The number of people with dementia in the United States is expected to rise dramatically over the next 25 years, experts say, putting increasing pressure on a health care system that is already struggling to help them amid the Trump administration’s budget cuts.
According to a new study from Jama Neurology, the annual incidence of new cases of dementia worldwide will more than double, from 11.4 million in 2023 to 24.7 million in 2050. In the United States, the number of adults diagnosed with dementia each year will increase from 514,000 in 2020 to 1 million by 2060, according to a Jama study published in 2024.
The United States already does not have enough geriatric specialists or people working in home care and 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 needs to focus on preventing dementia, discovering new drugs to at least delay its onset and recruiting people for the demanding tasks of providing care for people with Alzheimer’s, people in the field say.
“Families will absorb enormous emotional and financial costs … because dementia often requires years of increasing supervision and hands-on care, which our health care system is not really designed to provide,” said Jordan Weiss, an assistant professor at NYU Langone’s Optimal Aging Institute.
The number of people with dementia is expected to increase because life expectancy has increased in recent decades, meaning more people are entering the age groups in which dementia is most common. Additionally, in the United States, the Hispanic population nearly doubled between 2000 and 2024, and this demographic group is 1.5 times more likely to develop dementia than white people, according to the Alzheimer’s Association.
“Even if you reduce the risk of dementia, the sheer number of adults entering the ages where dementia is most common will increase the number of people living with and developing dementia,” Weiss said.
Meanwhile, nursing homes are struggling to meet existing demand. Nearly all facilities reported difficulty recruiting new staff and two-thirds said the main problem was a lack of interested or qualified applicants, according to a 2024 report from the American Health Care Association, a nursing home lobbying group. About half said they had limited new resident admissions.
“We ask workers to perform very physically and emotionally demanding tasks. Helping people bathe, eat, dress and cope with cognitive decline, often for relatively low wages, unpredictable schedules and limited opportunities for advancement,” Weiss said.
The nation’s need for nursing assistants and home health aides is expected to increase 48% and 42% between 2020 and 2035, according to the Center for American Progress. And yet, as of May 2025, the median wage for nursing assistants in assisted living and home health care was less than $19 an hour, according to the Bureau of Labor Statistics. The median wage for home health aides was $17 an hour.
“The retention rate for these direct caregivers is really, really low because it’s really hard work. You can’t replace that with AI, and they’re not properly reimbursed,” said Regina Shih, a professor of epidemiology at Emory University who studies dementia and caregiving.
At the same time, the number of people becoming geriatric physicians has actually declined in recent decades. In 2000, there were 10,270 geriatricians in the United States; in 2022, there were only 7,413, according to a Jama report. It is one of the lowest paid medical specialties.
“I think part of it has to do with compensation” and “I just think interest in residency hasn’t necessarily kept pace with some other fields,” Weiss said.
States are taking steps to try to address labor shortages. By 2025, nearly 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 training 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, passed in 2025 and providing nearly $1 trillion in Medicaid spending cuts over 10 years. Medicaid funds more than half of what the country spends on long-term care, KFF reports.
“It is a serious challenge to expand access” to the growing number of people with dementia “who are eligible for Medicaid to receive services such as home care, personal care assistance, respite care,” Shih said.
However, positive developments have taken place in the field of geriatrics. In recent years, the Food and Drug Administration (FDA) has approved two drugs, Kisunla and Leqembi, that may slightly slow cognitive decline in some patients with early-stage Alzheimer’s disease. The agency also recently approved blood tests that can help diagnose the disease — and perhaps even predict whether they are likely to develop it.
“It can improve people’s lives, and it can do a lot to slow the decline or think about prevention, but it will be costly” for the health care system, said Julie Zissimopoulos, a professor at the University of Southern California and principal investigator of the U.S. Cost of Dementia Project.
Since a cure for Alzheimer’s disease doesn’t appear imminent, it’s important not to just wait for one, Weiss said.
“We have a real opportunity to reduce the risk of dementia through improved cardiovascular health (and) physical activity,” Weiss said. “Scientific advances are important, as is building a health system and infrastructure that can provide the care people already need. »
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