U.S. Primary Care Docs Unprepared for Surge in Alzheimer's Cases
Many U.S. primary care doctors worry they aren't ready to care for the growing ranks of Americans with Alzheimer's disease, a new report suggests.
In a Alzheimer's Association survey, half of primary care doctors said the U.S. medical profession is unprepared for the coming surge in Alzheimer's cases.
Right now, it's estimated that more than 5 million Americans age 65 and older have the disease, according to the Alzheimer's Association. That figure is expected to almost triple by 2050.
And the doctors who are worried about the future have good reason, according to Dr. Sharon Brangman, inaugural chair of geriatrics at the State University of New York Upstate Medical University in Syracuse.
In fact, she said, the future is already here -- with too few doctors able to care for dementia patients and direct their families to resources for additional help.
"It's not enough to just prescribe medication," Brangman said. "The day-to-day care of people with dementia is really hard. And a lot of doctors aren't comfortable with that."
Brangman, a past president of the American Geriatrics Society, was not involved in the new report.
The survey findings are part of the Alzheimer's Association's latest Alzheimer's Disease Facts and Figures report, released March 11. The annual publication gives an overview of the state of the disease in the United States.
The association decided to include a survey this time around to get physicians' perspective, according to chief program officer Joanne Pike.
"Primary care physicians are on the front lines for treating any medical condition, not dementia," Pike said. But their role in dementia care, she added, will become increasingly critical as the number of Americans with the brain disease swells to possibly 15 million over the next 30 years.
Based on the survey, primary care doctors are already feeling the pressure. "The majority said they are getting questions about dementia at least every few days," Pike said. "And their patients expect them to be able to answer."
Yet 27% of doctors said they are "never" or only "sometimes" able to do that.
Doctors do want to stay up-to-date and give patients the information they need, the survey found. But education and training opportunities can be hard to come by: Fewer than half of the doctors surveyed said they'd pursued continuing education on dementia care -- often citing too few options and a lack of time.
Younger doctors were more likely than their older peers to have had some education and training in dementia care during medical school and residency. Still, two-thirds of doctors who'd had such education described it as "too little."
Primary care doctors did commonly refer dementia patients to specialists, such as neurologists and geriatricians. But, the report shows, the United States has far too few specialists to manage the demand.
Right now, for example, there are just over 5,200 geriatricians nationwide. That number would have to balloon to over 46,000 by 2050, just to meet the needs of 30% of Americans age 65 and up.
Primary care doctors -- as well as other providers such as nurses, aides and social workers -- will necessarily play an ever-increasing role in dementia care, according to Pike and Brangman.
"Medical school curriculums need to devote more time to dementia, and aging in general," Brangman said.
As for doctors already in practice, education needs to be more accessible, Pike said. The Alzheimer's Association is looking at innovative ways, she noted, including "tele-mentoring" programs that would allow doctors to learn remotely from dementia experts.
But dementia care goes beyond technical knowledge. Family caregivers are ultimately on the front lines, Brangman pointed out, and they need help managing day-to-day challenges.
Social workers are a vital part of that, she said. But that kind of support is not available in all health care systems.
Still, other local resources exist, and doctors should at least be able to direct families to them, Brangman said. Those include caregiver support groups, regional agencies on aging, or local chapters of the Alzheimer's Association or American Geriatrics Society.
Pike said the Alzheimer's Association also has a 24-hour helpline and online resources for family caregivers.
"People with dementia need constant supervision," Brangman said. And their primary caregiver -- typically an elderly spouse -- may have their own health issues to manage, along with everything else.
"We shouldn't make it difficult for them to find help," Brangman said.
The Alzheimer's Association offers resources for family caregivers.
SOURCES: Joanne Pike, Dr.P.H., chief program officer, Alzheimer's Association, Chicago; Sharon Brangman, M.D., inaugural chair, Department of Geriatrics, and director, Center of Excellence for Alzheimer's Disease, Central New York Region, SUNY Upstate Medical University, Syracuse, N.Y., and past president, American Geriatrics Society, New York City; Alzheimer's Disease Facts and Figures, March 11, 2020