Geographic variation in shortfalls of dementia specialists in the United States

Abstract

Dementia specialists – neurologists, geriatricians, and geriatric psychiatrists – serve a critical clinical function in diagnosing early-stage Alzheimer’s disease and determining eligibility for treatment with disease-modifying therapies. However, the availability of dementia specialists is limited and varies across the U.S. Using data from the Area Health Resources Files, we found that the median density of dementia specialists across hospital referral regions in U.S. is 29.7 per 100,000 population aged 65 and older (interquartile range 20.7 to 44.0). We derived thresholds of 33 to 45 dementia specialists per 100,000 population aged 65 and older as the provider density necessary to care for older adults with mild cognitive impairment and dementia. Based on these thresholds, we estimated that 34% to 60% of the population aged 65 and older resided in areas with potential dementia specialist shortfalls. The extent of potential shortfalls varied by state and rurality. A better understanding of potential gaps in the availability of dementia specialists will inform policies and practices to ensure access to services for people with cognitive impairment and dementia.