Dementia friendly communities blog post 01/06/2017
by Dr Stefanie Buckner
Earlier DemCom blogs have focused on what Dementia Friendly Communities are, and on measuring their impact. This post looks at dementia friendliness in relation to age-friendliness. Both are approaches that have been adopted in a rapidly growing number of contexts in the UK and internationally in recent years.
In 2006, the World Health Organization (WHO) responded to the global trends of population ageing and urbanisation with its Age-Friendly Cities programme. At the root of this programme is the con-cept of active aging – allowing people to realise their potential for wellbeing and to participate in society according to their circumstances, while also providing them with support should they need it. An Age-Friendly City, according to WHO, “encourages active ageing by optimizing opportunities for health, participation and security in order to enhance quality of life as people age” (1, p.1). WHO identifies eight interlinking domains of Age-Friendly Cities:
In recent years the age-friendly agenda has been expanded to communities. Cities and communities that commit to improving their age-friendliness and want to share their experiences can join the Global Network of Age-Friendly Cities and Communities (GNAFCC). There are currently over 450 communities in 37 countries (2). WHO provides resources to support their efforts, including a checklist of essential features of Age-Friendly Cities (3), and a more recent set of core indicators of age-friendliness (4).
Age is a risk factor for dementia. In 2015, the estimated number of people living with dementia was 46.8 million. This was projected to reach 131.5 million by 2050, and the total worldwide cost of de-mentia was estimated to rise to US$ 2 trillion by 2030 (5). These figures highlight the need for action.
A wide range of initiatives approach this health issue from different angles, including prevention, diagnosis, treatment, cure, and care and support. Among these, Dementia Friendly Communities have emerged as a population level response that emphasises awareness raising and supporting people affected by dementia in their communities. As one of our previous blogs has pointed out, Dementia Friendly Communities come in different shapes and sizes.
Compared to Age-Friendly Cities and Communities, Dementia Friendly Communities are a more recent phenomenon, globally at least. That said, in individual countries efforts to create dementia friendly environments have a lengthy history. Relevant pioneering work in Japan dates back to the early 1990s. In India, dementia friendly initiatives can be traced to 2004. In Scotland, the term De-mentia Friendly Community was introduced in 2001 through an Alzheimer Scotland publication (6). In the UK/England, it was the 2012 Prime Minister’s Challenge on Dementia that put Dementia Friendly Communities on the agenda. Since then, over 200 communities have been recognised by the Alzheimer’s Society as ‘working towards dementia friendly status’.
At present, at a global level no programme and support structures that are comparable to those for Age-Friendly Cities and Communities exist for Dementia Friendly Communities. However, efforts by WHO are under way to create a toolkit and evaluation guidance for Dementia Friendly Communities.
Age-Friendly Cities and Communities and Dementia Friendly Communities have common assump-tions and themes. They both emphasise
• the important contributions older people and people affected by dementia (both those living with dementia and their carers) make to their local community,
• the need for clear and committed leadership, collaboration by a range of stakeholders, and adequate and sustainable resourcing,
• the assets as well as the needs of older people and people affected by dementia,
• the provision of appropriate services and facilities.
One of the questions that DemCom is asking is: What does a dementia friendly community provide that is not already addressed by an age-friendly one? What are the specific priorities and needs, for example when thinking about urban design, transport, addressing stigma?
Earlier work on community engagement recognised that the starting point for Dementia Friendly Communities is awareness raising. There is also an increasing emphasis on the rights of people with dementia to participate in their local communities (7). Language around dementia is important. It reveals the underlying assumptions of what can and cannot be achieved and how people with de-mentia are defined by wider society. Even the well-intentioned term ‘friendliness’ is open to chal-lenge. There are perceptions of the term ‘friendly’ as patronising and disempowering (8), and alternative terminology such as ‘dementia enabling’ is advocated (see our previous blog).
The assumption that ‘what is age-friendly benefits everyone’ is a common one. In turn, there is widespread understanding that ‘what is dementia friendly is also age-friendly’. We can distinguish between age-friendly and dementia friendly at an analytic level. Yet in reality the boundaries are blurred.
Commentators have argued that an age-friendly approach may mean that dementia-specific needs are inadvertently neglected. At the same time, it can benefit the sustainability and reach of dementia friendly activity (9). On the other hand, it has been suggested that an exclusive focus on dementia may be too narrow. It can result in wider community forces being missed out. Also, it risks older age becoming equated with dementia (10).
The DemCom study will develop a tool for evaluating Dementia Friendly Communities that has its roots in an evaluation tool for Age-Friendly Cities. As well as synergies between both approaches, it will highlight where a focus on dementia friendliness is distinct, and how this can shape the lives of people affected by dementia and the wider communities in which they live.
Please see here for more information on the DEMCOM project
1. World Health Organization. Global Age-Friendly Cities: A guide. Geneva: WHO; 2007.
2. World Health Organization. Age-friendly world nd [Available from: https://extranet.who.int/agefriendlyworld/.
3. World Health Organization. Checklist of essential features of Age-Friendly Cities. 2007.
4. World Health Organization Centre for Health Development. Measuring the age-friendliness of cities: A guide to using core indicators. Kobe, Japan; 2015.
5. Alzheimer’s Disease International. World Alzheimer Report 2015. The Global Impact of Dementia. 2015.
6. Alzheimer’s Disease International. Dementia Friendly Communities global developments. London; 2016.
7. Goodman C, Buswell M, Russell B, Bunn F, Mayrhofer A. Community Engagement Evidence Synthesis : A final report for Alzheimer’s Society. Hatfield, UK; 2017.
8. Imogen Blood & Associates, Innovations in Dementia. Evidence Review of Dementia Friendly Communities. 2017.
9. Turner N, Morken L. Better together: A comparative analysis of Age-Friendly and Dementia Friendly Communities. Washington DC; 2016.
10. McCann K. Top tips: creating an age-friendly city. The Guardian. 20/10/2012.