Dementia-Friendly Communities Have Spread Faster Than the Evidence

Dementia-friendly communities and initiatives have spread across the world, from more than 17 million trained “dementia supporters” in Japan to hundreds of local dementia-friendly communities in England^[1][2]. The evidence on what they change for people living with dementia has not kept pace: recent reviews could find only a handful of evaluations, which their authors described as preliminary^[3].

The idea behind them is simple and humane. A diagnosis of dementia should not mean losing the shop where you have always bought your paper, the bus route into town, the choir, the place of worship or the football ground. Dementia-friendly work asks the rest of society to adapt: staff who know how to help when someone is confused at a till, signs that are easy to follow, meeting places where people with dementia and their families are welcome, and people living with dementia themselves helping to decide what changes. This article sets out what these initiatives are, how widely countries report them, and what evaluations have found.

The problem these initiatives set out to solve: most people surveyed still see dementia as a normal part of aging

Dementia-friendly work is a response to stigma and exclusion, which the most recent global survey suggests remain widespread. Alzheimer’s Disease International’s World Alzheimer Report 2024 drew on a survey of more than 40,000 people across 166 countries and territories. It found that 80% of the general public, and 65% of health and care professionals, believe dementia is a normal part of aging, and that 88% of people living with dementia who responded said they had experienced discrimination^[4]. These are responses from people who chose to take part, not a representative sample of any country.

WHO’s Global dementia action plan made this a measurable goal. Its targets for 2025 were that every country would have at least one functioning public awareness campaign on dementia, and that half of all countries would have at least one dementia-friendly initiative to foster a “dementia-inclusive society”^[5]. WHO defines these initiatives broadly, as “all activities and actions that promote lasting change to the social and/or physical environment in order to make societies more inclusive of people with dementia, their families and carers”^[5]. That breadth means very different activities can carry the same label.

The phrase covers several different things. Reviews group them into a few recurring strategies: involving people with dementia and carers directly, designing more inclusive buildings and public spaces, public education to reduce stigma, and approaches tailored to a particular community^[6]. Some are tied to a place; others are “communities of interest”.

Two in three reporting countries have initiatives, but poorer countries are far less likely to

The best cross-country picture comes from WHO’s Global status report on the public health response to dementia (2021), which used data that 62 countries submitted to its Global Dementia Observatory. Approximately two thirds of those countries reported running awareness campaigns, and 41 of the 62 reported initiatives to improve the accessibility of the physical and social environment, including for people with dementia^[5]. Only 29% of those 41 were low- or middle-income countries, even though WHO notes that most people with dementia live in low- and middle-income countries^[5].

The same report shows how civil society carries much of this work: a majority of national awareness campaigns (25 of 41) were at least partly run by non-governmental organisations, and only 5 of 37 countries said their campaigns were tailored to specific audiences^[5]. About two thirds (66%) of reporting countries provided training and education on dementia to populations outside the health and social care sectors^[5].

When countries described what their initiatives covered, most named accessible public spaces and buildings and community places where older people can meet; assistive technology was covered least^[5]. These are self-reports of whether something exists. They say nothing about how many people it reaches, how well it works, or whether people living with dementia notice any difference. The 62 reporting countries are also not a random sample of the world: if countries with more developed dementia policies are more likely to report, the global picture could be less complete than these figures suggest.

The models differ widely: mass training in Japan, local recognition schemes in England

Japan runs the largest training programme we found. Through its national Dementia Supporter Caravan programme, 17,217,383 people had been trained as “dementia supporters” by 30 June 2026, according to the programme’s national secretariat^[1]. That is a count of people trained, not a measure of what they do afterwards. Japan also offers one of the clearest examples of people living with dementia leading the work. WHO highlights Machida City, near Tokyo, where people living with dementia meet weekly at a “Living Together with Dementia” meeting and have written 16 statements setting out the kind of inclusive community they want to live in^[5].

England took a place-based route. After national policy endorsed dementia-friendly communities in 2012, Alzheimer’s Society ran a recognition process for them. A 2019 scoping study identified 284 dementia-friendly communities in England: 251 defined by a geographical place and 33 communities of interest. Of a sample of 100, 89 had been set up or started activities after the 2012 endorsement. Awareness raising was the most common activity, approaches to evaluation varied, and there was “little evidence of findings having effected change”^[2]. A companion study found that 115 of England’s 209 health commissioning areas of the time had at least one recognised community, and that they were more common where the number of recorded dementia diagnoses was higher, though not where the prevalence rate was higher^[7].

The Dementia Friends programme, a brief community intervention to improve knowledge of and attitudes to dementia that began in the UK, has been taken up elsewhere. In Israel, an evaluation noted that its effectiveness outside the UK is “under-evaluated”^[8]. Australia has tested a different route for rural areas: a co-designed “virtual” dementia-friendly community combining a website and app, peer-support video calls and local technology learning hubs^[9]. The idea has also moved into hospitals and shops, where staff and environments rather than whole towns are the focus^[10][11].

These are not comparable measures, and none of them tells us how many people living with dementia are better off.

The evaluation evidence is thin: a few dozen studies at most, and very few measuring impact

Several research teams have tried to gather the evidence together, and each has found little to work with. A 2021 scoping review of strategies for social inclusion included 29 papers^[6]. A 2022 rapid realist review identified 7,154 records but could include only 22 papers that evaluated outcomes using data from people with dementia or their carers^[12]. A 2024 realist review of dementia-friendly communities defined by place included seven papers, and its authors described “limited research exploring the implementation of such interventions in the community context”^[13]. A 2023 scoping review, covering papers to November 2022, found 477 articles, of which four were about the impact of dementia-friendly initiatives; those four were preliminary studies of training and awareness work^[3].

The same pattern shows up in single settings. A 2026 review of dementia-inclusive shops identified ten academic and 59 non-academic resources, and concluded that although dementia-friendly initiatives “have been widely implemented across the retail sector, there remains a critical gap in rigorous evaluation of their effectiveness and long-term impact”^[11]. The 2023 scoping review found no quantitative evaluation of “dementia villages”, a model of residential care sometimes discussed alongside dementia-friendly communities^[3].

In England, where the movement grew fastest, the 2019 scoping study concluded that “a systematic approach to evaluation is lacking”^[2]. WHO reached a similar view globally, calling for guidance on how to implement, evaluate and scale up dementia-friendly initiatives^[5].

None of this means the initiatives do not work. It means that, in most places, nobody has measured whether they do, for whom, and at what cost. We found no randomised trial of a whole place-based dementia-friendly community, and no study that followed people living with dementia over years to see whether living in one changed how long they stayed active in their neighbourhood. That is a finding of our search, not proof that no such study exists.

Where outcomes were measured: more connection and knowledge, less clear change in behaviour

The studies that did measure outcomes offer some encouragement, with clear limits. In England, 240 people living with dementia in six dementia-friendly communities completed a survey. Around half knew they lived in one, and those who knew were more likely to take part in leisure activities, attend community centres and feel valued for their contributions to the community^[14]. This was a single survey at one point in time, so it cannot show whether the community caused the difference or whether more involved people were simply more aware of it. The authors noted that quantitative evaluations of people’s experiences in these communities “are scarce”^[14].

The strongest design we found came from rural Australia. A stepped-wedge cluster-randomised trial of the Verily Connect virtual community, with 113 participants across 12 rural communities between 2018 and 2020, found that carers’ sense of social support rose over 32 weeks, with a marginal trend towards less care demand. Engagement was highest early on and then declined sharply^[9]. Its outcome measures were taken from carers, not from people living with dementia, and it was small. For more on carers, see our article on unpaid carers; for the particular gaps in remote areas, see dementia in rural and remote areas.

Awareness training changes knowledge more readily than behaviour. In the Israeli Dementia Friends evaluation, 820 people took part at baseline and 205 at three months. Knowledge rose and positive emotional reactions improved, but discriminatory behaviour “showed no significant change”. The authors concluded that “more comprehensive strategies beyond education are needed to fully address stigma”^[8]. With three in four participants lost by follow-up and no comparison group, even the gains in knowledge are uncertain.

Hospitals point the same way. A realist review of dementia-friendly hospital care, drawing on 15 stakeholder interviews and 28 publications in its main synthesis, concluded that “dementia awareness training alone will not improve dementia care or outcomes for patients with dementia”; what mattered was support from senior staff with dementia expertise to put learning into practice^[10]. In shops, the retail review warned that some interventions may themselves stigmatise people living with dementia^[11].

Across 22 evaluations, the 2022 realist review found the outcomes people with dementia and carers reported were contact with others, enjoyment, less stress and support, and that these depended on the kind of initiative and the role people with dementia played in it: as a patient, a team member or an active citizen^[12].

What the evidence asks of us

The case for dementia-inclusive societies does not rest on trial results. It rests on the rights of people living with dementia to take part in ordinary life, which WHO links to the UN Convention on the Rights of Persons with Disabilities^[5]. But good intentions are not the same as good outcomes, and the evidence points to several things funders, governments and organisations could do.

• Put people living with dementia at the centre, not on the receiving end. WHO names their central role “at all stages of planning, implementation and evaluation” as the key to success^[5], and the realist evidence suggests outcomes depend on the role people with dementia are given^[12]. Machida City’s statements, written by people living with dementia, show what that can look like^[5].
• Build evaluation in from the start. England’s experience shows hundreds of communities can grow without a shared way of showing whether they help^[2]. Funders could ask for common outcome measures that include the views of people living with dementia, and for comparison groups where that is feasible.
• Go beyond awareness. Training numbers are easy to count, but the Israeli and hospital evidence suggests awareness alone does not change behaviour or care^[8][10]. Changes to environments, services and staff support are harder to deliver and need to be measured too. Our article on dementia training for the health and care workforce looks at the professional side.
• Close the gap between richer and poorer countries. WHO calls for more concerted action “particularly in LMICs where the majority of people with dementia live”^[5], and its toolkit Towards a dementia-inclusive society is designed to help countries start, evaluate and scale up initiatives^[5].
• Do not let community goodwill stand in for services. A welcoming shop or library cannot replace a timely diagnosis or support afterwards; see our article on post-diagnostic support.

Language: this piece uses person-first language ("people living with dementia", "people with dementia"), as most dementia organisations and people with lived experience prefer, and uses clinical terms such as "Alzheimer's disease" or "mild cognitive impairment" only where a study, dataset or diagnosis refers to that specific condition.

Why we're publishing this

Dementia charities, Alzheimer’s associations and local groups have done much of the work of making communities more welcoming, often with little funding and few tools for showing what it achieves. We publish this to give them, and the people living with dementia who lead so much of it, an honest account of the evidence: what has been built, what has been measured and where the gaps are. For the wider library, see dementia research.

How to read this data

The figures here come from very different kinds of source. WHO’s country data are self-reports from 62 governments to the Global Dementia Observatory, collected before the 2021 report; they record whether an initiative exists, not its reach or quality, and the percentages in the first chart are our calculations from WHO’s country counts. Japan’s figure is a running count of people trained, published by the programme itself. The ADI figures come from a large global survey of people who chose to respond, not a representative sample. The evaluations are mostly cross-sectional surveys, before-and-after studies without a comparison group, and qualitative work; the one cluster-randomised trial was small and measured carers. Reviews overlap, so their study counts should not be added up. Most of the evaluations we found come from high-income countries, and we may have missed studies published in other languages.

Use this data

Free to cite with attribution to Understanding Aging. Charities, carers' groups, campaigners and journalists are welcome to reuse these figures and charts. For the underlying figures as a spreadsheet, get in touch.

Important: This article summarises published research and statistics for general information. It is not medical, care or financial advice and cannot be used to diagnose, treat or predict anything about an individual. If you have concerns about your own or someone else's memory or health, please speak to a GP or another qualified health professional.

Sources

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2. Buckner S, Darlington N, Woodward M, et al. Dementia Friendly Communities in England: a scoping study. International Journal of Geriatric Psychiatry, 2019. europepmc.org/article/MED/30993756
3. Krier D, de Boer B, Hiligsmann M, Wittwer J, Amieva H. Evaluation of dementia-friendly initiatives, small-scale homelike residential care, and dementia village models: a scoping review. Journal of the American Medical Directors Association, 2023. europepmc.org/article/MED/37121264
4. Alzheimer’s Disease International. World Alzheimer Report 2024. Alzheimer’s Disease International, 2024. alzint.org/resource/world-alzheimer-report-2024
5. World Health Organization. Global status report on the public health response to dementia. WHO, 2021. who.int/publications/i/item/9789240033245
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9. Blackberry I, Rasekaba T, Morgan D, et al. Virtual dementia-friendly communities (Verily Connect) stepped-wedge cluster-randomised controlled trial: improving dementia caregiver wellbeing in rural Australia. Geriatrics, 2023. europepmc.org/article/MED/37736885
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