Geriatrics Perspectives From Japan

Abstract In 2025, Japan’s baby boomers will cross the threshold of 75 years of age; a phenomenon that has been referred to as “the 2025 crisis”, resulting in a significant burden on the healthcare system. To address this issue, the Japanese government is establishing the Integrated Community Care System, to provide comprehensive medical and long-term care services in each community. In cooperation with government and affiliated organizations, the Japan Geriatrics Society (JGS) has been working to develop the Integrated Community Care System. As a result of this effort, geriatric medicine is being integrated into the health care system through incentives for practitioners. For instance, medical facilities can be reimbursed if they perform comprehensive geriatric assessments (CGA) and CGA-based management/care. Additionally, home care medicine and polypharmacy are emerging issues of interest to the government. In this symposium, I will discuss how JGS has been trying to achieve “Aging in Place” in Japan.


EAST MEETS WEST: HOME AND COMMUNITY BASED CARE TO ENHANCE AGING IN PLACE
Chair: Takashi Amano Co-Chair: Megumi Inoue Although the magnitude and rate of aging in Japan and the United States differ, the drastic change in population structure has resulted in common challenges in both countries. One challenge is assisting older people in staying in the community. Enhancement of home-and community-based care allows older people to remain in their homes or spaces of their choice without moving into an institution to receive necessary care. This symposium includes four presentations (two from Japan and two from the U.S.) examining various efforts surrounding home-and community-based care designed to strengthen older people's abilities to stay in the community. The presenters will cover a wide range of strategies that have been implemented in both countries. The first presenter will describe the development and delivery of a project to expand Arizona's dementia capable system. The second presenter will describe initiatives of a professional association of geriatrics to promote the concept of aging in place. The third presenter will discuss the Home Hazard Removal Program (HARP), a new home hazard removal and fall risk self-management program delivered in the home by occupational therapists. The fourth presenter will discuss Japan's national policy priority of promoting the use of home health care within the community-based integrated care system. The symposium will conclude with a review of similarities and differences of various efforts, summarize common goals and challenges, and identify best practices.

EXPANDING ARIZONA'S DEMENTIA CAPABLE SYSTEM DAVID Coon, Arizona State University, Phoenix, Arizona, United States
Currently, 5.8 million US adults live with Alzheimer's disease (ADRD); the number is expected to double by 2050. Arizona will experience the greatest percent increase in ADRD by 2025. This project targeted three underserved groups in order to expand Arizona's dementia capable system: people living alone with ADRD; people with Down Syndrome or another intellectual/developmental disability (DS/IDD) aging with ADRD and their family caregivers; and people with ADRD and their caregivers in the Latino community. This presentation describes the development and delivery of the project's educational workshops, case management services, and evidence-based programs. Over 2,220 participants have participated in workshops to date with the largest percentage being case managers, care coordinators, and discharge planners. Evaluations have been extremely positive with 86.1% being "very likely" to recommend the project to others. The presentation concludes with findings and lessons learned regarding the delivery of the project's evidence-based programs and case management services.

GERIATRICS PERSPECTIVES FROM JAPAN
Masahiro Akishita, 1 and Satoru Mochizuki, 2 1. The University of Tokyo, Tokyo,Japan,Hino,Tokyo,Japan In 2025, Japan's baby boomers will cross the threshold of 75 years of age; a phenomenon that has been referred to as "the 2025 crisis", resulting in a significant burden on the healthcare system. To address this issue, the Japanese government is establishing the Integrated Community Care System, to provide comprehensive medical and long-term care services in each community. In cooperation with government and affiliated organizations, the Japan Geriatrics Society (JGS) has been working to develop the Integrated Community Care System. As a result of this effort, geriatric medicine is being integrated into the health care system through incentives for practitioners. For instance, medical facilities can be reimbursed if they perform comprehensive geriatric assessments (CGA) and CGA-based management/ care. Additionally, home care medicine and polypharmacy are emerging issues of interest to the government. In this symposium, I will discuss how JGS has been trying to achieve "Aging in Place" in Japan.

A HOME HAZARD REMOVAL PROGRAM TO REDUCE FALLS IN COMMUNITY-DWELLING OLDER ADULTS Susy Stark, Washington Unversity, St Louis, Missouri, United States
The majority of falls experienced by older adults occur in the home with home hazards associated with an increased risk of falling. Low-income older adults, who have more disability and live in substandard housing, need feasible interventions to help them safely age in place. The Home Hazard Removal Program (HARP) is a new home hazard removal and fall risk self-management program delivered in the home by occupational therapists to prevent falls. To evaluate the program, a randomized control trial was conducted with 310 community-dwelling older adults receiving aging services in the community. HARP had high acceptability with older adults and was feasible to deliver in the community. Adjusted for fall risk, individuals in the HARP group fell 1.4 times versus 2.2 times in the control group over 12 months. This low-cost home hazard removal program demonstrated acceptability, feasibility, and a significant reduction in falls for at-risk community-dwelling older adults.

JAPAN'S NEW FRAMEWORK ON DEMENTIA CARE Kenji Toba, Tokyo Metropolitan Institute for Geriatrics and Gerontology , Tokyo Metropolitan Institute for Gerontology, Tokyo, Japan
The number of people with dementia in Japan is everincreasing. In 2020, 6 million people lived with dementia. The number is expected to increase to 9 million in 2040. This means that a person with dementia will be supported by three working people. To prepare for the big wave of dementia, Japan released the New Orange Plan in January 2015. In 2019, the Framework for Promoting Dementia Care was issued by the Japanese cabinet in which prevention and the opportunity for persons with dementia to age in place were set as the main goals. This framework requires all ministries to promote people's awareness about individuals with cognitive impairment. The educational targets include taxi drivers, retail shop clerks, bankers, police, and people working in the criminal justice system. I will discuss the New Framework which has potential to assist the country in supporting people living with dementia. The Terrie Fox Wetle Rising Star Award in health Services and Aging Research is an award named in honor of Fox Wetle, PhD, who is internationally recognized for her contributions to aging, public health, and health care research. The award recognizes health services researchers in early or middle-career phases who have made significant contributions that embody the value of multidisciplinary health services science and are likely to have a sustained, high impact on practice and research. This aware lecture will be presented by the 2021 Award Recipient, Andrea Gilmore-Bykovskyi, PhD, RN, and will highlight emergent findings and foci in her dementia-focused health services research program. In particular, the award lecture will discuss progress in investigating social and behavioral communication patterns among individuals with moderate to advanced dementia; and the role of temporally situated observational measures and inclusion of persons with dementia and their caregivers in this line of research. The lecture will conclude with a discussion of next steps for this area of investigation surrounding assessment of episodes of lucidity in advanced dementia; and considerations for strengthening progress in outcome evaluation among persons living with dementia through multidisciplinary and community-informed health services research.

IRVING S. WRIGHT AWARD: CELLULAR RECYCLING IN AGING AND DISEASE: THE IMPORTANCE OF TAKING OUT THE TRASH Malene Hansen, Sanford Burnham Prebys Medical Discovery Institute, La Jolla, California, United States
Aging is greatly influenced by quality-control processes that keep the materials inside our cells in proper shape and function. One of these processes is called autophagy, which means "self-eating". This cellular recycling process can digest damaged components to provide new and better parts for the cell. Autophagy plays important roles in many age-related diseases and has been directly linked to aging. In our laboratory, we use the microscopic soil-dwelling round worm C. elegans to understand how autophagy is linked to aging and disease. In this Wright Award seminar, I will discuss our progress on understanding how autophagy is regulated during normal aging and how it may promote a long and healthy lifespan.