The number of people with dementia in the United States is projected to increase dramatically over the next ۲۵ years, which will place increasing strain on a healthcare system already struggling to help them amid cuts by the Trump administration, experts say.
According to a new study in Jama Neurology, the annual incidence of new dementia cases globally will more than double, from ۱۱.۴m in ۲۰۲۳ to ۲۴.۷m in ۲۰۵۰. In the United States, the number of adults diagnosed with dementia each year will increase from ۵۱۴,۰۰۰ in ۲۰۲۰ to ۱m by ۲۰۶۰, according to a Jama study published in ۲۰۲۴.
The United States already does not have enough geriatric specialists or people working in home care and at nursing homes. The Trump administration has also significantly cut funding for Medicaid, which covers a substantial portion of long-term care.
Those gaps mean the country must focus on preventing dementia, discovering new drugs to at least delay its onset and recruiting people for the demanding jobs of providing care for individuals with Alzheimer’s, people in the field say.
“Families will be absorbing enormous emotional and financial costs … because dementia often requires years of increasing supervision and hands-on care, which our healthcare system is not really designed to provide,” said Jordan Weiss, an assistant professor at the Optimal Aging Institute at NYU Langone.
The number of people with dementia is projected to increase because life expectancy has gone up in recent decades, which means larger numbers of people are entering the age brackets in which dementia is most common. Also, in the United States, the Hispanic population almost doubled between ۲۰۰۰ and ۲۰۲۴, and that demographic is ۱.۵ times as likely to develop dementia as white people, according to the Alzheimer’s Association.
“Even if you reduce the risk of dementia, just the sheer number of adults who are entering the ages where dementia is most common will increase the number of people living with and who develop dementia,” Weiss said.
Meanwhile, nursing homes are struggling to meet the existing demand. Almost all facilities reported difficulty recruiting new staff and two-thirds said a primary issue was a lack of interested or qualified candidates, according to a ۲۰۲۴ report from the American Health Care Association, a nursing home lobbying group. About half reported that they had limited new admissions of residents.
“We are asking workers to perform what are very physically and emotionally demanding jobs. Helping people bathe, eat, dress and navigate cognitive decline, often for relatively low wages, unpredictable hours, and limited opportunities for advancement,” Weiss said.
The country’s need for nursing assistants and home health aides is expected to increase by ۴۸% and ۴۲% between ۲۰۲۰ and ۲۰۳۵, according to the Center for American Progress. And yet, the median wage in May ۲۰۲۵ for nursing assistants at assisted living facilities and in home healthcare was less than $۱۹ an hour, according to the Bureau of Labor Statistics. The median wage for home health aides was $۱۷ an hour.
“The retention rate of those direct care workers is really, really low because it’s really difficult work. You can’t replace that with AI, and they are not getting adequately reimbursed,” said Regina Shih, a professor of epidemiology at Emory University who studies dementia and caregiving.
Meanwhile, the number of people becoming geriatric doctors has actually decreased in recent decades. In ۲۰۰۰, there were ۱۰,۲۷۰ geriatricians in the US; in ۲۰۲۲, there were only ۷,۴۱۳, according to a Jama report. It is among the lowest-paid medical specialties.
“I think it in part is related to compensation,” and “I just think residency interest hasn’t necessarily kept pace with some other fields,” Weiss said.
States are taking steps to try to address the labor shortages. In ۲۰۲۵, almost half reported offering incentive payments to recruit or retain Medicaid home care workers, according to a KFF survey.
South Carolina created a loan forgiveness program for physicians who complete fellowships in geriatrics or geriatric psychiatry and practice in the state for at least five years.
But states must also now contend with Donald Trump’s One Big Beautiful Bill Act, which passed in ۲۰۲۵ and included nearly $۱tn in cuts to Medicaid spending over ۱۰ years. Medicaid pays for more than half of what the country spends on long-term care, KFF reports.
“It’s a serious challenge for expanding access” to the growing number of people with dementia “who are eligible for Medicaid to get services like home care, personal care aid, respite care”, Shih said.
There have, however, been positive developments in geriatric medicine. In recent years, the Food and Drug Administration (FDA) approved two drugs, Kisunla and Leqembi, that can modestly slow cognitive decline among some patients with early Alzheimer’s disease. The agency has also recently approved blood tests that can help diagnose the disease – and perhaps even predict if they are likely to develop it.
“It may improve people’s lives, and it may do a lot for how we slow decline or think about prevention, but it will be costly” for the healthcare system, said Julie Zissimopoulos, a University of Southern California professor and principal investigator of the US Cost of Dementia Project.
Given that a cure for Alzheimer’s does not appear to be imminent, it is important that we don’t just wait for one, Weiss said.
“We have a real opportunity to reduce dementia risk through better cardiovascular health [and] physical activity,” Weiss said. “Scientific breakthroughs matter, but so does building a healthcare system and infrastructure capable of delivering the care that people already need.”
