In January 2016 the Comprehensive Strategy to Accelerate Dementia Measures （New Orange Plan） was announced by the Ministry of Health, Labour and Welfare. This New Orange Plan expressly states the “improved involvement of pharmacies and pharmacists in the care of dementia,” so that pharmacies and pharmacists are expected to provide appropriate medication counseling to patients with dementia. In this context we conducted a questionnaire survey about difficult dementia cases. Subjects of the questionnaire were 165 pharmacists highly knowledgeable in dementia. More than 90.3％ of the pharmacists had experienced problems when dealing with demented persons, the most frequent of which was the assertion “I have used up all my medicine.” Again, 89.1％ of the pharmacists also responded they were told “I did not receive the prescribed medicine,” indicating the necessity of appropriate measures for these situations.

In the Integrated Community Care System, pharmacists are expected to play a central role in addressing patients’ drug problems. Therefore, it is necessary to know the patients’ drug problems as well as the occupations of professionals in solving these problems, and to clarify the problems to be preferentially resolved. Thus, we surveyed care managers working in a district near the Josai University pharmacy about their drug problem recognition and the professionals who solved these problems. Many of the care managers identified “the patient has leftover drugs” and “the patient has declining cognitive abilities” as drug problems. Many of the care managers expected pharmacists to solve the problems of “the patient has leftover drugs” and “the patient does not understand the dosage regimen.” “The patient has leftover drugs,” “the patient needs allotting of drugs to ensure adherence,” “the patient does not understand the significance of the meditation,” and “the patient does not understand the dosage regimen” are drug problems in which pharmacists should preferentially intervene and play a role in the Integrated Community Care System.

For elderly persons who started home medical care, prescriptions were reviewed from the viewpoint of proper use, and support was provided through interprofessional collaboration. The patient was a 79-year-old woman with gait disturbance, bath refusal, depression, sleep disorder, and behavioral and psychological symptoms of dementia (BPSD), but conversation increased as the eating habits improved and mental state stabilized, making gait possible. Family support was also a key for amelioration. Intervention resulted in improved quality of life (QOL) and outpatient treatment became possible following home medical care. In order switch from home medical care to outpatient care, it is also important for each person (e.g., pharmacists, nurses, caregivers, nursing care support counselors) to participate as a member of a medical team to quickly sense changes and share information among with the key persons in medical care/nursing care in community-based integrated care system, or the primary care physician.