Cross-industry and multidisciplinary
collaboration to promote innovation of"dementia-friendly" goods and services in Kyoto
Professor Jin Narumoto, MD, PhD
Department of Psychiatry,
Kyoto Prefectural University of Medicine, Japan
Decision Making Support Organization Japan

Prevalence of dementia in Japan (2012)• People with Dementia

4.62 million• People with Mild Cognitive Impairment

4.00 million

Proportion to the total population is 6.8% (8.62/127 million)
%
100
79.5
80
6160

41.4

40
20

13.6
2.9

21.8

4.1

065-69 70-74 75-79 80-84 85-89 90-94

95-Grant-in-Aid for Scientific Research grant (Comprehensive Research Project on Dementia)
Comprehensive research report "Prevalence of dementia in urban areas and response todysfunction of dementia" (Representative: Takashi Asada) 2012

2With no worry
even when lost

Cross-Industry Collaboration is essential

CommuterCan use evenwith dementia.

Restaurant

Housing

Can use even withdementia and can use thenecessary administrativeservices.

Local
Government

Can use the necessary
caregiving services.

BankSupermarket

Care
Medicine

Can receive thenecessary
medical care.

Able to rent
property that suitsyouAble to withdraw
the money
necessary forliving. Protectedfrom fraud andabuse.

Can shop without
undue worries.

3

Policy Maker

Ministry of Economy,
Trade and Industry

Cross-Ministry Collaboration is also essential
Commuter

Making Platform

Restaurant

Housing

Ministry ofPublic
Management,
Home Affairs,
Posts andTelecommunications

Local
Government

Bank

Supermarket

Care
Ministry ofHealth, Labourand Welfare

Ministry of Land,
Infrastructure, Transportand Tourism

Financial Services
AgencyConsumer Affairs
AgencyMedicine4Commitments of ministries in Japan• Ministry of Economy, Trade and Industry– Dementia-friendly innovation alliance working group– Subsidy for creating dementia-friendly product and service• Financial Services Agency– Guidance for dementia-friendly bank
– Subsidy for creating sophisticated capacity assessment method
using digital technology• Consumer Affairs Agency– Project for supporting consumer with dementia

5

To create innovative cross-industrial collaboration
Consortium

Joint Declaration
on DementiaFriendly CrossIndustry
Collaboration

Declaration for “dementia friendly” service

Decision-Making
Support Organization
Japan (DMSOJ)- Guideline for each type of industry- Creation of “dementia friendly” service basedon collaboration of different type of industry

Companies that try to create “dementia friendly” service

FinanceInsurance

Retailing

Transportation

Patients and Family

Information
communication

Medical adviser(KPUM)

Provide information about
dementia friendly informal
supports in the community
Municipal
officeMedicalCare

CompanyOffice

MedicalCare

Security
Service

Consumer organization,
Research institute

Alliance with local dementia
friendly city consortiums
Town B

Town ACompanyOffice

Realestate

Municipal
officeTown C
MedicalCare

CompanyOffice

Municipal
officeMedicalCare

6Consortium for Dementia-Friendly Cross-Industry
Collaboration• Twenty companies from various industries participated• Participants were separated into 5 groups to create businessidea and declaration• People with dementia and their family, professionals in medicaland care field and other stakeholders also participated

Joint Declaration
on DementiaFriendly CrossIndustry
Collaboration

7

Joint Declaration on Dementia-Friendly Cross-Industry Collaboration

This calligraphy was written by Kogetsu Yamada who was 96 and amaster of Suimei Calligraphy Organization.
Joint Declaration
on DementiaFriendly CrossIndustry
Collaboration

8

Joint Declaration on Dementia-Friendly Cross-Industry Collaboration■ Listen to the voices of people with dementia:
1. Start with understanding dementia
2. Act toward the realization of thewishes for each person living withdementia
3. Support better use of medical careand long-term care
4. Support you to play an active role insociety, regardless of whether you areliving with dementia
5. Delivering entertainment that you
can enjoy, regardless of whether you
are living with dementia
Joint Declaration
on DementiaFriendly CrossIndustry
Collaboration

6. Create new services for people withyoung-onset dementia
7. Support people who are support
persons for those living withdementia
8. Deliver useful information by utilizing
various tools
9. Contribute to create a society that
prepares for cognitive decline
10. Cooperate across industries

Translated by Jin Narumoto

9Integrated service for people with dementia directed by ALSOK*

Dementia Friendly Community
Promote understanding of dementia
throughawareness campaigns (VR events）
Social involvement
Local events
By utilizing special shoes,
comparison & check of walking amount on the Web

Reduce loneliness

Use the donationfor empowermentof people withdementia

Sustainability of project
Frail prevention + Improve QOL

Reduction of public long-term careexpenseDonation Model
Kyoto special design Card of Electronic Money“nanaco”

Donation of certain percentage of the usage【Life support services】
physical /watching support, preventing fraud /fire etc...

*ALSOK: Sohgo Security Services Co., Ltd.

910

ICT solution for connecting people having dementia with other people

Problem「Mutual aid ×ＩＣＴ」＝ＩＣＴ care involving cooperators ＝ Implemented into our society
Person with dementia at home & family

Person with dementia
and their family①Doctors

Managementsystem

After diagnosis
Not connected to・medical・welfare・administration

UnattendedInterval①Doctors②Social workers③Support groups
Provide information（connection）
App
Considered
functions & contents
forpeople withdementia②Social workers③ Support groups
for dementia

Connection
withsomeoneMatching
make one’s will
come true

Expanded ICT care
（Integrated care system through ICT）

※MutualTaking long time..
before receiving
care service

Placesfor SNS

Person with dementia
and their family

Cooperators route
Encourageapp
downloaded

Cooperators①Support for downloading the app Support fromcooperators②Support for use of the app

Connection
withinformationMaking
friends

Realplace & role

working

Developsurvey＆researchservice

To achieve goal

Verify the effects
cooperatingorganizations
Managementsystem

Establish
business model

Information ofdaily supports

survey & sponsorship

General Incorporated Association ″Safety Net Linkage”

1011

Stabilize business transaction with the elderly• Check a person’s capacity to validate the transaction• Provide decision-making support according to thecapacity
To achieve the goals• Education, guideline and supporting service

12https://coltem.com/Since 2013
Implementation of Decision-Making
SupportCollaboration Center of Law, Technology andMedicine for Autonomy of Older Adults
ICT × Decision-Making Support

Kyoto
IoT ×Capacity Assessment
Remote Assessment ×Decision-Making Capacity

Financial institution ×Decision-Making Support

SOMPO
RESEARCH
INSTITUTE
SUMITOMO LIFE

Cognition and Emotion×Decision-Making

Civil law ×Decision-Making Support

KYOTO SHINKIN BANK
Sumitomo Mitsui Banking Corporation
MUFG Bank

Supported by Japan Science and Technology

13Financial Management and Cognitive Decline
Healthy

MCI

Wastefulness
Management Failure

Mild

Moderate

SevereTerminal

After Death

Unawareness ofImpairment
Delusion oftheft

Victim of Fraud and Abuse
Difficulty of Decision Making

If a bank has 1 million elderly customers,
4000 of them would develop dementia in 1 year.
(One year incident rate of dementia = 4/1000)13

Estimated number of person with dementia in insurance policyholders

Total: 905,327
Person with dementia: 105,578

300,000

250,000

200,000

150,000

100,000

50,000

0
65-69

70-74

75-79
Policyholders

80-84

85-89

90-94

person with dementia

14

Financial capacity from medical point of view
Financial capacity can be influenced by• Cognitive impairment– Memory, Executive function, Attention…

• Experience and Literacy

Financial institution should• assess financial capacity• value process of doing business with elderly costumers• give a clear explanation about the characteristics ofproduct including risk and commission
Ogawa and Narumoto, Financial Affairs (2019)16

Decision-Making Support Organization Japan (DMSOJ)
Supporter

Shared Decision Making• Easy-to-understandexplanation• Capacity assessment• Provide adequate information• Ensuring transparency

Witness• Record• Endorsement

Healthcare

Testament• Assurance of
ethical validity of
medical practice• Evaluation ofconsent capacity

DecisionMaking
SupportContract• Explanation andprocedure based onprinciple of suitability• Capacity assessment• Capacityassessment• Exclude undue
influence

FinancialManagement• Assurance of necessityof expenditure• Capacity assessment

https://www.dmsoj.com/

17

Textbook for bankers to provide dementia-friendly services[Contents]• Understanding of dementia (from a medical point ofview)• Features of each major dementia• Need for regional collaboration, multi-occupation
collaboration
Basic knowledge to know
• How to communicate with the elderly• How to build a relationship of trust with the elderly• What is decision-making capacity• Points to notice dementia in financial institutions• Collaboration between financial institutions andpublic support counterparts
Case Study• "Repeat losing passbooks “• "Economic abuse“• "Fraud"

17

Certification for bankers to provide dementia friendly-services

Provided by KINZAI Institute for Financial Affairs, INC

18

Card Controls: Essential care for elderly’s payment
Cashless cards could be controlled, through algorithms and apps
Visa Transaction Controls(Source) VISA Development Center Website

Card Monitor Functions(Source) BMO Harris Bank Website

19

Multi Stakeholder Financial Care
Universal

Light Care/MCI

Heavy Care

BequestNeeds

Financial planning,
prevention of crime

Daily financial care

Economicabuse/financial
crime prevention

Orderly Procedure(for the family)

Services(Software)
Personal financialmanagement,
fraud alerts(Algorithm)
Fraud alerts,
expense monitoring,safe payment(Monitoring)
Guardian services,
secure data sharing,alerts to 3rd parties(Procedures)
Data sharing,accounting,insurance

FamilyAccount

MFBanksEMoney

PatientFamily

Authorization

Alert onlyGuardian

Advisors

Financial
Institutions

CreditCards

Access to all data

20

Thank you for your attention
Professor Jin Narumoto, MD, PhD
Kyoto Prefectural University of Medicine, Japan

Email: jnaru@koto.kpu-m.ac.jp