Authors Revisit Old Case and Suggest New Action Plan on Dementia Care, Support

July 26, 2018

The burdens and challenges of caring for someone with dementia are significant for family caregivers. In 2007, a tragic case brought worldwide attention to this issue when a 91-year-old man living with dementia wandered onto a railway line in Japan and was killed by a moving train, causing extensive delays and other problems. The railway sued the deceased’s family and was awarded more than 7 million yen (this was reversed on appeal).

The July issue of JAMDA features a special focus on care for persons with dementia. In “Who Is Responsible? A Man with Dementia Wanders from Home, Is Hit by a Train, and Dies,” Dr. Yuchi Young et al. reviewed the case and proposed a call to action to help support families caring for loved ones with this illness. This case, the authors observed, emphasizes the unpredictable nature of dementia in terms of its cost to manage and its impact on society. They suggested the need to address three critical issues: wandering (elopement) intervention strategies to improve safety, ethical issues related to autonomy and privacy, and, in Japan, national plans related to dementia care.

The authors particularly emphasized the need to address issues related to wandering. They noted that up to 60% of people with dementia wander, and 50% of those who do so and aren’t found within 24 hours face serious risk of injury—including falls, fractures, dehydration, and traffic accidents. While there are tracking devises and other means to prevent or discourage wandering, these pose ethical dilemmas. As the authors noted, “The fundamental human rights of privacy and dignity may be compromised while assuring safety.”

The authors proposed a call to action to ensure that health care policy and funding can keep pace with the family dynamics and epidemiology of aging, particularly regarding dementia. They suggested policies that consider the application of technology and its associated ethical issues related to dementia care and the inclusion of dementia care options in health care and advance directives. As they noted, “A proactive approach is the only way to preserve autonomy while ensuring safety.”

This study was conducted by researchers at the Department of Health Policy, Management, and Behavior in the School of Public Health at the State University of New York in Rensselaer; the Department of Economics at the State University of New York College of Arts and Sciences in Albany; and the Department of Economics at Rutgers University in Camden, NJ.

For more information on the findings and more details about the study, click here. To contact the researchers or JAMDA editor for an interview, please email



JAMDA is the official journal of AMDA – The Society for Post-Acute and Long-Term Care Medicine. JAMDA publishes peer-reviewed articles including original studies, reviews, clinical experience articles, case reports, and more, on all topics more important to post-acute and long-term care medicine. Visit for more information.

About the Society for Post-Acute and Long-Term Care Medicine
AMDA – The Society for Post-Acute and Long-Term Care Medicine is the only medical specialty society representing the community of over 50,000 medical directors, physicians, nurse practitioners, physician assistants, and other practitioners working in the various post-acute and long-term care (PALTC) settings. Dedicated to defining and improving quality, we advance our mission through timely professional development, evidence-based clinical guidance, and tireless advocacy on behalf of members, patients, families, and staff. Visit for more information.