Financial skills can erode before dementia is even suspected
Filed under: Retire, Health, Relationships
When Mom begins to mislay her car keys, or Dad misses bathing for a couple of days, many of us realize that it might be time to take at peek at their finances to make sure nothing has gone awry. However, this could be much too late. According to a couple of recent studies, patients with mild memory problems may already be exhibiting signs of financial impairment, putting their assets at risk.
I had the chance to talk in a telephone interview with one the field's foremost experts on Alzheimer's and financial behavior, Dr. Daniel Marson J.D., Ph.D., professor and director of the Alzheimer's Disease Center in the Department of Neurology at the University of Alabama at Birmingham, who recently completed a new study on this topic.
What key piece of information should people consider when dealing with cognitive impairment and personal finance?
When you're dealing with an elderly person who is beginning to show memory loss, the memory loss and ability to express themselves are important in what might be developing dementia, but the real face of dementia is when functional changes occur. You can put up with senior moments of memory lapses, but when someone is beginning to break down in using the checkbook, paying bill two or three times, or getting exploited through get-rich schemes, you have to step in. That is often really the first indicator for families that they are dealing with dementia and that there is a disability now, forcing them to engage and provide care and oversight that they didn't have to before.
What did your new study find?
We've been interested in financial capacity as a set of skills in the elderly since the mid-1990s. We've found that financial skills are considerably impaired in mild Alzheimer's Disease and in advanced impairment when patients move to the moderate level of A.D.
In this study we took a group of people with mild cognitive impairment, which is not Alzheimer's Disease by definition yet but is a condition of abnormal memory loss that puts this group at risk for progressing to A.D. Those who indeed did progress and convert to A.D. over the course of a year showed detectable changes in their ability to do more complex financial tasks.
If you have someone who already has abnormal memory loss and may be at risk for developing a dementia in the future, and begin to see interval changes or changes from a prior baseline in their ability to manage different financial tasks it may be a harbinger that they will be progressing to A.D.
In an earlier study, we found that patients with mild cognitive impairment already have some subtle but detectable changes in their financial skills. (The current) study shows that those who are progressing show changes over time that is detectable.
How do you measure a decline in financial capability?
The Financial Capability Instrument is a test we developed in the 1990s as a research instrument that would tap a wide range of skills such as naming and counting currency, paying bills, making simple investment decisions, and navigating bank statements.
You can look at very different skills and some ...may be changing in mild cognitive impairment and some may not. For example, the ability to name money or count currency is not going to be affected in MCI (mild cognitive impairment). Some of the very complex skills may show changes as early as MCI, though.
An earlier study that you participated in called into question the ability of caregivers to accurately evaluate a patient's financial ability. Could you speak to that?
"The Wadley Study in 2003 showed that by the time you have early Alzheimer's Disease your ability to self-appraise your financial functioning has become very poor. These people almost always overestimate their abilities, think that they are able to do much more than they are able to do.
Caregiver and family reports are very important... but their reports are often biased. They can be in denial because they don't want to admit Dad is slipping, or sometimes they overestimate the impairment because they are so torn up. Problems with the reliability of caregiver reports makes it important to consider other approaches to measuring financial skills.
What would you suggest to someone who is dealing with mild cognitive impairment?
Physicians need to be mindful as they treat someone with mild cognitive impairment to possible changes in financial skills as an indication of a progression toward dementia....Most physicians are not able to do a financial capacity assessment, but they can ask patients if they are still handling the checkbook OK, or engaging in risky behaviors they didn't before.
If it comes down to issues of financial capacity or they need a more finely grained exam they can refer the patient to a specialist who can do a financial capability evaluation. Neuropsychologists can look not just at their memory function or thinking ability, but how well they are functioning in certain important domains such as financial skills.
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From my talk with Dr. Marson and review of some of his studies I took away these bullet points:
- In the early stages of cognitive impairment, people can start making financial mistakes before they exhibit other symptoms that their doctor or loved ones might recognize.
- As the disease progresses, so does the erosion of financial ability, and this can be measured.
- People with this problem commonly don't recognize that they are slipping.
- Caregivers understandably have trouble accurately judging the patient's financial disability.
Learn the 10 warning signs of Alzheimer's Disease
Reader Comments (Page 1 of 5)
10-01-2009 @ 11:03AM
margaret opine said...
THERE IS STILL A PERSON IN THERE....
I am an advocate and I am a senior citizen who has a non-profit organization of seniors helping seniors. One of our associates were diagnosed as "prescribed" in this article. The State and her four children literally took her life away from her and she is in a facility, which looks fabulous but the people don't speak english around her and there are serious social issues. That's where we come in. We hope to preserve and support the person that is in the body that has been diagnosed with a diminishing disease.
Some seniors do not bathe everyday. Some people in some countries do not bathe everyday. In some facilities where people are housed the people are not bathe everyday. So, please don't take non-bathing as a strike against the senior's freedom. About the money, yes, because the senior needs money to take care of them it is probably a good idea to watch the finances or even to take charge of them. So, some assistance may be needed at some point but we believe in performing those tasks for the senior with disabiling problems as "assistance", as "help", as "support' to the senior, at least to some point. The goal we hope to gain is a senior who ACCEPTS help, TRUST help and therefore feels GLAD and appreciative to have that help as oppose to coming in, tearing down the senior's life and commandeering their bank accounts and not allowing them to see the records or check on their finances to see what is going on. We act as advocates for seniors allowing them to have a voice against their "oppressors", who are usually well-meaning children, offspring, who feel they are performing some loving care.
We know that there is a problem when the elder begins to say, "If this is love then I don't want any of it."...and that is followed by: "I'm going to change my will." All of this, by the senior, is an effort to gain some power and control over their lives, all of this to still feel like a person that matters.
They're still in there, the 'person' is still in there and needs to be nurtured though they have a disabling problem.
Seniors who experience the 'Invasion' instead of the 'Help' will feel like dying and hope to die than to suffer degradative feelings under the power of those they gave birth to and worked so hard to protect.
WHILE IT IS TRUE...that a senior can need help but I don't think bathing or a disorderly house should be the criteria but more like a host of clear problems and issues should be used to bring this individual's personal life to an end and put it under the charge of others who will do what they want and then insist that the elder accept it and appreciate it.
The elder I speak of is ambulatory, can count money, can think, is bright, looks good, bathes everyday, wants to exercise but the facility has problems with that and she wants to be in control of her diet because she is gaining weight and has bowel problems from the diet. The facility wants to give meds for that instead of allowing the elder to tell them about increasing the fiber in her diet and what fiber regiment she has always used.
While it might appear that the children are helping their mother by putting her in a facility, things are eroding; the elder says she will change her will and she is feeling, after two years away from her personal life, that taking her life away was not an act of love. (And, she feels that way, in our opinion as seniors, because it was "taken away"; there was no discussion; her opinion did not matter yet she feels she is suffering the opinons of others.) We understand both sides, we really do. Most of the seniors in our group were the children who took care of our parents but at home, in their homes, or in our homes. We understand both sides. We don't agree with the senior all the time and we tell them when we think they're off the mark.
There has to be a better way to help an elder live their life through gracefully with some integrity. Afterall, we all get old.
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10-01-2009 @ 1:27PM
oh geeeeeeeeeze said...
thank you, what a lovely way to make us all aware
that we need to keep kindness and love in our dealing
with senior citizens
You are a blessing
10-01-2009 @ 6:02PM
Sheri said...
I never write comments, but I think Dr's just want one more thing printed about what "they" are doing. And yes for the most part I am thankful they are there.
But how many have a parent with this problem. My dad now 90, has good days and bad bads. People need to educate themselves on issues that affect them. That's all that keeps me going. Other family members not living close think perhaps dad is just fine---dential perhaps.
I only hope people take a short sec and read what you have written, you are correct. Thanks.
10-01-2009 @ 8:22PM
Kathleen Adams said...
Thank you, Margaret. While experiencing the mental losses of my own mother, I learned the importance of independence and how vital it was to the quality of life she experienced. The was so much I was able to assist with that ensured her safety. If done with thoughtful respect, it was accepted with affection, rather than viewed as encroachment and insult. Again, thank you for your gracious wisdom.
10-01-2009 @ 10:14PM
carol said...
I have to agree. I remember when my mom and her sisters took care of their mom(my grandmother) when she was dying. They stayed at her house and took care of her and they all took turns. My mom has dementia, and has bad and good days. What amazes me is that generations have changed. I'm 45 and would be willing to help take care of my mom if need be, but we try to let her keep her independence as much as possible (of course with us watching over her, etc). I think it is important for an elderly person to have their independence. When we try to take things away from them it makes them feel unworthy. My mom had 11 kids and of course we are all adults now. We have some that never go around to even acknowledge how she is, yet, we know when something happens....they will be the first one to arrive to see what they will get. I think everyone has "one of those" in there family. I am just thankful I still have my mom and I cherish that everyday of my life. I give my mom a lot of credit to almost be 80 and do as well as she is doing. I hope she continues on that path and I think she will as long as we let her keep her independence as much as possible.
10-05-2009 @ 9:44AM
odsasan said...
Thank you. Very insightful and compassionate. My mother designated my youngest brother as her power of attorney, with complete control over her modest, by most standards, savings, although she had no dementia. He took such good care of her money that he didn't allow her to have any of her own (she was in a "facility" for her final two years, having broken her hip, and in a sense, given up), with the excuse that the staff might take it. So when she needed little extras like getting her hair done, the other children (5 of us) had to give it to her, which we didn't mind, but she did. She was a proud woman who prided herself in becoming independent through thrift and diligent savings. But she was not allowed access to her own money by her son to do the little things she loved to do--buy presents for weddings, give small cash gifts to new grandchildren or buy holiday gifts for her caretakers. My brother denied her even a little pocket money. There was nothing we could do. She had signed all her money over to him. Turns out she had left the bulk of her estate (which as I said was small) to my brother, who had cleverly taken her to a doctor the day before she changed her will to prove that she was in sound mind when she re-wrote her will. Hence the husbandry of her savings!
10-05-2009 @ 10:47AM
Sal santoro said...
Margaret
It is difficult to disagree with such an accorate appeal to the dignity and rispect we all should treat our aging parents with.. The real problem underlining these events is deeply routed in the demise of the American Family where fathers and mothers risk becoming a "problem" for the kids so focused on either professional success or surviving. These individuals can only offer ...at the best ( and some of them can not) an invenstment of money ( that msot of the time comes from their parents finanzes to start with) to avoid having to make some sacrifices and invenst some of their time with the aging parents. Fundamentally, what it comes down to is simply " You can only harvest what you have planted and cultivated during your entire life" . We have a father who si now 96 years old, and a mother who is now 93 years old. Our father has gone through three successfull by-passes, our mother has battled breast cancer for the past six years, and has many senior moments. We have managed through the love of all four children and the support of the medicare institution to keep them both in our house. they selected which house to stay and the one who did not get the first choice have been very disappointed. We continue to tell them that we are making arrangements for the 100 birthday coming up and we do not want to hear about the cchallenges with all the aliments they have. I tell my father to slow down when I hold his arm and help him walk....after all I do not have the good legs he does.....
There are 16 grand-grand children continuosely visiting and the entire family strongly believes taht we are able to overcome many differences and conflict because of their continuing presence in our lives. If I had to tell you any specific good thing they ever did to deserve this kind of care and love....I could not tell you other than they always preached respect for life and institutions. It is sad to know that there are mothers and fathers relegate to istitutions that could never provide a stimulus for enjoyng the rest fo their lives and continue to enrich us just with their presence. It did not take us (as a family) any hardships that ruined our lives, and we go to estremes to back each other when there is an emergency. The pleasure or burden (whichever you choose) to be there and make them feel safe and loved is shared. Mind you, our family has a lot of "unfinished business" (like many other families) which we have elected to put on a "parking lot" paper. until they die. I suspect that the family is going to have some difficult time staying "as glued, as it is right now" after they die.Consequently we are going to go to estremes to keep them alive ...for a very long time. You see...when the seeds they planted will loose the roots they provide....the entire family tree might fall apart and die. Until that time we remind everyone that there is no greater return for any invenstment to take care of a mother and father when they are fragile and vulnerable.....and you have to be very carefull about waht you are planting right now....your children are wacthing you... You will harvest only what you plant.
The opportunity is in reversing the demise of the american family ..immolated to the altar of success, convenience and greed.
Rispectfully
Sal Santoroi
10-16-2009 @ 9:31PM
Frank said...
You are right on!! We did what you say here with Mom. We tried hard to keep her with family, but when she almost killed my sister's little son by trying to help, the inevitable came. We first tried in-home caregivers but she drove every one of them out. So, a nursing home became the only option left. Mom hated that "home."
When we cleaned out the house we found that most valuables were gone. No evidence of break-in meant that she must have given stuff away. She also had "cleaned out," which included insurance policies and financial records.
The points I want to make are that where finances and property are concerned, remember that it is THEIRS, not yours, so if it disappears, get over it. Don't jump the gun and take over their life too soon, but it is a good idea to help them put their valuables somewhere so they don't get ripped off by theives. We should have.
10-05-2009 @ 12:00PM
T said...
I agree with Margaret. Dr. Marsen is just another talking head bolstering his career. Of course as we age we slow down mentally and we hope someone can help us deal with some new limitations. We don't have to label every 80+ year old as an Alzheimers patient, or demented. Unless we are selling a drug of course. -T
10-05-2009 @ 12:08PM
Concerned for Elderly said...
I completely agree with you. The elderly that are in this position and judged by financial accounting are often put at a disadvantage. Often times, the men of this generation took care of finances and for the first time in their life, many women are having to look at this. It is unfair to judge by the clutter in their home. Have these people not heard of arthritis or other physical pains? Help can come in better ways such as committing to cleaning their mom's home once per week. Baths for dry thin skin are not always necessary daily and often can worsen a skin condition. If they are constantly leaving burners on, gassing the home, beginning to get malnourished, ok, lets talk. My husband's grandmother lived at home alone until age 98. They placed her in a nursing home when she fell and fractured her hip. When they learned that she was on no meds and only ate 2 times per day, they were very upset. Now she had functioned for 98 years, paid her bills on time, maintained the same weight and her blood work was all normal but suddenly she shouldn't be living on her own? She fell while gathering wood for her stove at 98. She died less than a year later. They finally had put her on blood thinners because she was gaining weight too...from their "diet" without much fiber and definitely not the "exercise" she was accustomed to....which was practically none in the nursing home.
People be careful about putting "labels" so quickly on your aging parents because your life is too busy to slow down and help them. Your kids will do the same thing to you some day only worse because you have already demonstrated a need to satisfy yourself first. It isn't easy caring for your aging parents but it is part of life. We seem to have forgotten that and are quick to label with Alzheimers.
10-01-2009 @ 12:40PM
dawn cunningham said...
I am sick and tired of people wanting to take over their parents estates as they age to "protect" it. This is only selfish and greedy. The money belongs to the people who earned it and if kids are soooooo concerned the state will get their hands on Mom and Dads bucks then get off your ass and help your folks out. Don't take away their dignity, freedom or possessions. NOTHING is more important than family which sad to say is becoming a lost art.
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10-05-2009 @ 1:45PM
Norma Warner said...
You are sooo right...As I see my mother aging it seems my siblings call her less and less.. Yes they are further away than I but the little time it takes for a phone call in their busy life asounds me..I am considering that I will have to give up my job to be close and 'help' if it is needed. It is hard to do because my income is needed but my job takes me traveling the US.. The decision is hard but I know I will treasure my time with her..
10-05-2009 @ 12:33PM
P. Cohee said...
Amen, It will be a cold day in Hell when my kids or anybody else takes over my finances
10-01-2009 @ 5:24PM
Hannah said...
I understand the need for compassion of an elderly person, but I deal with one every day who has no impairments at all and he is extremely abusive toward all of his children and their families. He has been verbally abusive his entire adult life. So what do you do with a senior of 80 plus years like that? I am at the end of my rope with the constant demands, temper tantrums, cursing, yelling, and now he has started the occasional pushing and shoving if he doesn't get his way. He does not live with me (thank God) but calls many times during the week demanding someone come and "help" him...in reality, he has alienated all of his friends, and there are times when his kids do not want to have anything to do with him. He doesn't need "help" he just wants someone to abuse. I can't do it anymore!
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10-01-2009 @ 11:03PM
gerry said...
I too have a mother that was that way & finally we put her in a home due to her insisting on driving - ( her car was in the garage & a tire was missing from the rim) the pushing turned into hitting - stories about things that had no ending - she had been a mean spirited person most of her life & your Dad sounds a lot like her. It was difficult for me to distinguish if her behavior was just old age or what, so I can sympathize with your situation, when they start pushing it won't be long before they escalate more violently. In our case we had to take over & got her to admit herself into the hospital to prove us wrong - that was 5 years ago & she is still in assisted living, sometimes that is where people need to be.
10-05-2009 @ 1:42PM
Dee said...
My Grandmother was like that, and she lived with us, died at 98!
My Dad was a saint, but the arguments between her and my Mom, this was my Mom's Mother, were imbedded in my mind forever! This was years ago, but the negatve influence lived on in all 6 of us, now in our 50's. My parents always said if they had a chance to do it all again, they wouldn't let her live with them.
You put up with it because deep down it's a love bond. You need to make a positive choice for him.....assisted living..etc. You are not responsible for his miserableness, and if it's pain, most of us live with it every day, give him aleve!
10-01-2009 @ 5:42PM
arentany said...
Hmmm. My father, a physics professor, once set his notes on fire in the lecture hall -- by reaching to take his pipe out of his mouth, but instead taking his glasses off. He would misplace everything. He died dementia-free last year at the age of 92. So I'm wondering about the predictive value of your syndrome. If he was an anomaly, how do we differentiate who is and who isn't. If you are using the "significant number" argument, I think you know the basic rule: statistical data cannot predict the outcome of any individual case, by its very nature. So just how do you overcome this problem (built into the mathematical model itself that you use)? If you know how to do this, rather than a mundane hack, you have the Nobel.
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10-01-2009 @ 6:05PM
cyberdale said...
With all due respect, I doubt commenter #3 has ever been in this situation. It is not the "state" that we had to worry about. Instead, it was the army of scum who take advantage of the elderly. My 80-year-old dad had always been very responsible financially, having retired to Florida some 20+ years ago. By accident I discovered that he had been notified by scammers about winning a (completely bogus) Spanish Lottery, and was about to send them a photocopy of his driver's license, SS# and bank account #s! One Google search was enough to expose the scam, and I printed out that and other information warning never to respond to "lottery windfalls"--especially since he couldn't recall ever entering one!
He seemed to understand, but what I didn't know was that he had already wired about $20,000 to various scammers in Canada and Jamaica. Other, barely legal, companies would send him official-looking "lottery winnings" and asked him to send in $15 processing fees. He never looked at the fine print that stated that he hadn't won anything, was only signing up for a "newsletter" listing lotteries he could enter in the future--oh, and authorizing these clowns to make regular debits from his checking account!! Literally dozens of these "announcements" would arrive in the mail each day, and Dad would dutifully write out the small checks (about $800 a month's worth!). Meanwhile bills were getting lost in the shuffle, and taxes went unfiled. He opened up a home equity line of credit and withdrew money from his annuity, even though he incurred major penalties and taxes for doing so. Further advice to give up the fake lotteries was seemingly agreed to, then forgotten about.
In short, he had lost control of his finances, and my siblings and I had no choice but to move in. At first he was a little embarrassed, but when we explained how much money he had thrown away, most of it never to be seen again, he admitted that he *shouldn't* have the checkbook (of course, the next day we had to explain it all over again).
This has NOTHING to do with being "selfish or greedy." My dad was putting himself in serious danger of being completely cleaned out. Once these scammers know they have a "live one," the word spreads and soon it's like a piranha feeding frenzy. I don't care if I never see a dime of inheritance--I just want him to keep what he worked so hard to build up.
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10-05-2009 @ 12:35PM
Debby said...
Cyberdale: Reading your story was like reading about my own Dad who is also in his 80s. He was always very responsible financially and had a great retirement. When my Mom died, he made several poor financial moves and then was scammed in the same way as your Dad (lottery winnings, etc.). He was wiring money to people in various countries and by the time his girlfriend finally blew the whistle, he had already given away $50k. Now he's in a financial mess and is living in her house and having to rent his out. I printed off the same information that you did and sent to him. Sadly, he doesn't want to acknowledge that he was scammed and still believes he has something coming to him.
10-01-2009 @ 6:55PM
CTOBEY said...
MY GRANDFATHER IS GOING ON 92 AND CAN STILL DRIVE,KEEP FINANCES AS STRAIGHT AS ANYONE ELSE IN THE FAMILY (REGARDLESS OF AGE) AND WILL PROBABLY LIVE TO BE CLOSE TO THE CENTURY MARK. PROVIDING IF OVERPRESCRIBING PHYSICIANS KEEP THEIR VISITS TO ROUTINE CHECKUPS. AND THE HOSPICE GOONS WITH THEIR MORPHINE TRIAGE PEDDLE THEIR OPIATES ON THE NEXT BLOCK.GOD BLESS OUR SENIORS AND OUR COUNTRY!
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