The Bali province has entered the era of the aging population structure in 2017 as the percentage of the elderly population reached 10.79%. The condition places Bali with the highest number of elderly people outside the Java area. Improvements in health, migration, high life expectancy, and the success of family planning programs have contributed to the increasing number of elderly people in Bali. The population aging phenomenon did not solely occur in Bali but also nationally and globally. Along with the aging population, degenerative diseases such as dementia are also increasing.

Dementia is a disease with a series of symptoms of decreased brain function such as memory, emotion, problem-solving, including communication that is progressive in nature to the point where it is no longer possible to carry out daily activities. In 2015, the World Alzheimer's Report estimated there were 9.9 million new cases of dementia each year worldwide and one new case every three seconds. The economic costs incurred for the upper-middle-income countries, such as Indonesia, are estimated at US$ 2.2 billion per year. This fee includes medical, social, and informal nursing costs.

Until the end of 2015, data on the prevalence of dementia at the population level was not available in Indonesia. The SurveyMETER study in Yogyakarta at the end of 2015 was the first study in Indonesia on the prevalence of dementia at the population level with a large sample. Indonesia is in dire need of dementia prevalence data in other provinces for planning for dementia management at local and national levels.

The Dementia Study in Bali Province conducted in March-April 2018 could answer the challenge of the need for data at the population level outside Java. In order to provide information as well as to find out the condition of dementia outside Java in general and Bali in particular. The study was conducted by SurveyMETER in collaboration with the Faculty of Economics and Business at Udayana University, the Suryani Institute, and Alzheimer's Indonesia (ALZI) with support from the Knowledge Sector Initiative (KSI). The study was conducted in all regencies/cities in Bali Province with a total of 1,685 elderly respondents in 117 villages. The data is then analyzed based on risk factors to support the birth of a sustainability policy in Bali which includes a policy for people with dementia.

Similar to Yogyakarta, the study in Bali used three instruments: MMSE, AD8, and IADL for the elderly who answered themselves during interviews and used AD8 and IADL from their caregivers. The data shows that the prevalence of elderly dementia in Bali Province is 1.6 times higher than the elderly in DI Yogyakarta.

This is due to the various risk factors that the elderly in Bali have greater scores than those compared to Yogyakarta. Among these factors are lower education levels for older adults in Bali, more living in rural areas, more reporting of high blood pressure, more unemployed people, and more older adults not participating in elderly activities.

Bivariate analysis showed the elderly who participated in social activities or occupied a job reveal a much lower prevalence of dementia (half) compared to unemployed elderly or unengaged in social activities. Elderly who are still working or doing social activities in Bali Province with dementia reached 23%. The prevalence of dementia is not solely influenced by employment status but also by the type of work. Jobs such as unpaid or paid family workers with clear working hours provide little stimulation to the brain so that it has the highest prevalence rate, then was self-employed, and the lowest prevalence occurred in those with the status of private or government employees.

In order to prevent dementia and ensure that the elderly are always healthy, have the opportunity to participate in the economic and social fields, it is necessary to establish a friendly area for the elderly and dementia. Elderly and dementia-friendly areas will improve the quality of life of People with Dementia and their caregivers. The four main components of a dementia-friendly area are People with Dementia themself, community, institutions, and partnerships.

The Alzheimer's Disease International (ADI) document in its presentation on the principles of the physical environment specifically mentions the need to identify opportunities to collaborate with groups that carry out elderly-friendly area initiatives. In Indonesia, regulations for the establishment of an elderly area have developed quite rapidly after a study conducted on the capacity assessment of elderly-friendly cities in 14 cities in 2013 by the SurveyMETER and CAS UI studies. In 2017, Regulation of the Minister of Social Affairs of the Republic of Indonesia Number 4 concerning Guidelines for the Development of Elderly Friendly Areas was issued. The guidelines not only cover the eight dimensions of WHO 2007 elderly-friendly cities but also contain a number of important dimensions that are added to adapt to the context of problems in Indonesia, including having a sustainability policy, religious and mental-spiritual services, social advocacy, legal assistance; and/or protection of the elderly from threats and acts of violence.

The first criteria to categorize as an elderly-friendly area is to have a policy for the elderly. The policy must reflect partiality to the elderly and indiscriminative. It can be in the form of a regional regulation or a regional head regulation. Those are translated into the strategic plans and financing are sourced from the regional budget (APBD), state budget (APBN), grants, etc.

The existence of an elderly policy that includes people with dementia policy is very important because: it can ensure the establishment of an elderly-and-dementia-friendly area; make health policies and social services related to the elderly and dementia a priority; improve the knowledge, understanding, attitudes, and behavior of public servants and professionals related to elderly and dementia; increase investment in health and social systems to improve care and services for the elderly and dementia; increase the priority of the research agenda on the elderly and dementia. All of the efforts will lead to strengthening the position of the elderly in the country to strengthen development, preserve cultural values, and inspire the young generation.