organisation to encourage engagement among the residents. Sports events are also organised regularly to encourage and promote a healthy lifestyle among residents.

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Wakadabai Estate

Creating an Intergenerational Community:

To encourage engagement from children and younger adults, a facilty for mothers group known as Wakaba Family Plaza Soramame can be found in Wakadabai. A safe space for mother’s of infants and toddlers to interact, support and exchange vital parenting information with each other and older adults. Older adults with early childhood qualifications can find work as advisors, helping to support young mothers, sharing with them their years of wisdom. Coming into Wakaba Family Plaza Soramame, you may find three generations interacting and hanging out together.

Meaning Occupation:

The Wakabadai Non-Profit Organisation also helps to find jobs for older adults.

Older adults can also showcase their culinary skills at Haru Dining, a restaurant staffed by older women living in the area serving up old school, heartwarming home cooked meals.

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Assistance with Activities of Daily Living:

Residents can also tap on a home help service at the cost of 490 JPY per hour which covers everything from house chores to transport to get their food or groceries delivered. Transport is highly efficient with buses running every 3 mins to the major train station, currently, residents are campaigning for a train station to be built close to their vicinity.

Other accessible facilities in the area include a post office, supermarkets, salons, restaurants, shops, gyms and parks.

Healthcare:

When it comes to healthcare, the Community Centre run by the Yokohama City Council also provides exercise classes for older adults, a care facility for older adults during the day, and medical staff such as nurses are available to provide older adults health and medical advice.

In addition, Asagao, a district nursing service consisting of nursing and medical staff from an acute hospital in the area man an emergency hotline that is accessible for residents in the estate at all times of the day or night. On top of the hotline, staff also provide and provide home care to the residents in the community.

When it comes to high care needs, residential aged care facilities are also located in the estate for residents who are too frail to reside in their own home.

With all the facilities to encourage a positive ageing in place, it is no wonder that the rates of older adults requiring nursing care much lower than the average rates found in other estates in Yokohama. In Wakabadai, the rates of nursing care currently stand at 12 percent whereas, on average 17.5 percent of older adults in each estate is found to require nursing care at home.

Wakadabai has shown that ageing in place is possible and it is achievable in the big cities with high-density living. With key elements in place, council and community support, we all can grow old gracefully in the luxury of our homes.

Dementia, prevention & our children

There are 23 million people living with dementia in the Asia Pacific Region in 2015, costing the region a whopping US$185 billion. Little education exists on dementia for our children aside from countries such Australia, Japan, with some children attaining information in countries such as Korea, Singapore, Taiwan and China. However, there is nothing in the national curriculums to prepare children for Dementia or help children to fully understand  the need of dementia inclusive enabling communities or the preventative measures required for them to put in place at a young age to reduce their risk of dementia especially those brought about by lifestyle factors.

Ireland with slightly less than half the number of people living with dementia at approximately 20,000 people, and a population of 1.8 million and a land mass of 14,130 km2. Alzheimer’s Society reported that at least 30% of the young will know a person living with dementia. Last Wednesday it was announced on the Alzheimer’s Society website that Alzheimer’s Society and the Council for the Curriculum, Examinations and Assessment have included dementia in the school syllabus, making Northern Ireland the first to have a dementia friendly generation.

The resources are also available not just in English but also in the Irish language. Click here to view resources.

PRIMARY SCHOOL: The Archie Project from Reminiscence Learning has created a unique and innovative intergenerational awareness project to reduce the stigma associated with dementia. They believe that by engaging with young children they are dispelling the fear of dementia and changing the attitudes of our workforce for the future, providing education to support early diagnosis. Archie’s Story follows a scarecrow with dementia on his journey from exclusion to inclusion. The accompanying Archie workbook goes on to help children understand how Archie’s state of wellbeing improves by being understood, loved and included — a simple concept but one that both children and adults can relate to. The Archie Project provide books, workbooks, assemblies, scarecrow parades, Archie-related activities, training, drama and recognisable merchandise so that everyone can connect with the Archie character and learn how to engage with people with dementia in their families and communities. Links between schools and care homes enable children to put their new dementia awareness into practice. By increasing their knowledge of dementia, the project gives them confidence to interact with residents during visits to local care homes, where they take part in shared activities such as singing, gardening activities, coffee mornings, shared lunches, snooker, craft activities, tea dances and storytelling. Archie mascots encourage conversation and engagement with people at all stages of dementia. For more information visit www.reminiscencelearning.co.uk/archie (Source Alz Soc Youtube)

The promotion of dementia awareness not only helps us to create a better multi-generational dementia inclusive society but for our children, it will help them better understand the need for education and the impacts of negative lifestyle choices. A study based on a Comparison of the Prevalence of Dementia in the United States in 2000 and 2012 published in JAMA internal Medicine on the 21st November indicated that education appears to be a protector against dementia. Dr Kenneth Langa theorises that education “actually creates more, and more complicated, connections between the nerve cells so that you’re able to keep thinking normally later into life.”

In addition, Director of the Division of Behavioral and Social Research in the National Institute on Aging, John Haaga adds that “Education can not only change the brain, it can change your whole life… It affects what kind of work you do, of course. It also affects who your friends are, who you’re married to, whether you’re married. All aspects of life are affected by educational attainment.”

When children learn about dementia and the brain, they will also learn about the risk factors which will help them to adhere to healthier lifestyle choices. According to Dr Alina Cohen, “factors such as adhering to a healthy lifestyle including a diet that is rich in essential nutrients, regular exercise engagement, and having an adequate cardiovascular profile all seem to be effective ways by which to preserve cognitive function and delay cognitive decline.” This study by York University presented evidence that the delay of dementia is connected with healthy living which in turn aids higher brain function. On a whole, our children will understand the importance of education, strategies to building cognitive resilience and understand the need for a healthy lifestyle for a healthy brain. There are a whole lot more pros than cons in this picture and policy makers should really sit up and start using their brains to look at how this can be implemented. Students will be able to understand the effects of stress on the brain, the importance of prevention and help-seeking behaviours especially in the areas of anxiety and depression. On a systemic level, this will create not only a friendlier, integrated and healthier multi-generational society but one that in the future may potentially see a reduction in healthcare spending as a result of unhealthy lifestyle choices.

SECONDARY SCHOOL: In the summer of 2012, Stoke Damerel Community College was invited to become one of 21 Pioneer Schools as part of the Prime Minister’s Challenge on Dementia. The school took a unique approach to dementia education, placing it across the curriculum into as many subjects as possible and endeavouring to work in partnership with their community and local and national organisations. They placed emphasis on creative processes and outcomes, intergenerational contact and active learning. Subject leaders were actively engaged in determining the shape of dementia education in their own subjects. Some of the most successful projects at the school were those that involved creative ways of working and intergenerational activities. For example, as part of the PE curriculum, people with dementia visited the school to play croquet with year 7 students. For more information visit http://www.sdcc.net (Source Alz Soc Youtube)

In addition to Primary and Secondary school, Scout groups have also joined the cause On such program is A Million Hands a program that supports 4 main social issues, dementia being one of the four that have been selected by the young. The objective is to empower and enable the young and the youths to tackle these issues head on and have the courage to make a change. In the areas of dementia, Scouts may find themselves helping people with dementia to fight isolation or helping with awareness by teaching people to spot signs and symptoms of dementia.They may work to try and work to make communities more accessible and even work to campaign for a cure and improve the lives of people with dementia.

Dementia as part of the educational curriculum could well be a means to improve not just the future of our children but perhaps the society as a whole.

Why we need Geriatric ERs in Asia

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CNN (Source: Geriatric ERs reduce stress, risks for older patients – CNN.com) recently touched on the need for Geriatric emergency rooms (ER) that can provide seniors with better care. According to the world bank, in 2010 there were 211 million older adults 65 years and above in East Asia and even in a little island in Singapore, by 2020, 1 in 5 Singaporean will be an older Adult. We have hospitals for children across Asia, isn’t it about time we started having at least an ER for older adults? Wouldn’t this not only be beneficial to the patient and their family but beneficial to the outputs in terms of care and the cost to the system as well. We all know that hospitals are detrimental environments for older adults and especially so for people with dementia.

  • unfamiliar alien environment
  • difficulty in orientation
  • high levels of negative stimulation from noise, smell, temperature…
  • constant interruptions to sleep well into the night
  • lack of autonomy
  • lack of natural light

We also know the benefits for the patient if we improve the acute environment and the care provided, but there are also wider benefits for society and especially for the family. With dependency ratios increasing in Asia and higher life expectancy rates, think China, with 1.3 billion people and a 4,2,1 family structure. With 4 grandparents, a couple, and their child, and now with the removal of the one-child policy, you may have 2 children in the family. If an older adult has been admitted into the emergency room the stressors on the family, especially the working adult will be incredible. Anyone who is a parent and are caring for parents will know this. This is not inclusive of the 30 million bachelors in China who will be the sole caregiver of their parents. How can we have an effective workforce if there is a constant worry that our parents are not getting adequate medical care in hospitals, on top of juggling work, kids and worrying about the health of 3 other older adults in the family? As a child you can’t not worry about your parents especially when it involves the ER, it’s only natural. A parent going to the ER is possibly one of the scariest thing a child can experience. On top of that, there are the worries about the out of pocket cost for care. The least we could get really is a decent healthcare system that can help care for older adults, and a geriatric ER will be a good start. In a Geriatric ER at least we know our parents are getting the right care from the start and in the right environment, that in itself will be a great relief from the get go.

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We’ve all heard of the Chinese proverb:

“The superior doctor prevents sickness; The mediocre doctor attends to impending sickness; The inferior doctor treats actual sickness”.

A cultural change in care requires collaboration and evidence, and the success of early intervention will reduce the operational and financial strain on the health and social care system. Isn’t it time, for the hospitals in Asia that can make a change start doing something about it and adopt a salutogenic approach to care? Isn’t it time we start taking our own advice?

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Singapore’s Dementia Friendly Community: Forget Us Not

Singapore has a Dementia Friendly Community in Yishun, this is a joint awareness initiative by Lien Foundation and Khoo Teck Puat Hospital. The campaign is known as  “Forget Us Not” the campaign. The website is available in both English and Chinese. A good resource for all Asians to check out to gain some basic knowledge about dementia.

For people overseas this may be a good resource if you are working with an Asian client or for people living in Asia, this may be a good resource to share with your clients to have them understand more about dementia. It’s simple and easy, with short write-ups and visuals to help bring the message across.

Visit their website: Forget Us Not – Home

Singapore Member of Parliament speaks up on alternatives to Nursing Homes

It’s good to see that even members of parliament are getting involved in the conversation of improving the care of people with dementia in Singapore. MP for Tanjong Pagar GRC Dr Chia Shi-Lu spoke up in Parliament citing that new models need to be explored especially for people with caregivers. Dr Chia also recommended that partnerships with foreign institutions and industries should be carried out.

Read more about the straits times article below.

Traditional nursing homes may be excessive for some residents, while studies have shown that restoring the autonomy of the residents has many positive effects on their well-being, says the MP for Tanjong Pagar GRC in Parliament.

Source: More alternatives to nursing homes needed: Dr Chia Shi-Lu – Channel NewsAsia

A Better Way of Looking at Dementia Care in Asia: The 4 Big Zeros

This is pretty amazing, a models of care from an organisation providing care in Japan. This is just incredible, it’s just so simple and functional.

At first glance, it looks confusing, like what? 4 big zeros? Zero wheelchairs? What does that mean? That the organisation don’t provide wheelchairs?

image from http://www.sompocare-next.jp/

4 zero is a really outstanding care philosophy, to ensure that the organisation work towards the physiological and mental health of the resident to ensure that their independence, dignity and autonomy is maintained as long as possible. So much so that until the end of days they will never have to live with diapers, assisted baths, tube feeding or wheelchairs.

1. Zero Diapers/pads

2. Zero Special baths

3. Zero Tube feeds

4. Zero Wheelchairs

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That really sums up the care that we need to provide to ensure that the people with dementia have a great quality of life. Too often we take it for granted that it’s okay for people to wear diapers/pads, to have assisted baths, to be on feed tubes and to grow old is to literally lose your mobility. Be it a home care service, residential aged care, or in acute care, that’s what we all should be aiming to help everyone live better. To ensure that people living with dementia can live healthy, respected and meaningful lives without the added pain, humiliation and anguish that we so flippantly systematically introduce into their lives.

Residents have told me that they are uncomfortable, humiliating, and some have even felt the need to become reclusive, as they are conscious that their pads or diapers may smell. This is awful for a person’s well-being. Living with dementia, it’s stressful enough to ensure that each day is lived to it’s fullest, to remember to do the things that they need to do. On top of that having to wear, change and walk around with a diaper or pad, really is one of the last things anyone really needs. Zero Diapers/Pads!

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As a child, can you remember getting your body scrubbed and being twirled around to be mopped up in the shower. Like a military exercise, the shower never comes on when you want it and it’s always too hot or too cold. Think of the dances that you did and the anxiety it brings trying to avoid that first blast of water. The pelting of water smacking into your face when you least expected it. Lots of scrubbing and before you know it, it’s all done and you are bundled out faster a bag of groceries at the supermarket at lunch time.

Some people rally appreciated their showers, they sing in the shower, play with the foam in their hair in the shower, and just sometimes after a long day which feels like the end of the world, they may just stand in the shower with the water streaming down on me in silence. Just listening to the sound of the water, enjoying the calming warmth in serenity, it’s much needed especially after a rough day.

Having assisted baths are just not the same, and for anyone who has showered a resident. Residents have mentioned that they don’t care anymore and for some it is frustrating and they get annoyed especially if they get a different person helping them with their shower that they may not be familiar with, and rightly so. Imagine having a stranger seeing you naked or scrubbing you, or standing in the room watching you while you try and enjoy a warm shower. We should try and help people to maintain their independence and mobility as long as we possibly can, so that for everyone who enjoys a nice hot shower by themselves in private, they can keep rocking on. Zero Special/Assisted Baths!

Imagine never being able to eat. Food is the breath of life, from the moment of birth we taste the sweetest of milk, we lick the salt off the palm of our sweaty little hands and as we grow, continue to enjoy the luxurious experience of having a meal. We open our auditory perception to the vibrators around us, to the sound of chewing in our mouths, the crackle and pops, the slurping, chomping of meat and vegetables, the crunching of chips. We open our senses to a world of gustatory perception, from the sweetness of honey to the heat of the beloved bird’s eye chillis from Southeast Asia. Our 5000 taste buds activating their 100 taste receptor cells, kicking themselves into action, working hard to make each meal an adventure (Siverthorn 2007). When the odorant molecules creep towards us and bind themselves to our olfactory receptors, we can’t help but take in the information that these little molecules have given us and up the glomerulus, the information is sent, right into our olfactory bulb that helps us make sense of the delight close by. They say we eat with our eyes, and watching chefs like Jamie Oliver put together a feast before us, some say it’s almost as good as having the meal in itself. Let’s not even talk about the tactioception, the spring of a baked muffin out of the oven or themoception, the cold of a vanilla ice cream, or the warmth of Ramen on a winter’s afternoon.

Kuraoka & Nakayama (2014) stated that common causes of issues that might require percutaneous endoscopic gastrostomy (PEG) where a tube runs pass the mouth and through the adomon to deliver contents the stomache include;

  • inability to independently have their meals as a result of cognitive deterioration
  • loss of interest/appetite in having their meals as a result of depression or poor mental health
  • damage to nerves and muscles required for the eating and swallowing in the event of stroke

Research (Taylor et al 1992), found that up to 70% of people with PEG will encounter complications ranging from minor to severe with survival probibility of 1.5 years to 4 years after referrel. Increased risk of death was also stated in the study and it was stated that individuals with people with low risk of survival will not benefit from having a PEG. A multitude of ethical issues that arise from PEG includes the stress and frustration that caregivers feel to have to make decisions regarding their loved ones being on PEG and most of these decision-making procession may only range for a few minutes, forcing caregivers to make an on the spot decision regarding this critical issue (Kuraoka & Nakayama 2014).

We should do our best to keep older adults, happy, healthy and independent and not flippantly take the important issues for granted and have people live with PEG feeding tubes/Nasal Gastric (NG) tubes. Zero Tube Feeds!

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The last of all is a big issue and a lot of people grapple with nurses and caregivers alike. We are all afraid of our loved ones and residents falling, in Asia we are also attuned to over caring and being time poor it’s a lot easier for us to do things for others then to allow them to do it themselves with our assistance. We pride efficiency and timeliness at the cost of the independence for others. This however is not fully attributed to staff, Residents, families and clients have to be aware of these issues as well. They have to be aware of the issues that are tied to muscle atropher or disuse atrophy which occurs from loss of physical activity. It’s not uncommon to see a person after recovering from a fall, filled with intense anxiety and grappled with fear that they literally wake up, sit in a wheel chair and never find the strength to be mobile again. Some nursing staff may also have encountered residents who on top of not wanting to walk, insist on being pushed around in a wheelchair. Residents feel that they pay for their care and therefore they should be wheeled everywhere and should not lose out, as caregivers and families, do they realise that the emphasis on the dollar is impacting their cognitive and physical health resulting in their loss of movement?

Just the basic movement of walking, in the part to the bus shelter, getting up to grab a drink result in the activation of different muscle synergies and motor corticol regions in our brain. Each movement that we take for granted and carry out with ease sets off a blaze of neurons. Imagine walking in the garden or a park, feeling the sun on your face or the breeze, or the heat and humidity working up a sweat. We are surrounded by a constant ball of experiences, though little they make up a whole of how we conprehend and understand our bodies, mind and the environment around us. The simple things in life are lessons in itself. We know (Ahlskog 2011) that physical exercise is a critial cost-effective preventative element against dementia and brain aging, so why are organisations strapping their clients down and paying for programmes which may not have adequate evidence base in the preventative treatment of dementia and brain ageing?

We should be working towards enhancing, enabling and empowering people to be healthy and fit, to help them maintain their independence, autonomy and mobility in an inclusive environment. Zero Wheelchairs!

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We have the obligations to provide good care for the people around us, to maintain a sense of harmony and homeostatis to keep our inclusive and complex society moving. Putting the needs of fulfilling black and white key performance indicators that provide quantitative information without any qualitative outcome for the people we are meant to care for is no outcome at all. What does it mean to give a part of ourselves and our time to pursure the more important and meaningful things in life and not just keeping up the numbers. Unlike the West, we were brought up with values that put the needs of society before our own, and we need to remember that and not pursue our own needs at all cost for our own brighter future at the risk of poorer health outcome for others.


 

References:

Ahlskog JE, Geda YE, Graff-Radford NR, Petersen RC. Physical exercise as a
preventive or disease-modifying treatment of dementia and brain aging. Mayo Clin
Proc. 2011 Sep;86(9):876-84.

de March, Claire A.; Ryu, SangEun; Sicard, Gilles; Moon, Cheil; Golebiowski, Jérôme (September 2015). “Structure–odour relationships reviewed in the postgenomic era”. Flavour and Fragrance Journal 30 (5): 342–361

Kuraoka, Y. & Nakayama, K., 2014. A decision aid regarding long-term tube feeding targeting substitute decision makers for cognitively impaired older persons in Japan: A small-scale before-and-after study. BMC geriatrics, 14(1), p.16. Available at: http://www.ncbi.nlm.nih.gov/pubmed/24495735.

Rana M, Yani MS, Asavasopon S, Fisher BE, Kutch JJ. Brain Connectivity
Associated with Muscle Synergies in Humans. J Neurosci. 2015 Nov
4;35(44):14708-16.

Silverthorn, D. U. (2007). Human physiology: An integrated approach. San Francisco: Pearson/Benjamin Cummings.

Taylor CA, Larson DE, Ballard DJ, Bergstrom LR, Silverstein MD, Zinsmeister
AR, DiMagno EP. Predictors of outcome after percutaneous endoscopic gastrostomy:
a community-based study. Mayo Clin Proc. 1992 Nov;67(11):1042-9.

Other sources: 私たちの特長 | SOMPOケアネクストの有料老人ホーム・介護施設


 

Disclaimer: Just to be clear the blogger does not work or receive any funding from the company or organization in this article.