SPOILERS! There may be spoilers in this post. Do not read further, if it concerns you.

It is definitely my age that gives Shintaro Kago’s Dementia 21 a little more bite. A little more darkness. A little more sadness. And a little more humor.

A friend once told me that Herman Hesse’s Steppenwolf tells an entirely different story when read as a 30-year-old than the one a high schooler reads when assigned it in English class. I’ve only read it once in my 30s, but wonder what story will be if I re-read it now?

Sadly, the only thing I remember from Steppenwolf does not involve the book at all. Instead, I remember a scene from its movie adaptation where Max Von Sydow as Harry Haller narrates the birth of “a wolf of the steppes” in an animated sequence.

Dementia 21 might be my Steppenwolf, a book whose story metamorphosizes as the reader ages. Remembering myself as a teen or 20-something, I might not have come away with the same sadness and contradictions in Dementia 21’s stories, though I might have been fascinated by the surreal and comical plots.

Yukie Sakai is an aide at Green Net, a private home eldercare company. Their motto is “There’s no place like home in the twilight of life” and Yukie is the best at bringing this statement to life. She is Green Net’s top-rated aide. These ratings are based on feedback her patients enter on a handheld device that looks like a TV remote. They simply click one of five choices: Wonderful, Good, Fair, Poor, or Awful.

The horror begins when a jealous colleague conspires with Yukie’s supervisor to rig the ratings system, so Yukie falls to the very bottom. Her supervisor then threatens to fire her if her ratings don’t improve. To ensure she doesn’t succeed, her supervisor assigns her to the company’s most difficult cases.

Yukie’s first assignment is Eiko Koike, a bedridden 85-year-old whose home aides have all died in “freak accidents.” The “accidents” began immediately for Yukie. Many trips and falls, culminating with a set of heavy dressers collapsing onto her bed. Fortunately, she was not on it at the time. However, she was in time to catch a brief glimpse of a “monster’s” shadow scurrying away. Her initial instinct is to protect her Eiko from the monster, but she quickly learns that the patient is the monster!

Eiko had taught herself to contort her body, bending her legs above her head and “walking” with her hands. Distorted by dim lights and shadow, she was turned into a “monster.” Eiko has been killing her home aides as revenge for her husband’s death. She blames them for playing games with him and overstimulating him into a coronary. As she readied to kill Yukie, Eiko has her own coronary episode and begs Yukie for her medication. Yukie hesitates and demands, “I’ll give you your medicine in exchange for a high score!”

I didn’t think much about this moment until I read Anime UK News’ review of Dementia 21. The reviewer points out Yukie’s “darker side.”

At the end of the day, she is doing this for points and sometimes her actions are not always in the client’s best interest. She is driven, which is admirable, but sometimes this drive can blur the line between her and the less savoury characters in the story. Though it does make her a far more interesting character and provides additional depth to both her and the themes on society and behaviour.

Nanae Matsushima’s story might be an example of Yukie’s “darkness,” but I felt it simply illustrated her naiveté. In the story Nanae’s daughter-in-law is irritated at her because her independence is giving her low scores on the “National Standardized Senior Citizen Examination.” The test determines how elderly a person is. The more feeble an elderly person is, the more successful they are on the exam.

Nanae boxes regularly, eats hearty meals, has few wrinkles, and dresses “casually.” When Yukie asks Nanae’s daughter-in-law if it is really necessary to damage Nanae’s health, so she seems more feeble and elderly, the daughter-in-law drives her to a shanty town of abandoned old people and scolds, “Do you want Mother to have a wretched future?” Scared straight by the sight of the elderly crammed together without health and other services, Yukie implements a strict regimen to “age” Nanae.

While I think the reviewer’s observation is insightful, I struggle to call it Yukie’s “darker side.” Shintaro Kago never gives readers a glimpse of Yukie life outside of work. Even when her mother is introduced, it is within the context of Yukie’s attempt to win the C-1 Grand Prix, the “dream of every home health aide in the nation.” Who is Yukie is at the end of the working day? How are her interactions outside of a caregiver-client dynamic? With what has been shown, I just assumed Yukie’s motivation was her desire to be the best eldercare aide she can be, and there is no darkness is wishing to reap the accompanying benefits like more money and ratings’ points.

Dementia 21 is a surreal journey into elder care that reveals society’s inability to address the needs of the elderly. And when they attempt to do so, it is through technology instead of humanity, which results in creating horrible new “monsters” like mind-controlling AI dentures that self-replicate and venture out to seek new mouths to enslave.

I need to add that happily Dementia 21 is not all social criticism and satire. It’s also a lot of imaginative psychedelic fun like an adventure in an interconnected world within the wrinkled folds of skin of elderly people everywhere.