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The story
“We cut back on his medication, and the bedridden patient started walking.” An article in which psychiatrist Hideki Wada and Moyo Kimura, a former Ministry of Health, Labour and Welfare medical officer, criticize the harms of excessive medication and treatment for the elderly — so-called “overbearing medicine” — became a hot topic on 5channel’s News Express+ board. In the thread, several posters shared firsthand accounts of care facilities and hospitals reaching for sedatives out of fear of lawsuits over falls, or simply due to staff shortages. Others pushed back, raising concerns that the “stopped his meds and he started walking” anecdote was spreading without any data to back it up, and warning of the dangers of patients discontinuing medication on their own judgment. Opinion in the thread was split.
Go to the hospital, see a doctor, take your medication properly — we’ve always believed that’s what it means to protect your health. But in Japan, where access to medical care is supposed to be so easy, why hasn’t the number of bedridden elderly people gone down?
Hideki Wada, a psychiatrist who has spent decades observing elder care on the front lines, and Moyo Kimura, a former medical officer at the Ministry of Health, Labour and Welfare, argue that “overbearing medicine” is behind this.
There are hospital cases, they say, where simply reducing an elderly patient’s medication was enough to get someone who had been bedridden walking again. Does more medical care really mean better health? The two experts challenge the “common sense” behind elder care in Japan.
Source: news.yahoo.co.jp / Original article here
What people said
Senile old folks especially are a problem if they move around, so they get sedated into compliance.
I mean, facilities do face lawsuit risk if a senile old person falls and has an accident, but if they're bedridden from the drugs, that's one less thing to worry about.
Dementia patients are a handful, sure, but…
the elderly don't exist for the facility's convenience. There's got to be a better way to handle this.
Seriously? I've been prescribed triazolam and Dayvigo for about 5 years now — is that bad?
https://blog-imgs-46.fc2.com/n/u/k/nukomishuranu/201010211914076ac.jpg
In another 20 years, what'll they have to strap on us old folks to snap us to attention?
I used to carry a Type 44 cavalry carbine.
their symptoms come back and they end up at the hospital again,
and by then they've built up tolerance so the drug doesn't work as well, so the doctor prescribes something else — and then they stop that on their own judgment too.
It's insane.
Because it's profitable, that's why!
If anything, what we need is a drug that gives you the pin-pin-korori death.
Being bedridden causes bedsores, so it's actually easier on caregivers if patients get up and move around a bit during the day.
If they're hale and hearty, they wouldn't need a drug to drop dead, would they?
True.
What we need is "bedridden-then-drop-dead."
It's not outdated at all.
There's an enormous number of bedridden elderly people in homes, care facilities, and hospitals.
You just don't notice if you don't have anyone like that in your own family.
This, exactly…
I do home-visit medical care, and I get a lot of requests like "the facility staff are exhausted, could you prescribe something to keep the resident sedated?"
…I'm in the camp that refuses, though.
I really don't want to end up with dementia.
Why would anything need to be done about it?
It's insurance-covered healthcare spending, not my problem.
Who's going to hold back for someone else's sake?
there ought to be data proving it… so what does the data actually say?
Without that, it's just a scam story.
Which drug, for which condition, are we even talking about?
That gap is what's turned nursing care and medicine into a massive industry.
The Ministry of Health, Labour and Welfare wants to close that gap between average and healthy life expectancy as much as possible — shorten it.
https://kennet.mhlw.go.jp/information/information/wp-content/uploads/Gap_Average_Life_Expectancy_and_HALE_202502.png
Must look pretty absurd from a doctor's point of view.
There are quite a few patients who stop taking even the meds that are genuinely dangerous to skip.
With type 1, you're aware of the disease from childhood, so you're able to manage yourself properly.
Type 2 is… a different story.
Re: #133
There's a thing called a "medication-reduction bonus," so hospitals will try to cut your meds once you're admitted.
With outside prescriptions, the hospital doesn't make any money off whatever drugs get prescribed after you're discharged anyway.
For elderly people in care facilities, the "golden path" is dementia → wandering → falling → fracture → bedridden.
The Japan Medical Association gets singled out a lot, but
out in the regions, the real power players in medicine are the local university professors
who hold hiring authority and budget control, and can freely adjust how many doctors get dispatched to affiliated hospitals.
Because of that manpower gap, independent clinic doctors are in an overwhelmingly weak position (if a big hospital refuses to take a severe case, the clinic doctor is left with nowhere to turn).
The Medical Association is basically a guild that independent practitioners formed to help each other out.
…but the trend now is toward turning all independent practices into outpatient-only clinics and concentrating hospital beds at the big hospitals,
so really, it's the universities and big hospitals that still hold the stronger hand…
Background and key points of this discussion
The term “overbearing medicine” refers to how medication and testing beyond what’s necessary can actually strip elderly patients of their physical and mental function. Ministry of Health, Labour and Welfare statistics have long shown a gap of roughly 8 to 9 years between average life expectancy and healthy life expectancy, and closing that gap has been treated as a policy challenge for medical and elder care. The thread split over the question of “who the prescriptions are really for” — some posters offered firsthand accounts of sedatives being used because of understaffed facilities or to avoid lawsuits, while others warned that stopping medication on one’s own judgment risks rebound symptoms and drug tolerance. It was also noted that there’s a structural incentive at play: hospitals actually lose revenue when they trim a patient’s medications during a hospital stay (due to a “medication-reduction bonus” system), so the situation isn’t as simple as “doctors prescribe drugs just to make money.” The article itself offers no data backing up the specific claim that reducing medication got a patient walking again — it’s worth keeping in mind that this is an individual anecdote.
*This article is compiled from excerpts and a summary of the 5ch (News Express+) thread “‘We Cut His Meds and the Bedridden Patient Started Walking’ — The Reality of the ‘Overbearing Medicine’ Turning Japan’s Elderly Frail.”
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