12 Mar 2020

More than 5 million Americans currently live with Alzheimer’s disease, and that number will likely triple by 2050, according to the Alzheimer’s Association’s annual Facts and Figures report, released March 11. The deluge of cases could overwhelm a system ill-prepared to deal with it, the association notes in a special section on Alzheimer’s management in primary care. In a survey of 1,000 primary care physicians, most said they are on the “front lines” of dementia care, but almost three-quarters had received little to no residency training in this area. Half of these physicians considered ongoing training options too limited and predicted that their medical field will be unable to meet future demands for care.

Primary care physicians regularly care for dementia patients, but receive little training.

The U.S. has too few dementia specialists to handle burgeoning caseload.

Every other PCP believes the field is unprepared for the coming surge.

Survey participants were balanced by age and gender, as well as by geographic region, specialty, years in practice, and type of practice, to match the demographics of primary care physicians in the U.S. Overall, the respondents saw a pressing need for dementia expertise in primary care. Half of them noted that they answer questions about dementia at least every few days in their practice. On average, 40 percent of their patients are 65 or older, and 13 percent of this age group has been diagnosed with dementia. Nearly nine in 10 respondents know the number of dementia patients will rise over the next five years.

Physicians Anticipate Shortage. Many primary care physicians believe their field is unprepared to handle the coming dementia caseload. [Courtesy of the Alzheimer’s Association.]

Many physicians said they are not ready to meet the challenge. Thirty-nine percent were uncomfortable making a diagnosis of dementia, 27 percent were uncomfortable answering questions about the disorder. Nearly a third said training options are difficult to access, and 37 percent said most of their training comes from learning on the job while treating dementia patients.

Can specialty clinics pick up the slack? Unlikely, the report concludes. While one-third of primary care physicians refer patients to dementia specialists at least once a month, 55 percent said there were too few specialists in their area to meet demand. The problem was particularly acute in less-populated areas. The Alzheimer’s Association compiled statistics on the number of geriatricians in each state and projected the number that would be needed by 2050 to meet demand. Overall, states would need to triple the number of specialists to have enough care for the coming dementia caseload. The number would have to increase ninefold to cover all elderly patients needing care of any sort.

How to encourage more dementia care training? The report suggests increased federal funding for medical education programs to boost enrollment, forgiving federal and state education loans to inspire more doctors to choose primary care in rural areas, and training nurse practitioners in dementia care.—Madolyn Bowman Rogers