The Coming Dementia Crisis—and the Cost of Doing Nothing

It’s like watching a slow-moving meteor approach in plain sight. Everyone can see it coming, everyone knows the damage will be catastrophic—and yet our collective response has been to shrug and hope a cocktail umbrella will be enough to protect ourselves. That is where America stands today with dementia. We have only a narrow and rapidly closing window to prepare: to strengthen care systems, support families, invest in risk reduction and treatment and build the infrastructure that could blunt the worst of the impact. If we fail to act now, the crisis will accelerate past the point where preparation is even possible—and we’ll be left with only wreckage.

The scale is staggering. The population over age 65 is the largest and fastest-growing in U.S. history. The risk of cognitive decline doesn’t just appear suddenly. It rises steadily after 65, then surges dramatically after 80 and especially after 85. Here’s what that really means: if you live long enough, dementia is not a remote possibility. One in three of us will develop it, and of those who don’t, many will end up as caregivers. No family is going to escape the reach of this disease.

When dementia arrives, everything changes. Persons living with the condition steadily, inevitably lose the ability to manage their daily lives or to participate fully in society. Patients have put themselves at risk of fires, car accidents, devastating financial scams–or found by police after wandering, frightened and disoriented, through their own neighborhoods. Missed medications and frequent hospitalizations are common. And behind every hospitalization is a family stretched to the breaking point, often with little support. 

Families barricade themselves during episodes of agitation, quit jobs to provide unpaid care and lose countless workdays that ripples across the greater economy. Now multiply that reality across 70 million baby boomers in the U.S., and you begin to see the scale of what’s coming. The social, economic and moral consequences will touch every community. We are nowhere near prepared. 

To meet today’s demand, the U.S. would need more than 125 times the number of dementia specialists currently practicing. The shortage grows worse by the day, turning wait times from months into years—and for many families, those lost years are devastating. Geriatrics has long faced a workforce crisis, but the gap is even wider in cognitive and behavioral neurology. 

Economically, the costs are already crushing: hospitalizations, home care, institutionalization and the unpaid labor of millions of caregivers. The Alzheimer’s Association estimates dementia costs the U.S. economy more than $400 billion annually, a figure projected to surpass $1 trillion by 2050. That number encompasses healthcare spending as well as lost productivity and the unpaid labor of millions of family caregivers. Without sufficient intervention, dementia care will continue to consume more healthcare dollars, driving premiums and straining Medicare and Medicaid budgets. Businesses will face mounting absenteeism and turnover as employees step away to care for their loved ones. The labor market will shrink as the need for skilled caregivers multiplies. 

We’ve seen a version of this before. Remember 2020, when every doctor became a Covid-19 doctor? The ripple effects of unpreparedness will similarly overwhelm the entire healthcare system. First, it will be the neurologists who don’t specialize in dementia, followed by primary care providers, cardiologists, gynecologists and even ER staff, who will all be drawn into grappling with the effects of mismanaged and inadequate dementia care: preventable falls at home, decompensated chronic conditions, acute episodes of psychosis or delirium. The U.S. healthcare system will expend additional resources and time caring for these patients without actually helping them manage their condition because there aren’t enough specialists to handle the need. 

The bitter irony is that we finally have treatments that work—two FDA-approved drugs that may slow Alzheimer’s progression in its early stages. But they’re expensive and most effective before symptoms are apparent, when diagnosis is hardest. Health plans are trying to balance short- and long-term costs, but dementia is a long game, and ignoring it until the crisis peaks will guarantee higher spending and greater suffering. So how is it then that we can ensure we’re prepared?

Public policy must catch up with demographic reality. Whether we invest now or pay later is no longer a moral question. It’s a macroeconomic one. For the broad public, we need to teach dementia literacy. While most Americans likely know the difference between “cancer” and “lung cancer,” few understand the difference between “dementia” and “Alzheimer’s disease.” Public understanding is the foundation of early detection. 

For healthcare professionals, we have to prepare every provider, regardless of their specialty, on how to recognize and respond to cognitive impairment. We also need to vastly modernize the policies and payment plans in healthcare. The new GUIDE model, which adjusts compensation for dementia care for traditional Medicare beneficiaries, is an encouraging step in the right direction. Modernizing Medicare and long-term care policy can reduce the burden on unpaid caregivers and improve access to in-home support. Creating workforce incentives—loan forgiveness, fellowship funding, salary parity—for physicians, nurses and social workers entering geriatrics and cognitive neurology can help mitigate the ongoing labor shortage. 

Our healthcare system must reward appropriate proactive care—and prioritize early intervention when care has the greatest impact—to ensure the right patients receive the right treatments at the right time, all the time. Policymakers must maintain a bipartisan focus. Regardless of political affiliation, we all have brains to protect and people to care for. 

The U.S. stil treats dementia as a private tragedy rather than a national policy issue. If we took anything away from the lessons learned during the pandemic, America needs a strategy that matches the scope of the challenge, one that algins public education, workforce development, research and clinical practice to meet the impending tsunami. 

Right now, we are not treating dementia with the urgency it demands. If we wait until the crisis is fully upon us, our options will shrink and the costs—both economic and human—will skyrocket. By 2050, dementia will impact every family. It’s coming for mine, and it’s coming for yours. Will we act now, or look back in 30 years, wishing we had done more before the meteor struck?