Where a Thousand Digital Eyes Keep Watch Over the Elderly

ITAMI, Japan — In his early 70s, Koji Uchida began to vanish.

The first time, the police found him sitting in front of a vending machine 17 miles from home. He began to go missing regularly, once wandering for two days before turning up at a stranger’s apartment, hungry and barely able to remember his name, his mind clouded by dementia.

At a loss for what to do, his family asked the local government to put Mr. Uchida under digital surveillance.

In Itami, the suburb of Osaka where Mr. Uchida’s family lives, more than 1,000 sensors line the streets, each unit emblazoned with a smiling cartoon figure bracketed by Wi-Fi squiggles. When Mr. Uchida went out walking, the system recorded his location through a beacon hidden in his wallet and sent his family a steady stream of alerts. When he veered off course, the family could easily find him.

Itami is one of several localities that have turned to electronic tracking as Japan, the world’s grayest nation, confronts an epidemic of dementia. The programs offer the promise of protecting those in cognitive decline while helping them retain some independence, but they have also evoked fears of Orwellian overreach.

Japan’s surveillance efforts presage the conundrums facing countries across the globe as their populations rapidly age: how to manage the huge expense of care for people living ever-longer lives, as well as the social costs to families and other loved ones.

The Japanese government sees the task as critical to the country’s future stability, envisioning fundamental changes to nearly every aspect of society, including education, health care and even, as in Itami, infrastructure.

The surveillance system there is one of the more extreme examples of this adaptation. Advocates for people with dementia, including some with the condition itself, have raised serious concerns about digital tracking, warning that the convenience and peace of mind offered by surveillance could threaten the dignity and freedom of those under watch.

The monitoring of older people has deepened questions of consent as electronic surveillance systems have become a fixture worldwide, applied broadly both in wealthy, open nations like the United States and Britain and in authoritarian ones like China.

Japanese people are intensely protective of their personal privacy, and many municipalities have adopted less intrusive forms of electronic tracking. As with any tool, the value of the Japanese systems will ultimately be determined by how they are used, said Kumiko Nagata, the lead researcher at the Tokyo Dementia Care Research and Training Center.

She sees promise in applications that give users more freedom by relieving fears that they will get lost. But she worries that the systems will “just be used as tools for dealing with ‘problem’ people” — anyone who has become a burden on a family or officials.

As the nation with the world’s oldest population, Japan is most vulnerable to the ravages of dementia: memory loss, confusion, slow physical decline and, most heartbreakingly, the ineluctable dissolution of the self and relationships with others.

Japan has the world’s highest proportion of people with dementia, at about 4.3 percent of the population, according to an estimate by the Organization for Economic Cooperation and Development. A 2012 Japanese government study found more than 4.62 million residents with dementia, and some researchers estimate that a quarter of the Japanese population will have the condition by 2045.

Dementia is the leading cause of missing-person cases in Japan. More than 17,000 people with dementia went missing in 2020, up from 9,600 in 2012, the first year official data was reported.

That year, the government issued its first national dementia policy, and it has been grappling ever since with building a legal framework to better accommodate those with the condition.

One major outcome has been an increased focus on helping people with dementia “age in place” — instead of consigning them to nursing homes — in hopes of improving their quality of life and lessening the load on overtaxed care facilities.

But home-based dementia care can be a major source of anxiety for caregivers and those in cognitive decline. While many localities in Japan offer adult day care, it can be expensive and leave gaps in supervision for those most likely to wander.

National policies and messaging on accommodating those with dementia often conflict with social expectations and the behavior of local authorities. Families sometimes hide away people with dementia, fearing that erratic behavior could attract social stigma or inconvenience the community. For those who repeatedly wander, the police may pressure families to keep them at home or closely monitor their movements.

In 2007, a 91-year-old man with dementia wandered away from his home in central Japan and was hit and killed by a train. Its operator sued his grieving family for…