Earticle

고령화로 인한 여러 가지 사회문제가 발생하는 가운데 치매노인의 증가도 이 중 하나라 할 수 있다. 치매 인구 증가에 따른 사회경제적 비용이 증가하는 상황에서 체계적이고 효율적인 치매관리 대책의 필요성이 제기되고 있는 가운데, 본 연구에서는 우리보다 앞서 치매관리 대책을 마련하여 실시하고 있는 일본의 치매관리 대책을 살펴 보았다. 특히 2015년 발표된 일본의 인지증시책추진종합전략(신오렌지 플랜)의 내용을 중점적으로 살펴보고 이를 통 해 우리나라 치매정책 발전 방안을 탐색하였다. 이에 따라 치매환자나 그 가족들의 입장을 반영한 지원내용의 포함, 초로기 치매에 대한 대응의 필요성, 초기집중지원팀과 같은 조기진단 및 조기대응을 위한 체계의 정비, 치매환자 및 고령자에 친화적인 지역 만들기의 지속적 추진, 그리고 치매에 대한 인식을 높이기 위한 캠페인의 전개 등이 제안되었다.

As various social problems have arisen due to the increase of the aging population, one of these problems is the increase of the elderly with dementia. The necessity of systematic and effective dementia management policies has been raised, as the increase of social and economic cost along with the growth of the dementia population. This study examined dementia management policy of Japan, where there is arranged and provided dementia management policy in advance. Especially, this study focuses on the contents of comprehensive promotion strategies for dementia policy(New orange plan) of Japan which was pronounced in 2015, and explores the development strategies for Korea by reviewing this plan. The suggestions through this study are provided as follows: inclusion of the support contents reflecting the dementia patients and their families, the necessity of coping for early onset dementia, organizing system for early diagnosis and prevention such as an early stage of intensive support team, a continuous progression for building the elderly-friendly community and conducting campaign for a deep understanding of dementia, are discussed.

In this paper, in order to clarify the transition of dementia policy in Japan, the description related to dementia was extracted and analyzed from past Annual Health and Welfare Report. As a result, I found the following question. ①Despite recognizing the problem of dementia in 1970, no special measures have been taken until the mid-1980s,②measures for elderly with dementia began in the mid-1980s, but countermeasures against dementia are not discussed much in the design of long-term care insurance system in the 1990s, ③measures dedicated to dementia have been taken rapidly from the mid 2000’s. Based on the perspective of medical policy and international trends, I examined these points as a result of ① the fact that medical expenses for the elderly were free of charge and hospitalization for psychiatry hospitals was taken as measures, ②The supply of care services is a priority issue and the desired care of dementia has not been established,③ The development of medical care and nursing care technology and international trends expanded alternative policies.

本論文においては、日本における認知症政策の変遷を明らかにするため、過去の厚生白書の中から認知症に関係する記述を抽出し、分析を行った。その結果、①1970年に認知症の問題を認識しているのにもかかわらず、80年代半ばに至るまで特段の対策がなされていない、②80年代半ばから痴呆老人対策が始まるが、90年代の介護保険の設計においては認知症対策があまり論じられない、③2000年代半ばから急速に認知症に特化した対策がとられるといった疑問点を見出した。これらの点について、医療や国際動向の観点を踏まえて考察した結果、①については老人医療費の無料化と精神病院への入院が対策となっていたこと、②介護サービスの量的確保が優先で認知症の望ましいケアが確立していなかったこと、③医療や介護のケア技術の進展や国際動向が政策の代替案を広げたことが要因と考えられた。

本論文においては、日本における認知症政策の変遷を明らかにするため、過去の厚生白書の中から認知症に関係する記述を抽出し、分析を行った。その結果、①1970年に認知症の問題を認識しているのにもかかわらず、80年代半ばに至るまで特段の対策がなされていない、②80年代半ばから痴呆老人対策が始まるが、90年代の介護保険の設計においては認知症対策があまり論じられない、③2000年代半ばから急速に認知症に特化した対策がとられるといった疑問点を見出した。これらの点について、医療や国際動向の観点を踏まえて考察した結果、①については老人医療費の無料化と精神病院への入院が対策となっていたこと、②介護サービスの量的確保が優先で認知症の望ましいケアが確立していなかったこと、③医療や介護のケア技術の進展や国際動向が政策の代替案を広げたことが要因と考えられた。

In this paper, in order to clarify the transition of dementia policy in Japan, the description related to dementia was extracted and analyzed from past Annual Health and Welfare Report. As a result, I found the following question. ①Despite recognizing the problem of dementia in 1970, no special measures have been taken until the mid-1980s,②measures for elderly with dementia began in the mid-1980s, but countermeasures against dementia are not discussed much in the design of long-term care insurance system in the 1990s, ③measures dedicated to dementia have been taken rapidly from the mid 2000’s. Based on the perspective of medical policy and international trends, I examined these points as a result of ① the fact that medical expenses for the elderly were free of charge and hospitalization for psychiatry hospitals was taken as measures, ②The supply of care services is a priority issue and the desired care of dementia has not been established,③ The development of medical care and nursing care technology and international trends expanded alternative policies.

Purpose: This study aims to draw implications for the advancement of Korea’s dementia policy by systematically examining Japan’s dementia policy, which has the highest level of aging in the world. Research design, data, and methodology: This study uses a qualitative research method to derive the characteristics and implications of Japanese dementia policies based on domestic prior studies related to Japan’s dementia policy and literature studies related to Japan’s major dementia policies. Results: As a result of the analysis, it was found that Japan’s dementia policy has the following four characteristics. First, in terms of policy design, a flexible step-up method is applied. Second, in terms of the subject of the policy, it is shifting from policies centered on specific ministries to national strategies at the government level. Third, in terms of policy operation, basic local governments are responding rather than the central government. Fourth, in terms of policy management, goals are specified and detailed KPIs are set. Implications: Japan’s dementia policy, which has developed six comprehensive policies over 30 years, has three implications for Korea’s dementia policy. First, there is a need to strengthen national dementia management governance. Second, there is a need to strengthen consumer-centered integrated dementia management services. Third, it is necessary to promote detailed tasks within the comprehensive dementia management plan in a balanced manner.

본 논문에서는 일본 노인 복지정책 흐름 속에서 치매노인에 대한 지원이 전개되어 온 과정을 고찰하고, 한국에 대한 시사점을 모색하였다. 일본에서의 치매노인에 대한 지원은 지금으로부터 불과 약 30년전인 1980년대부터 급속하게 전개되어 왔다. 특징으로는 첫 번째, 치매 정책을 전개함에 있어 민간 단체의 역할이 컸다는 점이다. 특히, 가족회는 치매 가족에 대한 상담 사업 실시뿐 아니라 대규모의 실태 조사를 실시하고 후생성에 지속적으로 요망서를 제출하여, 지역의 치매 노인과 가족의 요망을 국가 정책으로 연결하는 소셜액션의 역할을 하고 있다. 두 번째로, 고령화의 급속한 진전이 치매 노인 대책에 박차를 가한 배경으로 작용했다. 특히 75세 이상의 노인이 급속히 증가할 것으로 예상되면서, 치매 노인 대책의 본격적인 추진에 박차를 가하고 있다. 세 번째로, 개호자 및 가족 중심의 정책에서, 치매 노인 본인 중심의 정책으로 이행되고 있다. 이상의 내용으로부터, 한국에 주는 시사점을 살펴보면, 첫 번째로 치매 관련 민간 단체들의 활동을 촉진시키는 것이 필요하다. 두 번째로, 고령화율에 따른 대책의 점검이 필요하다. 급속하게 진행하고 있는 고령화 현상에 대처하기 위해서는 치매 대책에 있어서도 시급한 대응이 요구된다. 세 번째로, 치매 노인 본인의 시점에 입각한 정책 및 실천이 필요하다. ‘본인 시점’의 케어를 실현하기 위해 해외의 선구적인 실천 사례를 다양하게 살펴보는 것도 유효하다. 검증된 실천들은 한국 실정에 맞게 도입하고 정부는 본인 시점을 고려한 치매 정책을 추진시킬 필요가 있다.

This study overviews the process of the support to the elderly with dementia in terms of the public welfare policies for the aged in Japan and advances the future challenges and looks for suggestions. It only has been 30 years that the support to the aged with dementia started in Japan and it has been developed rapidly. There are 3 characteristics; first, a private organization did important role, social action as the background of support to the aged with dementia. Especially, “Alzheimer’s Association Japan” plays a big role by connecting the family demand to national policy. They not only execute consultation to the families of elderly with dementia, but also survey the nation-wide actual situation and submit the letter of demand continuously to Ministry of Health, Labour and Welfare. Secondly, the aged population has been increased with fast rate, which accelerated the support to the aged with dementia. Third, the execution of policy has been changed from family-centered to the elderly with dementia, themselves(person centerd care). These 3 characteristics suggest to Korea. First of all, promoting activity of the organization regarding dementia is needed. Second, inspection of the actions according to the aging rate. The more rapid aging rate, the more urgent measures to the dementia are needed. Lastly, the policy based on the elderly with dementia is required and it needs to be executed. Various foreign cases should be searched and then the method to realize the care in the point of patient himself should be looked through. It must be appropriated for the current Korea society and the government needs to prosecute the policy for the elderly with dementia with these concepts.