MW As baby boomers turn 80, there aren't enough doctors to treat 'emergency levels' of dementia patients

By Jessica Hall

'Dementia neurology deserts' already exist in 20 states. The future looks even more bleak.

As the oldest baby boomers turn 80 this year, the medical industry is already overtaxed in its ability to provide dementia care - let alone handle the expected barrage of cases in the future.

"It's a dire situation. It's already at emergency levels - to get a diagnosis, to get care, and all the points along the way," said Elizabeth Edgerly, senior director of community programs and services with the Alzheimer's Association. "As the baby boomers age, the disconnect between supply and demand is growing larger."

The lifetime risk of dementia after age 55 is about 42%, according to a recent study published in the journal Nature Medicine. Around 1 million adults in the U.S. are projected to develop dementia each year by 2060, compared with around 514,000 in 2020, the study found. More than 6 million Americans currently have Alzheimer's disease.

The current benchmark for adequate levels of care is 10 neurologists for every 10,000 people with dementia, according to the Alzheimer's Association. Twenty states have fewer than that, making them "dementia neurology deserts," Edgerly said.

"The gulf between the 'haves' and the 'have nots' will only get worse," she added.

Read: There aren't enough doctors to care for older people, and it's only going to get worse

The shortage in dementia caregivers comes as the population is increasingly aging - with more than 10,000 people turning 65 each day through 2027 - and as medical costs are rising and cuts to Medicaid programs are feared under the Trump administration.

Costs to cover medical expenses also are rising: A 65-year-old retiring in 2024 could expect to spend an average of $165,000 on healthcare and medical expenses during their retirement - up nearly 5% from 2023, according to Fidelity Investments.

Dementia care includes a variety of specialists and caregivers, including neurologists, geriatricians, primary-care physicians, psychiatrists and neuropsychologists. The country as a whole needs three times as many geriatricians as it currently has to handle the expected need by 2050, Edgerly said.

There is a substantial difference in specialist availability between urban and rural settings. For example, 44% of primary-care physicians in large cities and 54% of those in suburbs near a large city reported that there were not enough specialists in their area, according to the Alzheimer's Association. In contrast, 63% of primary-care physicians in a small city or town and 71% in a rural area reported a lack of specialists.

The average wait time to see a neurologist is 34 days nationally, but 18% of patients have to wait more than 90 days, Edgerly said. Patients in rural areas may wait three times as long as patients in urban areas, according to Rand Health Care, a research division of the Rand Corporation.

"That can delay or eliminate the possibility of treatment," Edgerly said. "There will be missed opportunities to provide care."

There is no cure for dementia. Medications such as Leqembi $(BIIB)$ $(ESAIY)$ are designated for mild cognitive impairment or the very early stages of Alzheimer's, making early detection imperative to slow down cognitive decline. In July, the U.S. Food and Drug Administration approved Eli Lilly's $(LLY)$ donanemab, also meant to slow the progression of early-stage Alzheimer's.

About 92% of all patients with mild cognitive impairment go undiagnosed, according to a 2023 study.

"It's shocking how much care is needed and the gaps in care that we currently have," Edgerly noted.

Dementia research is also at risk. About one-tenth of the workers at the National Institutes of Health's Center for Alzheimer's and Related Dementias, or CARD, lost their jobs in recent weeks due to the Trump administration's layoffs, according to a report in the New Republic.

A Trump administration spokesperson did not respond to requests for comment.

Care needed across the board

Many people are forced to travel to get treatment at memory-care centers, which usually are in urban areas or near teaching hospitals. Once a patient has a diagnosis, they often get sent back to their primary-care physician for regular care.

"Primary-care doctors are not trained to manage the situation, not trained to provide care along the path of the illness, and don't have the time, resources or skills needed for dementia care," said Faika Zanjani, professor of gerontology at Virginia Commonwealth University

In addition to neurologists and geriatricians, the medical industry needs more dementia training throughout the system, from nurses to social workers to nursing-home administrators to home healthcare workers, Zanjani said.

"We need more professionals literate around dementia care. The entire pipeline across the board needs to be improved," Zanjani said. "Without adequate care, people are not getting the correct diagnosis, treatment or support. Their life expectancies can be less. And it increases the caregiver burden all around them."

There has been an increase in telehealth to support physicians with backup expertise from specialists, Edgerly said. Telehealth also exists for the diagnosis, treatment and support of patients and their caregivers.

Joel Salinas, a practicing cognitive-behavioral neurologist and co-founder of Isaac Health, a dementia telehealth-care provider, said the dearth of care providers coming into the field and the level of care needed is a national health crisis.

"These conditions have been on the back burner way too long," Salinas said.

What does this mean for the future?

"Families are just really struggling to get care just to go to work. If they can't get care for a loved one, it means they can't keep their jobs," Edgerly said. "Only people who are effective at advocating and have funding and support will have access to care."

Salinas agreed, saying only VIPs will get care as numbers swell in the future - leaving vulnerable and marginalized people waiting longer for services.

Isaac Health is part of a Centers for Medicare and Medicaid Services program called the Guiding an Improved Dementia Experience (GUIDE) Model, which provides care and support to Medicare beneficiaries living with dementia and their families through telehealth.

"I see telehealth as the future of how care gets delivered. It will feel atypical to someone used to a brick-and-mortar experience, but it's not an inferior quality of care," Salinas said. "We don't have enough people to serve patients in person. Telehealth can stretch across the country to fill the gaps."

Geriatrics is one of the least popular tracks in medical schools for new physicians, with geriatric fellowships often going unfilled. To increase the number of dementia-care specialists, students need more financial incentives such as loan forgiveness and better career pathways to recruit and retain workers. And medical schools need to make gerontology part of their core curriculum, Edgerly said.

"It isn't sexy," Salinas said. "But it's a public-health crisis that has kept me up at night for years. I have very serious concerns about our health system's capacity to provide care."

-Jessica Hall

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March 01, 2025 08:25 ET (13:25 GMT)

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