Abstract
Home- and community-based services and supports for people living with dementia are a critical component of age-friendly ecosystems. Dementia Friendly America (DFA) provides a framework to align best practices across age-friendly and dementia-friendly sectors. This article describes the history and initiatives of the DFA movement. Many Area Agencies on Aging are leaders and convenors of dementia-friendly initiatives due to their extensive partnership networks and deep knowledge of local communities. Age-friendly and dementia-friendly initiatives can be integrated to enable older adults, including those with Alzheimer’s disease and related dementias, and their caregivers to have the highest quality of life possible.
Key Words
Dementia Friendly America, Area Agencies on Aging, age friendly, cross-sector collaboration
Close to 7 million people ages 65 and older in the United States are living with Alzheimer’s disease. That number is expected to grow to almost 13 million by 2050 (Alzheimer’s Association, 2024). It is imperative for public health departments, healthcare systems, businesses, social services providers, and the Aging Network to communicate and collaborate to ensure communities engage with the dementia-friendly movement in meaningful ways.
Community-based services and supports for people living with dementia are a critical component of age-friendly ecosystems. Each sector in an age-friendly ecosystem plays a crucial role in delivering the highest quality care and enhancing quality of life for those with Alzheimer’s disease and related dementias (ADRD) and their caregivers. The dementia-friendly communities movement offers a proven framework for aligning best practices to achieve this across age-friendly sectors. Given the crosscutting nature of these best practices and overlapping sectors, driving collaboration and innovation from the start is essential to advancing the broader age-friendly ecosystems movement.
At the forefront of this effort is Dementia Friendly America (DFA), the national leader in fostering community support for people living with dementia and their caregivers so they can safely remain in and engage with their communities. DFA is administered by USAging, which represents and supports the national network of Area Agencies on Aging (AAAs) and advocates for the Title VI Native American Aging Programs that help older adults, people with disabilities, and caregivers live with optimal health, well-being, independence, and dignity in their homes and communities. AAAs are key local leaders for DFA communities and connectors with age-friendly systems, drawing upon decades of experience in providing aging services for people living with dementia and their caregivers.
Dementia Friendly America
DFA is a national network of communities, organizations, and individuals committed to fostering a country where people living with ADRD and their caregivers can thrive in their communities. This means enabling people to participate as fully as they are able—whether it be riding public transportation, checking out library books, or shopping independently at local businesses. DFA provides a framework for collaboration across age-friendly and dementia-friendly sectors and initiatives.
DFA launched in 2015 as a collaborative effort that brought together national, state, and local leaders in dementia advocacy, policy, services, research, and caregiving to chart a path for creating communities that support people living with dementia and their caregivers.
Founding members of DFA included Ron Grant (living with Alzheimer’s) and Vicki Grant (his caregiver), Collective Action Lab, Trellis (formerly Metropolitan AAA, MN), USAging, LEAD Coalition, UsAgainstAlzheimer’s, African Americans Against Alzheimer’s, Global CEO Initiative, BrightFocus Foundation, LeadingAge, Blue Cross Blue Shield of Minnesota, Mayo Clinic, Volunteers of America, Otsuka pharmaceuticals, and Lilly pharmaceuticals.
The inaugural DFA communities included Boston, MA; Denver, CO; Montgomery County, MD; Prince George’s County, MD; Santa Clara County, CA; Tempe, AZ; and the states of Minnesota and West Virginia.
To become DFA communities, these entities pledged to include people living with dementia on their planning or “action teams” as participants and leaders, to maintain a collaborative cross-sector effort, and to adopt dementia-friendly practices and goals. Additionally, to demonstrate viability and sustainability, they were required to certify their coordination capacity and/or relationship with a local organization that could serve as a fiscal sponsor. These early adopters represented the various geographies, approaches, and populations that DFA strives to represent.
‘AAAs are effective Dementia-Friendly America community leads given their combined expertise in dementia-friendly programming and deep community connection.’
Over the past 10 years, DFA has expanded into a network spanning 44 states with more than 400 community programs and initiatives. DFA communities are typically led by community-based organizations, such as AAAs; aging services providers; or other organizations with deep roots in the community, such as colleges and universities, local foundations, and faith-based institutions. To further foster a collaborative approach, DFA engages “community conveners” in 30 states who act as liaisons between individual initiatives and DFA. Conveners come from Aging Network organizations and often also engage with State Plans on Aging and State Dementia Plans.
Taking a whole community approach, DFA sectors include public transportation, local government, hospitals, first responders, long-term care, healthcare providers, local businesses, libraries, faith communities, and financial services. Each DFA community includes an action team with sector leaders, people with dementia, and caregivers to develop resources, tools, and dementia-friendly practices tailored to the unique needs of their community.
DFA has developed sector guides with specific steps for becoming dementia friendly, as well as information on ADRD and how to interact with a person with dementia, create welcoming social engagement opportunities and cultural environments, and improve the physical environment in public spaces and systems. Common activities to support these goals include hosting dementia-friendly business trainings and Memory Cafés, offering Dementia Friends sessions, convening caregiver support groups, improving public signage, and translating dementia resources into different languages.
DFA also oversees Dementia Friends, an educational program that helps community members better understand ADRD and how it affects people. It is an entry point for anyone who wants to better support family members, friends, neighbors, customers, or patients living with dementia, as well as caregivers. As of March 2025, more than 192,500 people across the country have become Dementia Friends and have committed to taking individual dementia-friendly actions, demonstrating a significant leap forward in destigmatizing the disease (DFA, n.d.).
The Role of AAAs
AAAs are local leaders responsible for the planning, development, coordination, and delivery of a broad range of aging and other home- and community-based services in every community in the United States. Established by the Older Americans Act in 1973, AAAs support older adults, people with disabilities, and caregivers who live at home in their communities and are an integral part of age-friendly ecosystems.
As the number of people living with ADRD has grown, so have AAA supports and services for this population. In a recent poll of AAAs, all respondents (n=169 AAAs) indicated that they offer one or more services and supports designed or tailored specifically for people living with dementia and their caregivers. The most common services AAAs offered were information and referral (88%); respite (82%); nutrition (81%); caregiver training and education (75%); and in-home services such as personal care, homemaker, and/or chores (75%; USAging, 2025).
AAAs typically have extensive partnership networks with community-based organizations that align with both dementia- and age-friendly ecosystem sectors. These include transportation agencies (83%), disability service organizations (78%), federal departments/programs (75%), public health (74%), long-term care facilities (72%), hospitals and health systems (71%), emergency preparedness agencies (70%), housing programs (70%), faith-based organizations (69%), and law enforcement/first responders (69%; USAging, 2023).
AAAs also serve people with dementia and their caregivers through their cross-sector partnerships and contracts with healthcare entities. According to the 2023 CBO-Health Care Contracting Survey conducted by USAging’s Aging and Disability Business Institute in partnership with Scripps Gerontology Center at Miami University, 45% of AAAs hold one or more contracts with healthcare providers and payers such as health plans, health systems, accountable care organizations, Veterans Administration Medical Centers, and more (Aging and Disability Business Institute, 2024).
Seventeen percent of contracting CBOs indicated they were serving people with dementia as part of healthcare contracts, and 11% were providing dementia-specific services such as dementia care management, support groups, or Memory Cafés under contract with healthcare providers and payers (Kunkel & Lackmeyer, 2024).
These networks position AAAs as integral partners in livable community initiatives (USAging, n.d.) with 47% of AAAs involved in a livable community initiative. Specifically, 31% of AAAs are leading or involved in a dementia-friendly community initiative, with most having staff dedicated to the effort, and 30% of AAAs are leading or involved in an age-friendly community initiative, also with dedicated staff (USAging, 2023).
‘Massachusetts is now home to more than 100 age-friendly and 100 dementia-friendly towns and cities.’
AAAs are effective DFA community leads given their combined expertise in dementia-friendly programming and deep community connections. For example, Trellis (n.d.), a Minnesota-based AAA, leads the Dementia Friendly Community initiative for the Twin Cities. Trellis was part of the original working group that created Act on Alzheimer’s, the statewide initiative from which DFA was born. Having supported 59 communities in becoming dementia friendly, Trellis remains the backbone of this statewide effort. Trellis creates and maintains a host of resources and technical assistance ranging from general community education to clinical trainings for medical providers to resources that support culturally competent care, all designed to promote dementia awareness and responsiveness. Trellis also developed the Remember Project, which delivers 2-hour events that include short plays and facilitated conversations bringing to life real issues regarding care, diagnosis, the experience of dementia, and how relationships can be tested in unexpected ways.
An example of one sector leading a multisector partnership is Aging and Long-Term Care of Eastern Washington (ALTCEW), which is implementing a Building Dementia Capable Communities grant. Through the grant, ALTCEW has partnered with the local Alzheimer’s Association and multiple sectors, including leaders from public health, emergency response, healthcare, social service providers, parks and recreation, public libraries, and local advocates. Through this collaborative effort they will build direct services, professional education, and community supports for people living with dementia and their families throughout the area.
So far, the ALTCEW-led group has established support groups and memory cafes and is supporting the development of a “dementia garden” at a public park. They have worked to increase awareness of memory loss through Dementia Friends sessions and provided individualized professional trainings to increase the competency of social service, mental health, and medical providers in recognizing, communicating, and responding appropriately to people living with dementia. Efforts have expanded to develop dementia-friendly business certifications, providing recommendations for built environment and resources for staff training, so community members have safe and trusted places to go. Additionally, ALTCEW has worked with local crisis responders so that caregivers whose loved ones have wandered or been the subject of a Silver Alert get counseling from a Dementia Specialist to address behaviors and offer supportive services.
DFA and Age-Friendly Ecosystems
As the age-friendly movement grows, it is critical that dementia-friendly practices are consistently incorporated. To that end, DFA encourages its communities to align and collaborate with local age-friendly efforts by sharing resources and best practices.
For example, Age & Dementia Friendly Massachusetts (DFM), established in 2016 as an initiative of the Massachusetts Councils on Aging, was an early adopter of age- and dementia-friendly integration. To help communities become dementia friendly, DFM offers educational and networking events, access to online resources and technical assistance and guidance from a dedicated project manager. DFM pioneered an Age- and Dementia-Friendly Integration toolkit with a step-by-step guide for local communities. DFM also offers guidance on how established age-friendly programs can introduce dementia-friendly activities into their action plans. Massachusetts is now home to more than 100 age-friendly and 100 dementia-friendly towns and cities, of which more than 60 are both age and dementia friendly.
In North Carolina, the Centralina AAA leads Dementia Friendly Charlotte Mecklenburg (DFCM). DFCM was a partner in the formation of Age-Friendly Mecklenburg, and Age-Friendly Mecklenburg’s action plan (2021) includes several key actions that directly address support for people living with dementia across age-friendly sectors. As part of this work, DFCM provides educational resources and training to community partners including Parks and Recreation Departments, grocery stores, and other businesses in becoming dementia friendly. DFCM also provides individualized recommendations on best practices when serving people with dementia, including championing awareness of ADRD and offering Dementia Friends sessions throughout the county.
Conclusion
Given the rising number of older adults who will be living with ADRD, it is imperative that communities continue to coordinate age- and dementia-friendly efforts to best serve this population. DFA provides a framework for collaboration across age-friendly and dementia-friendly sectors and initiatives. To ensure continued growth and success, new DFA communities and age-friendly initiatives should determine common goals in the planning stages. Developing tailored action plans ensures that the needs of older adults in individual communities are met.
Additionally, many Aging Network agencies have multiple social engagement programs, such as “friendly visiting” and intergenerational programs. Agencies should incorporate dementia-friendly programming and practices into their menu of offerings. This could include making existing programming more dementia friendly—for example, educating friendly visiting volunteers through Dementia Friends. Or agencies could add dementia-specific support, such as a Memory Café, to agency programming.
As the age-friendly ecosystem movement continues to grow, the unique sectors operating within it are urged to incorporate dementia-friendly practices. And there is an opportunity for collaboration with other networks that serve older adults, people with ADRD, and caregivers. Given the number of older adults who have a disability as well as ADRD, this would include the disability network, and continuums of care to address the growing crisis of older adults experiencing homelessness, many of whom have dementia. State-based Multisector Plans on Aging are another opportunity to embed dementia-friendly community initiatives at every level in the age-friendly ecosystem. Finally, improved collaboration with public health and healthcare systems is critical, especially post-diagnosis, considering 80% of people with dementia live at home.
The age-friendly and dementia-friendly movements share common interests and goals—most importantly enabling older adults, including those with ADRD, and their caregivers to have the highest quality of life possible. Communities that pursue both approaches simultaneously and integrate activities where possible will have the greatest positive impact on those who are most in need.
Acknowledgements
The authors wish to thank USAging’s Marisa Scala-Foley, Sara Maloney, Virginia Dize, Molly French, Meredith Hanley, and Deborah Stone-Walls for contributing their insights to this article.
Mary Ek, MA, is director of Dementia Friendly America and Community Care Corps at USAging; Darya Rahbar, MS, is a program manager at USAging; Ginny Biggar is director of Program Marketing and Community Outreach at USAging; and Traci Wilson, DPhil, is director of Research at USAging; all are in Washington, DC. Ek may be reached at mek@usaging.org.
Photo credit: Shutterstock/foto_and_video
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