Developing an Indicator for Age-Friendly Communities: The Japan Gerontological Evaluation Study

BackgroundAge-friendly communities (AFCs) aim to create inclusive societies for older people. Despite the World Health Organization (WHO)s emphasis on incorporating dementia-friendliness across all phases, including planning, implementation, monitoring, evaluation, and scale-up, there are very few community-level indicators that incorporate dementia-friendly elements. ObjectiveTo develop a community-level AFC indicator based on WHO AFC guidelines incorporating dementia-friendly elements, and examine its validity and reliability. DesignA repeated cross-sectional study using data from the 2016 and 2019 waves of the Japan Gerontological Evaluation Study. Setting and SubjectsData were collected from 61 school districts in 16 Japanese municipalities, involving 45,162 individuals aged [≥]65 years in 2016, and 39,313 in 2019. The 2016 and 2019 datasets were the development and retest samples, respectively. MethodsAfter identifying 23 candidate items according to the WHO AFC guidelines and expert reviews, data were aggregated by school district. Exploratory factor analysis on the 2016 data helped derive factor structure, confirming reproducibility with the 2019 data. Internal consistency and test-retest reliability were evaluated. ResultsThe final 17-item indicator comprised three subscales: Social inclusion and dementia-friendliness (7 items, = 0.86), Social engagement and communication (5 items, = 0.78), and Age-friendly physical environment (5 items, = 0.82). The structure showed adequate test-retest reliability (r = 0.71-0.79; ICC = 0.67-0.78). ConclusionsA valid and reliable 17-item community-level indicator was developed, which aligns with the WHO framework and also incorporates dementia-friendly elements. This indicator is useful for monitoring and evaluating to promote the AFC and dementia-friendly communities.