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Lichtenberg PA, Tocco M, Hall LN. Financial decision-making deficits in scam cases: how frequent are they? J Elder Abuse Negl 2024; 36:84-89. [PMID: 38310559 DOI: 10.1080/08946566.2024.2311411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2024]
Abstract
Due to the rise in scams perpetrated against older adults, Adult Protective Service workers are more frequently involved in investigating these matters. One significant aspect of scam involvement is the assessment of informed financial decision-making. This study examined 175 consecutive scam cases APS workers investigated using a 10-item financial-decision making tool. Two-thirds of the sample displayed deficits in decision-making. The decision-making tool was effective in differentiating those rated as having deficits from those without deficits. Analysis of each scored item found differences between groups on six of the seven items. A review of the item responses illustrates the types of deficits in understanding and appreciation of the scam and its impact on the older person and their family.
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Affiliation(s)
- Peter A Lichtenberg
- Institute of Gerontology and Distinguished Professor of Psychology, Wayne State University, Detroit, Michigan, USA
| | - Maggie Tocco
- Institute of Gerontology and Distinguished Professor of Psychology, Wayne State University, Detroit, Michigan, USA
| | - Latoya N Hall
- Institute of Gerontology and Distinguished Professor of Psychology, Wayne State University, Detroit, Michigan, USA
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Huang W, Carlew A, Vas C, De Abreu I. Scam Susceptibility: Thoughts on How to Initially Approach and Manage Patients in a Geriatric Psychiatry Setting. J Psychiatr Pract 2024; 30:73-77. [PMID: 38227732 DOI: 10.1097/pra.0000000000000762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
Recent studies have demonstrated that older adults are more vulnerable to scams because of social isolation, economic affluence, mental disorders, struggles with technology, and cognitive impairments. In this report, we present the case of a 73-year-old man who fell victim to multiple scams over 8 years, leading to a loss of more than $100,000. We also discuss approaches to managing such patients in the outpatient setting. Susceptibility to scams is considered an increasing threat to the well-being of aging societies. The complexity of the problem and the scarcity of available studies make the management of such cases challenging for clinicians.
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Affiliation(s)
- Weijiao Huang
- HUANG, CARLEW, VAS, and DE ABREU: Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX
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Lichtenberg PA, Mandarino J, Fisher L, Tocco M, Moray J, Shipp M. Implementing a Financial Decision-Making Scale in APS Financial Exploitation Investigations: Use of the PARIHS Conceptual Framework. THE GERONTOLOGIST 2023; 63:501-510. [PMID: 35700036 PMCID: PMC9384297 DOI: 10.1093/geront/gnac085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Adult protective services (APS) agencies investigate cases of financial exploitation, and a critical aspect of such investigations is often the assessment of decision-making abilities. This study examined APS workers' implementation of a 10-item financial decision-making screening tool, the Financial Decision Tracker (FDT), across a 34-month period: pre-COVID-19, throughout COVID-19 restrictions, and for 1 year following the restrictions. RESEARCH DESIGN AND METHODS Using the Promoting Action in Research Implementation in the Health Services implementation science conceptual framework, we examined aspects of context, facilitation, and evidence to determine how well APS workers were trained, certified, and skilled in using the FDT. Using individual and group interviews, we assessed factors often related to successful implementation (context and facilitation) and measured the number of scales used, the types of decisions under investigation, and how the tool's scoring system aligned with the APS workers' final ratings (evidence). RESULTS Overall, implementation was sustained throughout the 34-month period. However, during COVID-19 restrictions, usage dropped to a rate 58% below that prior to and following the restrictions. A total of 839 scales were administered. Individuals with no decision-making deficits were slightly older (78.7 vs 77.1 years; t(837) = 2.54, p = .01) and had completed high school at a significantly higher rate (69% vs 59%, χ 2(1) = 5.20, p = .023) than those who had decision-making deficits. DISCUSSION AND IMPLICATIONS Overall, the implementation trial can be considered a success. The FDT was used so often and effectively that it is now an APS best practices tool, meaning that in audits, the correct use of the FDT will be assessed.
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Affiliation(s)
- Peter A Lichtenberg
- Address correspondence to: Peter A. Lichtenberg, PhD, ABPP, Institute of Gerontology, Wayne State University, 87 E. Ferry Street, Detroit, MI 48202, USA. E-mail:
| | - Joshua Mandarino
- Michigan Department of Health and Human Services, Benton Harbor, Michigan, USA
| | - Lisa Fisher
- Michigan Department of Health and Human Services, Benton Harbor, Michigan, USA
| | - Maggie Tocco
- Institute of Gerontology, Wayne State University, Detroit, Michigan, USA
| | - Juno Moray
- Institute of Gerontology, Wayne State University, Detroit, Michigan, USA
| | - Marie Shipp
- Michigan Department of Health and Human Services, Benton Harbor, Michigan, USA
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Lichtenberg PA, Tarraf W, Rorai VO, Roling M, Moray J, Gross EZ, Boyle PA. The WALLET Study: Examining early memory loss and personal finance. Innov Aging 2022; 6:igac038. [PMID: 35795136 PMCID: PMC9250658 DOI: 10.1093/geroni/igac038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Indexed: 11/27/2022] Open
Abstract
Background and Objectives This feasibility study tests a new approach for assessing personal finance in older persons with early memory loss. The project examines 2 primary outcomes that gauge the financial viability and well-being of older adults: wealth loss and financial exploitation. The overall objective is to determine the association of financial literacy and management, financial decision-making, and cognition with wealth loss and financial exploitation. Research Design and Methods This cross-sectional study recruited 46 participants who were 60 years of age or older. Participants were classified as having mild cognitive impairment, perceived cognitive impairment, or no cognitive impairment. The study coordinator arranged with each participant to obtain copies of their main checking account statements for 12 consecutive months within the previous 2 years and, if appropriate, credit card statements. All statements were de-identified and assigned a random ID number. Participants then completed 2 telephone interviews. Results The average participant age was 72 years (standard deviation [SD] = 7.7); 84% were female, 39% White, and 35% currently married. Average education was 16.2 years (SD = 2.4); mean yearly household income was almost $42,000 (SD = 25,752); and monthly social security payments averaged $1,446 (SD = 1,244). Our results indicate that the methods used to analyze checking account statements, followed by telephone interviews to verify identified trends, were useful in developing a financial behavior index to measure wealth loss. Discussion and Implications We demonstrate an alternative method for assessing personal finance using person-centered principles, which we believe are critical in the presence of diminished or impaired cognition. Our findings offer an innovative method for assessing the risk for wealth loss and financial exploitation.
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Affiliation(s)
| | - Wassim Tarraf
- Institute of Gerontology, Wayne State University, Detroit , Michigan, USA
- Department of Healthcare Sciences, Wayne State University, Detroit , Michigan, USA
| | - Vanessa O Rorai
- Institute of Gerontology, Wayne State University, Detroit , Michigan, USA
| | - Matthew Roling
- School of Business, Wayne State University, Detroit , Michigan, USA
| | - Juno Moray
- Institute of Gerontology, Wayne State University, Detroit , Michigan, USA
| | - Evan Z Gross
- Rehabilitation Institute of Michigan, Detroit , Michigan, USA
| | - Patricia A Boyle
- Rush Alzheimer Disease Center, Rush University Medical Center, Chicago , Illinois, USA
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Greene AJ. Elder Financial Abuse and Electronic Financial Instruments: Present and Future Considerations for Financial Capacity Assessments. Am J Geriatr Psychiatry 2022; 30:90-106. [PMID: 33781661 DOI: 10.1016/j.jagp.2021.02.045] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 02/24/2021] [Accepted: 04/01/2021] [Indexed: 11/25/2022]
Abstract
Personal economic stability is one of the core social determinants of health and longevity, and managing one's finances is an instrumental activity of daily living. Impaired financial decision-making can lead to poor health, emotional distress, and loss of independence and safety. Older adults in the United States lose billions of dollars annually to elder financial abuse (EFA), which may be preceded by a decline of capacity to make financial decisions. A literature review regarding EFA, electronic financial instruments (EFI), medical and financial decision-making capacity evaluations, and biomedical ethics was performed. Currently, there is no gold standard clinical assessment tool for evaluating financial capacity. The instruments in use have yet to formally integrate modern EFI that present novel mechanisms through which EFA can occur. This article summarizes the current state of EFA in the United States, risk factors and strategies for prevention, and offers a clinician administered screening questionnaire for addressing EFI use along with a semi-structured approach to clinical financial capacity assessments.
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Affiliation(s)
- Aaron J Greene
- UCLA/VA Greater Los Angeles Healthcare System, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA.
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Financial abuse of older people by third parties in banking institutions: a qualitative exploration. AGEING & SOCIETY 2021. [DOI: 10.1017/s0144686x21001574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Financial abuse is a significant form of elder maltreatment and is frequently ranked in the top two most common forms of abuse perpetration. Despite this, it is under-identified, under-reported and under-prosecuted. Financial institutions, such as banks, are important environments for identifying and responding to the financial abuse of older people. Traditionally, banks have not always been part of inter-sectorial responses to financial abuse, yet are important stakeholders. The aim of this study is to explore perceptions and experiences of financial abuse in five national banks. Data were collected from 20 bank managers and five members of the National Safeguarding Committee in the Republic of Ireland. Using thematic analysis, four themes were identified: defining a vulnerable adult; cases of financial abuse of vulnerable adults; case responses to financial abuse of vulnerable adults; and contextual issues. The data demonstrate the multiplicity of manifestations and the complexity of case investigation and management. Findings point to the need to enhance banks’ responses, through additional education and training, and promote integrated inter-sectorial collaboration. In addition, a change in societal beliefs is needed regarding financial entitlement, responding to ageism, public awareness of the consequences of financial decisions and types of financial abuse, as well as ensuring such crimes are addressed within the legal system.
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Lichtenberg PA, Tocco M, Campbell R, Shipp M. Which Items of the Financial Decision Tracker Differentiate Those with Decision-making Deficits from Those with No Deficits? Data from the Michigan APS Implementation Project. Clin Gerontol 2021; 44:577-584. [PMID: 33821777 PMCID: PMC8490207 DOI: 10.1080/07317115.2021.1901167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objectives: Lichtenberg et al. reported on the implementation of a 10-item financial decision-making screening scale (Financial Decision Tracker-FDT) in a state-wide Adult Protective Services (APS) project. This study examined which of the seven scored items, reflecting the Appelbaum & Grisso decisional abilities model, were most sensitive to decision-making deficits.Methods: The Financial Decision Tracker was administered to 445 adults aged 60 years of older during APS investigations of financial exploitation. APS workers administered the FDT as part of their financial exploitation investigation. Overall, seven scored FDT items were compared using T tests.Results: Six of the seven risk-scored items were significantly different between those with and without decision-making deficits. Two of the items had small effect sizes, and four items had moderate effect sizes. The larger, moderate effect sizes were related to risk to financial well-being (appreciation), impact on finances (understanding), and who benefits most from the decision (understanding).Conclusions: The main findings of the study supported the Appelbaum and Grisso's decision-making model and the ability of specific items related to understanding and appreciation to differentiate between individuals with and without financial decision-making deficits.Clinical Implications: The FDT is a clinically reliable and validated tool for older adults.
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Affiliation(s)
- Peter A Lichtenberg
- Institute of Gerontology and Merrill Palmer Skillman Institute, Distinguished University Service Professor of Psychology, Institute of Gerontology, Wayne State University, Detroit, Michigan, USA
| | - Maggie Tocco
- Institute of Gerontology, Wayne State University, Detroit, Michigan, USA
| | - Rebecca Campbell
- Institute of Gerontology and Department of Psychology, Wayne State University, Detroit, Michigan, USA
| | - Marie Shipp
- Department of Health and Human Services, State of Michigan, Lansing, Michigan, USA
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Loenneker HD, Becker S, Nussbaum S, Nuerk HC, Liepelt-Scarfone I. Arithmetic Errors in Financial Contexts in Parkinson's Disease. Front Psychol 2021; 12:629984. [PMID: 33935881 PMCID: PMC8079777 DOI: 10.3389/fpsyg.2021.629984] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 03/12/2021] [Indexed: 11/29/2022] Open
Abstract
Research on dyscalculia in neurodegenerative diseases is still scarce, despite high impact on patients' independence and activities of daily living function. Most studies address Alzheimer's Disease; however, patients with Parkinson's Disease (PD) also have a higher risk for cognitive impairment while the relation to arithmetic deficits in financial contexts has rarely been studied. Therefore, the current exploratory study investigates deficits in two simple arithmetic tasks in financial contexts administered within the Clinical Dementia Rating in a sample of 100 PD patients. Patients were classified as cognitively normal (PD-NC) or mildly impaired (PD-MCI) according to Level I consensus criteria, and assessed using a comprehensive neuropsychological test battery, neurological motor examination, and sociodemographic and clinical questionnaires. In total, 18% showed arithmetic deficits: they were predominately female, had longer disease duration, more impaired global cognition, but minor signs of depression compared to PD patients without arithmetic deficits. When correcting for clinical and sociodemographic confounders, greater impairments in attention and visuo-spatial/constructional domains predicted occurrence of arithmetic deficits. The type of deficit did not seem to be arbitrary but seemed to involve impaired place × value processing frequently. Our results argue for the importance of further systematic investigations of arithmetic deficits in PD with sensitive tests to confirm the results of our exploratory study that a specific subgroup of PD patients present themselves with dyscalculia.
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Affiliation(s)
- Hannah D. Loenneker
- Department of Psychology, Diagnostics and Cognitive Neuropsychology, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - Sara Becker
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, Tübingen, Germany
| | - Susanne Nussbaum
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, Tübingen, Germany
| | - Hans-Christoph Nuerk
- Department of Psychology, Diagnostics and Cognitive Neuropsychology, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - Inga Liepelt-Scarfone
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, Tübingen, Germany
- German Centre for Neurodegenerative Diseases (DZNE), Tübingen, Germany
- IB Hochschule für Gesundheit und Soziales, Stuttgart, Germany
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Lichtenberg PA, Tocco M, Campbell R, Shipp M. Implementation of financial decision making scales into statewide APS practice: the Michigan experience. J Elder Abuse Negl 2021; 33:33-46. [PMID: 33357079 PMCID: PMC7941736 DOI: 10.1080/08946566.2020.1864697] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
One of the long recognized challenges in Adult Protective Services and other human service works is the implementation of empirically validated tools into regular practice. One area where this is evident is the assessment of financial decision-making abilities in cases investigated for financial exploitation. Using the Promoting Action in Research Implementation in the Health Services (PARIHS) we examined the core aspects of evidence, facilitation and context. Further, the empirical findings of the scale usage were investigated. Over 400 APS workers were trained and certified using an online narrated training system. Over 500 scales were administered across a 12 month period, with 50% demonstrating financial decision-making deficits, and in 88% of the time the APS workers concurred with the risk rating system of the web-based system (https://olderadultnestegg.com).
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Affiliation(s)
- Peter A. Lichtenberg
- Director, Institute of Gerontology and Merrill Palmer Skillman Institute, Distinguished University Service Professor of Psychology, Institute of Gerontology, 87 E. Ferry Street, Wayne State University, Detroit, MI 48202
| | - Maggie Tocco
- Research Staff, Institute of Gerontology, 87 E. Ferry Street, Wayne State University, Detroit, MI 48202
| | - Rebecca Campbell
- Graduate Research Assistant, Institute of Gerontology and Department of Psychology, Wayne State University, 87 E. Ferry Street, Detroit, MI 48202
| | - Marie Shipp
- Adult Services Program Administrator, State of Michigan, Department of Health and Human Services
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Lichtenberg PA, Gross E, Ficker LJ. Quantifying Risk of Financial Incapacity and Financial Exploitation in Community-dwelling Older Adults: Utility of a Scoring System for the Lichtenberg Financial Decision-making Rating Scale. Clin Gerontol 2020; 43:266-280. [PMID: 29883276 PMCID: PMC6286690 DOI: 10.1080/07317115.2018.1485812] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Objectives: This work examines the clinical utility of the scoring system for the Lichtenberg Financial Decision-making Rating Scale (LFDRS) and its usefulness for decision making capacity and financial exploitation. Objective 1 was to examine the clinical utility of a person centered, empirically supported, financial decision making scale. Objective 2 was to determine whether the risk-scoring system created for this rating scale is sufficiently accurate for the use of cutoff scores in cases of decisional capacity and cases of suspected financial exploitation. Objective 3 was to examine whether cognitive decline and decisional impairment predicted suspected financial exploitation.Methods: Two hundred independently living, non-demented community-dwelling older adults comprised the sample. Participants completed the rating scale and other cognitive measures.Results: Receiver operating characteristic curves were in the good to excellent range for decisional capacity scoring, and in the fair to good range for financial exploitation.Conclusions: Analyses supported the conceptual link between decision making deficits and risk for exploitation, and supported the use of the risk-scoring system in a community-based population.Clinical Implications: This study adds to the empirical evidence supporting the use of the rating scale as a clinical tool assessing risk for financial decisional impairment and/or financial exploitation.
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Affiliation(s)
- Peter A Lichtenberg
- Institute of Gerontology & Merrill Palmer Skillman Institute, Professor of Psychology, Wayne State University, Detroit, MI, United States
| | - Evan Gross
- Institute of Gerontology & Department of Psychology, Institute of Gerontology, Detroit, MI, United States
| | - Lisa J Ficker
- Institute of Gerontology, Wayne State University, Detroit, MI, United States
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11
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Abstract
Objectives: This article examines the convergent validity and clinical utility of the 34-item short form of the Lichtenberg Financial Decision Rating Scale (LFDRS-SF). A briefer scale can lead to enhanced and efficient use of a person-centered approach to the assessment of financial decision-making.Methods: Using data on 200 community-dwelling older adults from Lichtenberg and colleagues (2017a), convergent validity was examined with cognitive and financial management measures using a correlational and regression approach. Receiver operating curve analyses for predicting decision-making ability classification and suspected financial exploitation classification were used to evaluate clinical utility.Results: The LFDRS-SF total risk score was significantly correlated with both cognitive and financial management measures, and the regression analysis predicted 9% of the LFDRS-SF measure. These results demonstrate not only convergent validity, but also the conceptual and empirical uniqueness of financial decision-making.Conclusions: The LFDRS-SF is a valid tool to assess real-world financial decision-making abilities.Clinical Implications: The LFDRS-SF offers an efficient way to assess financial decision-making. Training on the tool and automatic scoring and recommendations for next steps can be found at https://olderadultnestegg.com.
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Affiliation(s)
| | - Evan Gross
- Department of Psychology and Institute of Gerontology, Wayne State University, Detroit, MI, USA
| | - Rebecca Campbell
- Department of Psychology and Institute of Gerontology, Wayne State University, Detroit, MI, USA
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Ghesquiere AR, McAfee C, Burnett J. Measures of Financial Capacity: A Review. THE GERONTOLOGIST 2019; 59:e109-e129. [PMID: 28535272 DOI: 10.1093/geront/gnx045] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Indexed: 11/13/2022] Open
Abstract
PURPOSE OF THE STUDY Capacity to manage finances and make financial decisions can affect risk for financial exploitation and is often the basis for legal determinations of conservatorship/guardianship. Several structured assessments of financial capacity have been developed, but have not been compared regarding their focus, validity, or reliability. Therefore, we conducted a review of financial capacity measures to examine these factors. DESIGN AND METHODS We searched electronic databases, reference lists in identified articles, conference proceedings and other grey literature for measures of financial capacity. We then extracted data on the length and domains of each measure, the population for which they were intended, and their validity and reliability. RESULTS We identified 10 structured measures of financial capacity. Most measures could be completed in 25-30 min, and were designed to be administered to older adults with some level of cognitive impairment. Reliability and validity were high for most. IMPLICATIONS Measurement of financial capacity is complex and multidimensional. When selecting a measure of financial capacity, consideration should be made of the population of focus and the domains of capacity to be assessed. More work is needed on the cultural sensitivity of financial capacity measures, their acceptability, and their use in clinical work. Better understanding of when, and to whom, to administer different financial capacity measures could enhance the ability to accurately detect those suffering from impaired financial capacity, and prevent related negative outcomes like financial exploitation.
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Affiliation(s)
- Angela R Ghesquiere
- Brookdale Center for Healthy Aging, Hunter College of the City University of New York
| | - Caitlin McAfee
- Brookdale Center for Healthy Aging, Hunter College of the City University of New York
| | - Jason Burnett
- Texas Elder Abuse & Mistreatment Institute (TEAM) McGovern Medical School, Department of Internal Medicine, Division of Geriatric and Palliative Medicine, The University of Texas Health Science Center at Houston
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Purser K, Sullivan K. Capacity assessment and estate planning - the therapeutic importance of the individual. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2019; 64:88-98. [PMID: 31122645 DOI: 10.1016/j.ijlp.2019.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 01/30/2019] [Accepted: 02/20/2019] [Indexed: 06/09/2023]
Abstract
Demand for legal capacity assessments is increasing, especially assessments of financial capacity for estate planning purposes such as wills and enduring powers of attorney. This article proposes that such assessments will be improved by taking greater account of the client experience, including individual and relational factors and processes, and considering the practice framework. A literature review was undertaken with a two-fold aim: firstly, to understand the fundamentally important perspective (inclusive of these experiences) of the evaluee; and, secondly, to identify potential improvements in the capacity assessment process with a view to informing best practice. No studies were identified that directly addressed the individual perspective in capacity assessments. Case studies and commentaries that indirectly discuss the individual perspective were therefore analysed to identify any potential issues and recommendations. This analysis showed that individual factors, such as the evaluee's functional and disease status, and relational factors, such as trust, should be considered by examiners. This review demonstrates that there is a significant gap in the literature examining the individual's perspective and experiences in capacity assessments, as well as, any impact this may have on the assessment process and outcomes. Further research into this vital perspective is needed so that the experiences of those undergoing assessments can help inform best practice and ensure that optimal processes are adopted when assessing the capacity necessary to make legally recognised decisions. This article examines the importance of the participant perspective and experiences in capacity assessments through the novel lens of therapeutic jurisprudence. It includes practice suggestions and provides the direction for this future research.
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Affiliation(s)
- Kelly Purser
- Australian Centre for Health Law Research, Faculty of Law, Queensland University of Technology, Brisbane, Australia.
| | - Karen Sullivan
- Institute of Health and Biomedical Innovation, School of Psychology and Counselling, Faculty of Health, Queensland University of Technology, Brisbane, Australia
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Objective and subjective financial status and mortality among older adults in China. Arch Gerontol Geriatr 2018; 81:182-191. [PMID: 30597341 DOI: 10.1016/j.archger.2018.12.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 11/04/2018] [Accepted: 12/21/2018] [Indexed: 11/22/2022]
Abstract
The association between financial status and mortality in older adults is well documented. However, it is unclear whether the association may vary by objective and subjective indicators of financial status. To examine this issue, we used the latest four waves (2005, 2008/2009, 2011/2012, and 2014) of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) of community-residing adults aged 65 and older (n = 25,954). Financial status was assessed using eight objective, subjective, and culturally-oriented measures to capture various dimensions of financial resources at older ages. Multivariate hazard models were used to examine how different indicators of financial status were associated with subsequent mortality in all older adults and by age, gender, and urban-rural residence. Results showed that higher financial status-either objective or subjective-was associated with lower risks of mortality. Subjective assessments of financial status had stronger associations with mortality than objective assessments. The patterns were generally similar between young-old (aged 65-79) and the oldest-old (aged 80+), between women and men, and between rural and urban areas. Together, the findings offer new evidence to help improve the socioeconomic gradient in mortality among older adults in China.
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Campbell RJ, Gross E, Lichtenberg PA. Cross-validation of the screening scale in an adult protective services sample. J Elder Abuse Negl 2018; 31:25-37. [PMID: 30406729 DOI: 10.1080/08946566.2018.1531098] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Adult Protective Services (APS) professionals are often called on to assess decision-making capacity when investigating financial exploitation. Previous research found that in consecutive APS cases, a decision-making screening scale (LFDSS) also detected financial exploitation. The purpose of this study was to apply the clinical cutoff scores derived from the previous study to a new sample of APS cases. Using a sample of 105 participants, from APS workers across 5 counties this study investigated the clinical utility of the LFDSS to detect financial exploitation based on ratings by APS professionals using the scale. Results demonstrate that the LFDSS has excellent internal consistency and clinical utility properties. This paper provides support for use of the LFDSS as a reliable and valid instrument. Instructions for use of the LFDSS are included in the article, along with information about online support tools.
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Affiliation(s)
- Rebecca J Campbell
- a Institute of Gerontology and Department of Psychology , Wayne State University , Detroit , MI , USA
| | - Evan Gross
- a Institute of Gerontology and Department of Psychology , Wayne State University , Detroit , MI , USA
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Xiang Y, Hao L, Qiu L, Zhao Y, Gu D. Greater financial resources are associated with lower self-perceived uselessness among older adults in China: The urban and rural difference. Arch Gerontol Geriatr 2018; 75:171-180. [DOI: 10.1016/j.archger.2018.01.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 12/28/2017] [Accepted: 01/02/2018] [Indexed: 12/13/2022]
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Lichtenberg PA, Ocepek-Welikson K, Ficker LJ, Gross E, Rahman-Filipiak A, Teresi JA. Conceptual and Empirical Approaches to Financial Decision-making by Older Adults: Results from a Financial Decision-making Rating Scale. Clin Gerontol 2018; 41:42-65. [PMID: 29077531 PMCID: PMC5766370 DOI: 10.1080/07317115.2017.1367748] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES The objectives of this study were threefold: (1) to empirically test the conceptual model proposed by the Lichtenberg Financial Decision-making Rating Scale (LFDRS); (2) to examine the psychometric properties of the LFDRS contextual factors in financial decision-making by investigating both the reliability and convergent validity of the subscales and total scale, and (3) extending previous work on the scale through the collection of normative data on financial decision-making. METHODS A convenience sample of 200 independent function and community dwelling older adults underwent cognitive and financial management testing and were interviewed using the LFDRS. Confirmatory factor analysis, internal consistency measures, and hierarchical regression were used in a sample of 200 community-dwelling older adults, all of whom were making or had recently made a significant financial decision. RESULTS Results confirmed the scale's reliability and supported the conceptual model. Convergent validity analyses indicate that as hypothesized, cognition is a significant predictor of risk scores. Financial management scores, however, were not predictive of decision-making risk scores. CONCLUSIONS The psychometric properties of the LFDRS support the scale's use as it was proposed. CLINICAL IMPLICATIONS The LFDRS instructions and scale are provided for clinicians to use in financial capacity assessments.
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Affiliation(s)
- Peter A Lichtenberg
- a Institute of Gerontology, Wayne State University , Detroit , Michigan , USA.,b Merrill Palmer Skillman Institute, Wayne State University , Detroit , Michigan , USA
| | - Katja Ocepek-Welikson
- c Research Division , Hebrew Home at Riverdale; RiverSpring Health, New York , New York , USA
| | - Lisa J Ficker
- a Institute of Gerontology, Wayne State University , Detroit , Michigan , USA
| | - Evan Gross
- a Institute of Gerontology, Wayne State University , Detroit , Michigan , USA.,d Department of Psychology , Wayne State University , Detroit , Michigan , USA
| | - Analise Rahman-Filipiak
- e Neuropsychology Section , University of Michigan Health System , Ann Arbor , Michigan , USA
| | - Jeanne A Teresi
- c Research Division , Hebrew Home at Riverdale; RiverSpring Health, New York , New York , USA.,f Columbia University Stroud Center at New York State Psychiatric Institute, New York , New York , USA.,g Department of Geriatrics and Palliative Medicine , Weill Cornell Medical Center, New York , New York , USA
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Lichtenberg PA, Peck DA. Aging and Informed Financial Decision Making: New Tools for the Professional Working With Older Adults. CSA JOURNAL (DENVER, COLO.) 2018; 71:37-41. [PMID: 30467457 PMCID: PMC6245583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Peter A Lichtenberg
- The Institute of Gerontology and the Merrill Palmer Skillman Institute and Professor of Psychology at Wayne State University in Detroit
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20
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Teresi JA, Ocepek-Welikson K, Lichtenberg PA. Item response theory analysis of the Lichtenberg Financial Decision Screening Scale. J Elder Abuse Negl 2017; 29:213-228. [PMID: 28590882 DOI: 10.1080/08946566.2017.1338170] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The focus of these analyses was to examine the psychometric properties of the Lichtenberg Financial Decision Screening Scale (LFDSS). The purpose of the screen was to evaluate the decisional abilities and vulnerability to exploitation of older adults. Adults aged 60 and over were interviewed by social, legal, financial, or health services professionals who underwent in-person training on the administration and scoring of the scale. Professionals provided a rating of the decision-making abilities of the older adult. The analytic sample included 213 individuals with an average age of 76.9 (SD = 10.1). The majority (57%) were female. Data were analyzed using item response theory (IRT) methodology. The results supported the unidimensionality of the item set. Several IRT models were tested. Ten ordinal and binary items evidenced a slightly higher reliability estimate (0.85) than other versions and better coverage in terms of the range of reliable measurement across the continuum of financial incapacity.
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Affiliation(s)
- Jeanne A Teresi
- a Institute of Gerontology and Merrill Palmer Skillman Institute, Wayne State University , Detroit , Michigan , USA.,b Research Division , Hebrew Home at Riverdale, River Spring Health , Riverdale , New York , USA.,c Division of Geriatrics and Palliative Medicine , Weill Cornell Medical College, Cornell University , New York , New York , USA
| | - Katja Ocepek-Welikson
- a Institute of Gerontology and Merrill Palmer Skillman Institute, Wayne State University , Detroit , Michigan , USA
| | - Peter A Lichtenberg
- a Institute of Gerontology and Merrill Palmer Skillman Institute, Wayne State University , Detroit , Michigan , USA
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Lichtenberg PA, Teresi JA, Ocepek-Welikson K, Eimicke JP. Reliability and Validity of the Lichtenberg Financial Decision Screening Scale. Innov Aging 2017; 1. [PMID: 29034335 PMCID: PMC5637552 DOI: 10.1093/geroni/igx003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
The scarcity of empirically validated assessment instruments continues to impede the work of professionals in a number of fields, including medicine, finance, and estate planning; adult protective services; and criminal justice—and, more importantly, it impedes their ability to effectively assist and, in some case, protect their clients. Other professionals (e.g., legal, financial, medical, mental health services) are in a position to prevent financial exploitation and would benefit from access to new instruments. The Lichtenberg Financial Decision Screening Scale (LFDSS) was introduced in 2016, along with evidence for its convergent validity (Lichtenberg, P. A., Fickern, L., Rahman-Filipiak, A., Tatro, R., Farrell, C., Speir, J. J., … Jackman, J. D. (2016b). The Lichtenberg Financial Decision Screening Scale: A new tool for assessing financial decision making and preventing financial exploitation (2016). Journal of Elder Abuse and Neglect, 28, 134–151. doi:10.1080/08946566.2016.1168333). Using a sample of 213 participants, this study investigated the internal consistency of the LFDSS and its criterion validity based on ratings by professionals using the scale. Results demonstrate that the LFDSS has excellent internal consistency and clinical utility properties. This paper provides support for use of the LFDSS as a reliable and valid instrument. The LFDSS and instructions for its use are included in the article, along with information about online tools and support.
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Affiliation(s)
- Peter A Lichtenberg
- Institute of Gerontology, Wayne State University, 87 E. Ferry Street, Detroit, MI 48202, , 313-664-2633
| | - Jeanne A Teresi
- Columbia University Stroud Center at New York State Psychiatric Institute.,Research Division, Hebrew Home at Riverdale; RiverSpring Health.,Weill Cornell Medical Center, Department of Geriatrics and Palliative Medicine
| | | | - Joseph P Eimicke
- Research Division, Hebrew Home at Riverdale; RiverSpring Health.,Weill Cornell Medical Center, Department of Geriatrics and Palliative Medicine
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