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Dementia and the Unequal Cost of Care

Sharanya Singh·Oct 28, 2026

Introduction

Dementia is a group of conditions characterized by worsening cognitive decline over time. It can significantly affect memory, thinking, communication, and a person’s ability to manage everyday activities. Dementia is most common in adults over 65, although it is not a normal part of aging.

More than 55 million people worldwide live with dementia, and that number is projected to rise to about 139 million by 2050. Access to adequate care and support remains limited for many people, especially those with fewer socioeconomic resources. [1]

The Financial Toll of Dementia

Dementia is a progressive condition with no cure. Its effects on cognition can affect every aspect of daily life, including bathing, dressing, and preparing meals. As a result, the costs of treatment and caregiving can be considerable.

A University of Michigan study found that, within eight years of diagnosis, out of pocket healthcare spending more than doubled for people with dementia. Their net worth also declined by more than 60 percent over the same period. By comparison, similarly aged people without dementia did not experience substantial changes in either measure. [2]

The study also found that people with dementia were more likely to use paid in home care. Medicare, the federal health insurance program that primarily serves adults aged 65 and older, covers certain home health services only when specific eligibility requirements are met. It generally does not cover personal or custodial care when that is the only care a person needs, leaving many families to pay for these services themselves. [3]

Socioeconomic Barriers to Healthcare

The high costs associated with dementia can place a major burden on families, particularly those that are already financially vulnerable.

A Quebec study led by Claire Godard Sebillotte and Isabelle Vedel found that people with dementia living in socioeconomically deprived neighborhoods had less access to cognition specialists. They were also more likely to be hospitalized, visit the emergency department, die within a year of diagnosis, and receive prescriptions for antipsychotics or benzodiazepines. These medications can increase the risk of falls, confusion, and other adverse effects in older adults. The researchers suggested that differences in access to home and community support may help explain the greater reliance on these medications, although the study did not establish a direct cause. [4]

Families facing financial strain may need to prioritize food, housing, and other basic needs over healthcare expenses. Even when a person has health insurance, deductibles, copayments, medications, transportation, and long term support can remain difficult to afford.

Caregivers, especially unpaid family members and friends, can also face serious financial pressure. A 2007 estimate found that 37 percent of people caring for someone aged 50 or older had reduced their work hours or left their jobs. Lost wages, health insurance, retirement savings, and other employment benefits can deepen the financial burden of caregiving. [5]

Geographical Barriers to Healthcare

Geography can create additional barriers for people with dementia and their caregivers. Rural communities often have fewer healthcare providers, particularly specialists such as neurologists and geriatricians. Memory clinics, cognitive rehabilitation programs, and other dementia services may be limited or located far away. Unreliable transportation and long travel distances can cause people to delay regular checkups or specialist consultations, which may postpone diagnosis and treatment. [6]

Dementia Risk and Socioeconomic Status

Lower socioeconomic status is also associated with a greater risk of developing dementia. Education, employment, income, housing, transportation, access to medical care, neighborhood conditions, and community safety can all influence cognitive health across a person’s lifetime.

Research suggests that socioeconomic deprivation is associated with a higher risk of dementia even after genetic risk is considered. Other studies have linked lower income and education with a greater volume of white matter hyperintensities, changes visible on brain scans that are associated with small vessel disease and cognitive decline. Persistent low wages in midlife have also been associated with faster memory decline later in life. [7] [8] [9]

One study found that higher parental socioeconomic status appeared to buffer the relationship between the Alzheimer’s disease biomarker pTau181 and memory performance in middle aged adults. The finding suggests that early life socioeconomic conditions may contribute to cognitive reserve, although more research is needed to understand how and for whom this protection occurs. [10]

Potential Solutions

Reducing these disparities requires action both inside and outside the healthcare system.

Policies that improve neighborhood safety, access to nutritious food, education, clean outdoor spaces, and financial security may help reduce some modifiable dementia risks over time.

For people living far from health services, transportation programs, visiting or mobile clinics, telehealth support, and incentives for healthcare professionals to practice in underserved areas may improve access. Digital services should supplement, rather than replace, in person options for people who lack reliable internet access or need hands on care.

Dementia does not affect every family in the same way. Recognizing the financial, geographic, and social barriers that shape dementia care is an important step toward making diagnosis, treatment, and long term support more equitable.