Eighty-eight year-old demented woman lives alone independently.

Dear Editor,

An 88-year-old female with a Mini–Mental State Examination (MMSE)[1] score of 14 lives alone independently in Ogatsu ward, Ishinomaki, Japan. She has hypertension, and she is taken care of by our visiting care service. One day, we found that she could not take her drugs in a punctual manner. Drugs that had been left for 120 days or more were found in her house. She lives alone, cooks, washes, cleans the house, and also takes care of her garden. The Barthel Index[2] was fully scored, showing that her basic activity of daily living (ADL) was independent, whereas her instrumental ADL (IADL) was 4/8 on the IADL scale by Lawton and Brody.[3] Although she could not perform a 3-word recall and calculation in the MMSE, she can call telephone to her daughter and pay the doctor's fee correctly. She never travels far by herself as she cannot drive a car.

The care team discussed the reason of her independence and the plan on how to provide care for her. We concluded that she was independently capable of living in her own home in her small, very familiar community. She has three close, familiar friends nearby to frequently chat and drink tea with. Situated near the city of Ishinomaki – which was destroyed by the great tsunami in 2011 – her small community is safely located far from the city center and on a hilltop. These very stable circumstances keep her ADL independent. Olsen et al. also pointed out that the quality of life of home-dwelling individuals with dementia was better than that of nursing home residents.[4] Therefore, we decided to keep her surroundings the same as long as possible, monitored carefully by a team. Dementia is a severe socio-medical problem, but she suggests to us the possibility of and means to keeping life independent for demented elderly persons.

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