A new report says doctors and consumers both tend to overlook one of the most common and devastating problems of aging — the decline in patients' ability to manage their own financial affairs.
The first step to fixing this problem is giving it a name, according to Dr. Mark Lachs of Weill Cornell Medical College in New York and Duke Han of Rush University Medical Center in Chicago, coauthors of the report, who want to describe the condition as "age-associated financial vulnerability."
"It is my hope that by coining this term — age-associated financial vulnerability — it will begin to get physicians to think about this in all older people with and without cognitive problems in the same way they have begun to ask about advanced directives and driving safety as people age," Lachs said by email.
Writing in Annals of Internal Medicine, Lachs and Han define age-associated financial vulnerability as a pattern of risky behavior related to money that places an older adult at substantial risk for a considerable loss of resources that might result in dramatic changes in their quality of life and is inconsistent with choices the person made when they were younger.
Doctors need to understand how the aging brain, with or without neurological disease, influences financial decision-making, because elderly patients may not have earned income or a long enough investment horizon to recover from losses, Lachs said.
Financial exploitation is also the most common form of elder abuse, accounting for about half of cases, and this in turn can lead to bad health outcomes including depression, nursing home placement and increased mortality, he added.
Factors that can contribute to financial vulnerability among the elderly include cognitive or emotional decline; impairments in vision, hearing or mobility; serious progressive illness; and social isolation. Certain diseases and medications can also hasten cognitive decline and make it harder for older adults to manage their money.
While more research may be needed before doctors embrace age-associated financial vulnerability as a medical term or as the basis for a new clinical diagnosis, it remains important for doctors to understand the connection between money mistakes and cognitive decline, said Dr. Eric Widera, a geriatrics specialist at the University of California, San Francisco.
When a person starts to make even minor financial missteps as they age, this may be an indication of dementia, Widera, who wasn't involved in the article, said by email.
"Financial impairment is often one of the earliest clinical signs of emerging dementia, that often goes undiagnosed," Widera said. "It becomes exceedingly important that when these diagnoses are made, and when individuals still have the ability to make decisions, to think about things like advanced financial planning - assigning someone such as a family member to make designated financial decisions on their behalf."
People can also take steps in middle age to improve their financial literacy and keep an eye out for early indications that they need help managing their money, noted Dr. Leslie Kernisan, a geriatrician who blogs for families about money and other age-related problems at GeriatricsForCaregivers.net.
Indications that older adults may be vulnerable financially include taking longer to complete everyday financial tasks, reduced attention to details in financial documents, decline in everyday math skills, decreased understanding of financial concepts, and difficulty identifying risks in financial opportunities, Kernisan, who wasn't involved in the article, said by email.
"In an ideal world, it would make sense to assess for financial vulnerability as part of a regular comprehensive assessment for common age-related problems - falls, mobility issues, difficulty managing activities of daily living, isolation, cognitive changes - that often affect the health and life of seniors," Kernisan said.