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Glover CM, Yu L, Lichtenberg PA, Han SD, Lamar M, Stewart CC, Bennett DA, Barnes LL, Boyle PA. Factors Associated With Healthcare and Financial Decision Making Among Older Black Adults Without Dementia. Clin Gerontol 2024:1-17. [PMID: 38992940 DOI: 10.1080/07317115.2024.2375326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/13/2024]
Abstract
OBJECTIVES The study aims to identify factors associated with health care and financial decision-making among older Black adults without dementia. METHODS Participants (N = 326) underwent assessments of decision-making and completed measurements of factors from four categories: cognitive, contextual, psychosocial, and personality. We performed separate linear regression models to examine the association between each factor and decision-making and created a fully adjusted model. RESULTS Higher global cognition (estimate = 1.92, SE = 0.21, p < .0001) was associated with better decision-making. Contextual factors including higher current annual income (estimate = 0.23, SE = 0.05, p < .0001), higher childhood socioeconomic status (estimate = 0.48, SE = 0.18, p = .006), higher health and financial literacy (estimate = 0.08, SE = 0.01, p < .0001), and lower financial stress (estimate = -0.19, SE = 0.07, p = .01) were associated with better decision-making. More psychological well-being (estimate = 0.07, SE = 0.22, p = .001), a psychosocial factor, and less neuroticism (estimate = -0.06, SE = 0.02, p = .002), a personality factor, were associated with better decision-making. In the fully adjusted model, two factors, higher global cognition and higher literacy (health and financial), remained associated with better decision-making. CONCLUSIONS Cognitive and contextual factors serve as drivers of decision-making among older Black adults. CLINICAL IMPLICATIONS Clinicians may implement strategies to bolster cognition and improve health and financial literacy to facilitate optimal decision-making among older Black adults.
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Affiliation(s)
- Crystal M Glover
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA
- Department of Psychiatry and Behavioral Sciences, Rush Medical College, Chicago, Illinois, USA
- Department of Neurological Sciences, Rush Medical College, Chicago, Illinois, USA
| | - Lei Yu
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA
- Department of Neurological Sciences, Rush Medical College, Chicago, Illinois, USA
| | - Peter A Lichtenberg
- Institute of Gerontology, Wayne State University, Detroit, Michigan, USA
- Department of Psychology, Wayne State University, Detroit, Michigan, USA
| | - S Duke Han
- Department of Psychology, University of Southern California, Los Angeles, California, USA
- Department of Family Medicine, University of Southern California, Los Angeles, California, USA
- Department of Neurology, University of Southern California, Los Angeles, California, USA
- School of Gerontology, University of Southern California, Los Angeles, California, USA
| | - Melissa Lamar
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA
- Department of Psychiatry and Behavioral Sciences, Rush Medical College, Chicago, Illinois, USA
| | - Christopher C Stewart
- Department of Neurology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - David A Bennett
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA
- Department of Neurological Sciences, Rush Medical College, Chicago, Illinois, USA
| | - Lisa L Barnes
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA
- Department of Psychiatry and Behavioral Sciences, Rush Medical College, Chicago, Illinois, USA
- Department of Neurological Sciences, Rush Medical College, Chicago, Illinois, USA
| | - Patricia A Boyle
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA
- Department of Psychiatry and Behavioral Sciences, Rush Medical College, Chicago, Illinois, USA
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Lichtenberg PA, Rorai V, Flores EV, Tarraf W. The WALLET Study: Financial Decision Making and Key Financial Behaviors Associated with Excess Spending. Clin Gerontol 2024:1-12. [PMID: 38695303 DOI: 10.1080/07317115.2024.2348049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 04/22/2024] [Indexed: 05/24/2024]
Abstract
OBJECTIVES The Wealth Accumulation and Losses in Later life Early Cognitive Transitions (WALLET) study data was used to examine correlates with excess spending in older adults who do and do not have early memory loss. METHODS The WALLET study collected detailed financial information from participants' primary checking account statements (n = 150). Information on participant sociodemographic, health, and disability status, memory functioning, financial decision-making, and financial literacy was also collected. Participants either had no memory problems or early memory loss. Bivariate and multiple regression analyses were conducted. RESULTS The early memory loss group had significantly higher excess spending than those with no memory loss. Financial decision-making and higher-risk financial behaviors were also linked to higher excess spending. Early memory loss was no longer statistically significant after accounting for financial stressors and resources. CONCLUSIONS The multidimensional nature of financial capacity assessment has long been known. The WALLET study data is unique, however, in that it demonstrates the links between excess spending with decision-making, early memory loss, and a set of specific financial behaviors. CLINICAL IMPLICATIONS Real-world assessments of financial management and financial decision-making yield important information about how older adults are managing money and making key financial decisions. Checking account reviews can be used to determine excess spending.
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Affiliation(s)
- Peter A Lichtenberg
- Distinguished Department of Psychology, Institute of Gerontology, Wayne State University, Detroit, Michigan, USA
| | - Vanessa Rorai
- Institute of Gerontology, Wayne State University, Detroit, Michigan, USA
| | - Emily V Flores
- Research Assistant, Department of Psychology and Institute of Gerontology, Wayne State University, Detroit, Michigan, USA
| | - Wassim Tarraf
- Institute of Gerontology & Department of Healthcare Sciences, Wayne State University, Detroit, Michigan, USA
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Lichtenberg PA, Rorai V, Flores EV. A person-centered approach to financial capacity: early memory loss, financial management and decision-making. Aging Ment Health 2024:1-7. [PMID: 38595051 DOI: 10.1080/13607863.2024.2338199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 03/22/2024] [Indexed: 04/11/2024]
Abstract
OBJECTIVES Previous research has noted that a person-centered approach to financial capacity assessment is feasible. This study of personal finance included a review of 12 months of checking account statements followed by research interviews to investigate income, spending, financial literacy, and financial decision-making. The objective of the study was to determine the convergent validity of excess spending to contextual aspects of financial decision-making, financial literacy, and early memory loss. METHOD Participants were 114 adults over the age of 60 who came primarily from two research registries; the Healthier Black Elders registry and the Michigan Alzheimer's Disease Research Center registry. After sharing their checking statements participants completed two telephone interviews. Bivariate and multivariate analyses were used to compare those with no memory loss to the memory loss group, and to determine which measures were significantly related to excess spending. RESULTS There was a significant difference in excess spending between those with early memory loss and those with no memory loss. There was a significant difference in financial decision-making risk scores between the groups, as well as on a memory measure and a financial literacy measure. In a hierarchical regression analysis financial decision-making was the only measure significantly related to excess spending. CONCLUSION This study documented the convergent validity of person-centered measures of personal spending and financial decision-making with early memory loss. Early memory loss was related to both excess spending and contextual aspects of financial decision-making.
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Affiliation(s)
- Peter A Lichtenberg
- Institute of Gerontology and Distinguished Professor of Psychology, Wayne State University, Detroit, MI, USA
| | - Vanessa Rorai
- Institute of Gerontology, WALLET Study Coordinator, Detroit, MI, USA
| | - Emily V Flores
- Institute of Gerontology and Department of Psychology, Research Assistant, Detroit, MI, USA
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Lichtenberg PA. Illustrating a Person-Centered Approach to Financial Capacity Evaluations Through a Case Study. Clin Gerontol 2023; 46:639-643. [PMID: 36721979 PMCID: PMC10271959 DOI: 10.1080/07317115.2023.2174059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Although the National Institute of Medicine Social Security committee recommended that a person's financial capacity should be defined and assessed as real-world performance, there has been scant progress on creating methods to translate this idea into reliable methods. The current clinical comment focuses on analyzing actual financial management and decision-making in an evaluation to determine whether the older person needed a conservator. METHODS A case study is used to illustrate how to take a feasible approach to analyzing financial management and decisions and applying those to financial capacity assessment. RESULTS By employing a person-centered analysis of checking and credit card statements and using a semi-structured interview, the clinician was able to assess the financial management and decision-making skills of an older adult. CONCLUSIONS Clinical gerontologists have an ethical prerogative to enhance autonomy where possible. Analyzing a person's actual financial management records as opposed to hypothetical and perhaps unfamiliar financial tasks may represent a step forward in person-centered assessment of financial management and capacity. CLINICAL IMPLICATIONS Clinical gerontologists are often asked to provide financial capacity assessments. Using a person-centered approach to assessing financial management and financial decision-making offers a new and reliable method of assessing financial capacity.
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Affiliation(s)
- Peter A Lichtenberg
- Director, Institute of Gerontology and Distinguished Professor of Psychology, Wayne State University, Detroit, Michigan, USA
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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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Koerts J, Bangma DF, Mette C, Tucha L, Tucha O. Strengths and Weaknesses of Everyday Financial Knowledge and Judgment Skills of Adults with ADHD. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4656. [PMID: 36901665 PMCID: PMC10001631 DOI: 10.3390/ijerph20054656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 03/03/2023] [Accepted: 03/05/2023] [Indexed: 06/18/2023]
Abstract
Adequate financial capability is crucial in everyday life. This capability might, however, not be given to adults with ADHD. The present study aims to determine strengths and weaknesses regarding everyday financial knowledge and judgment skills in adults with ADHD. In addition, the impact of income is explored. Forty-five adults with ADHD (Mage = 36.6, SDage = 10.2) and 47 adults without ADHD (Mage = 38.5, SDage = 13.0) were included and were assessed with the Financial Competence Assessment Inventory. Adults with ADHD showed decreased scores regarding awareness of the arrival of bills, knowledge of own income, having a reserve fund for unexpected expenses, the ability to state long-term financial goals, own preferences for estate management, understanding of assets, legal action for debt, access to financial advice/counseling, and the ability to compare medical insurance plans as compared with adults without ADHD (all p < 0.001). However, no effect of income was found. In conclusion, adults with ADHD have difficulties with many aspects of everyday financial knowledge and skills, which might result in a plethora of personal and legal consequences. It is, therefore, of the utmost importance that professionals who support adults with ADHD proactively ask about everyday financial functioning so that assessment, financial support, and coaching can be provided.
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Affiliation(s)
- Janneke Koerts
- Department of Clinical and Developmental Neuropsychology, University of Groningen, 9712 TS Groningen, The Netherlands
| | - Dorien F. Bangma
- Department of Clinical and Developmental Neuropsychology, University of Groningen, 9712 TS Groningen, The Netherlands
- Novicare, 3542 AB Utrecht, The Netherlands
| | - Christian Mette
- Department of Social Work and Education, Protestant University of Applied Sciences Bochum, 44803 Bochum, Germany
- LVR Hospital Essen, 45147 Essen, Germany
- Faculty of Medicine, Department of Psychiatry and Psychotherapy, University of Duisburg-Essen, 45147 Essen, Germany
| | - Lara Tucha
- Department of Psychiatry and Psychotherapy, University Medical Center Rostock, 18147 Rostock, Germany
| | - Oliver Tucha
- Department of Clinical and Developmental Neuropsychology, University of Groningen, 9712 TS Groningen, The Netherlands
- Department of Psychiatry and Psychotherapy, University Medical Center Rostock, 18147 Rostock, Germany
- Department of Psychology, Maynooth University, National University of Ireland, W23 F2K8 Maynooth, Ireland
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Guo L, Cheng J, Zhang Z. Mapping the knowledge domain of financial decision making: A scientometric and bibliometric study. Front Psychol 2022; 13:1006412. [PMID: 36337546 PMCID: PMC9627155 DOI: 10.3389/fpsyg.2022.1006412] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 09/26/2022] [Indexed: 08/18/2023] Open
Abstract
Based on a 12-year bibliographic record collected from the Web of Science (Thomson Reuters) database, the present study aims to provide a macroscopic overview of the knowledge domain in financial decision making (FDM). A scientometric and bibliometric analysis was conducted on the literature published in the field from 2010 to 2021, using the CiteSpace software. The analysis focuses on the co-occurring categories, the geographic distributions, the vital references, the distribution of topics, as well as the research fronts and emerging trends of financial related decision making. The steady increase of papers published year by year demonstrated the increasing interest on this topic at the international level. The scientometric analysis of the literature showed that financial decision, investment decision, and financing decision stood out of the crowd of the research on FDM, suggesting their important role in FDM and its research. The results of citation burst analysis predicted the focus of topics, i.e., the impact of individual differences such as financial literacy, gender and age on FDM in the coming years. Different from the traditional approach of literature review, this bibliometric analysis offers a scientometric approach to reveal the status quo and the development trend of FDM by macro and quantitative means. In addition, future research directions for the field are recommended.
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Affiliation(s)
- Lin Guo
- Business School, University of Newcastle, Newcastle upon Tyne, United Kingdom
| | - Junlong Cheng
- Research Institute of Foreign Languages, Beijing Foreign Studies University, Beijing, China
- School of Foreign Languages, Guizhou Education University, Guiyang, China
| | - Zhishuo Zhang
- International Business School, Beijing Foreign Studies University, Beijing, China
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Karlawish J. Importance of Asking Older Adults Whether They Are Having Difficulty Managing Finances. JAMA Netw Open 2022; 5:e2231442. [PMID: 36098971 DOI: 10.1001/jamanetworkopen.2022.31442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Jason Karlawish
- Penn Memory Center, University of Pennsylvania Health System, Philadelphia
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
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Sunderaraman P, Lee S, Varangis E, Habeck C, Chapman S, Joyce JL, Hartstone W, Brickman AM, Stern Y, Cosentino S. Self-awareness for financial decision making abilities is linked to right temporal cortical thickness in older adults. Brain Imaging Behav 2022; 16:1139-1147. [PMID: 34761323 PMCID: PMC9202645 DOI: 10.1007/s11682-021-00590-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2021] [Indexed: 11/30/2022]
Abstract
Everyday financial decision making and the awareness of the integrity of one's financial decision making abilities (or financial awareness) are both critical to study in older adults as they can help identify those at risk for making suboptimal financial decisions and prevent financial loss. In the current study, we examined the cognitive and cortical thickness correlates of financial decision making and financial awareness in 59 community-dwelling participants co-enrolled in a larger study (mean age=68.35 years (SD=5.5), mean education=15.91 (SD=2.36), 61% = women, 67% = White, 30% = Black participants). Data from standardized measures of financial decision making and cognition was investigated along with FreeSurfer (v. 5.3) derived thickness regions. Based on metacognitive frameworks, financial awareness was measured along with a well-validated measure of memory awareness. Results revealed that numeracy, executive functioning and vocabulary were associated with financial decision making, whereas in analysis adjusted for financial decision making, memory awareness relative to cognition was most strongly linked to financial awareness. No significant associations between thickness and financial decision making were found. However, both financial and memory awareness were associated with the same right-hemisphere temporal thickness regions underscoring the idea of a common substrate of awareness. Interestingly, our findings converge with the emerging work on financial exploitation in which the right sided temporal regions have been found to play a prominent role. Incorporating the contributing role of self-awareness in various models of financial exploitation will be an important consideration for future studies.
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Affiliation(s)
- Preeti Sunderaraman
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Irving Medical Center, New York, NY, USA.
- Gertrude. H. Sergievsky Center, Columbia University Irving Medical Center, New York, NY, USA.
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA.
| | - Seonjoo Lee
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | - Eleanna Varangis
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Irving Medical Center, New York, NY, USA
- Gertrude. H. Sergievsky Center, Columbia University Irving Medical Center, New York, NY, USA
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | - Christian Habeck
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Irving Medical Center, New York, NY, USA
- Gertrude. H. Sergievsky Center, Columbia University Irving Medical Center, New York, NY, USA
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Silvia Chapman
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Irving Medical Center, New York, NY, USA
- Gertrude. H. Sergievsky Center, Columbia University Irving Medical Center, New York, NY, USA
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Jillian L Joyce
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Irving Medical Center, New York, NY, USA
- Gertrude. H. Sergievsky Center, Columbia University Irving Medical Center, New York, NY, USA
| | - Whitney Hartstone
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Irving Medical Center, New York, NY, USA
- Gertrude. H. Sergievsky Center, Columbia University Irving Medical Center, New York, NY, USA
| | - Adam M Brickman
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Irving Medical Center, New York, NY, USA
- Gertrude. H. Sergievsky Center, Columbia University Irving Medical Center, New York, NY, USA
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Yaakov Stern
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Irving Medical Center, New York, NY, USA
- Gertrude. H. Sergievsky Center, Columbia University Irving Medical Center, New York, NY, USA
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Stephanie Cosentino
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Irving Medical Center, New York, NY, USA
- Gertrude. H. Sergievsky Center, Columbia University Irving Medical Center, New York, NY, USA
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, 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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Danesin L, Giustiniani A, Arcara G, Burgio F. Financial Decision-Making in Neurological Patients. Brain Sci 2022; 12:brainsci12050529. [PMID: 35624916 PMCID: PMC9139159 DOI: 10.3390/brainsci12050529] [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: 02/22/2022] [Revised: 04/11/2022] [Accepted: 04/19/2022] [Indexed: 12/10/2022] Open
Abstract
Financial abilities (FA) are a multi-dimensional domain comprising a wide range of conceptual, pragmatical, and judgmental skills ranging from basic abilities, such as bill payment, to high level abilities, such as financial decision-making (FDM). Preserved FDM abilities include the capacity to recognize fraud attempts, and they are fundamental for a person’s independence. Previous studies have reported decreased FDM in older adults and in patients with mild cognitive impairment (MCI), who consequently become more susceptible to fraud attempts. However, FDM has scarcely been investigated in other neurological populations, and it is unclear whether FDM may be predicted by more basic FA. The aim of the present study was to investigate FDM across patients with MCI, Parkinson’s disease (PD), or stroke, as well as healthy controls (HC), and to explore to what extent FDM could be inferred by other FA. We collected FDM and FA performances using the NADL-F short battery. Performances in the NADL-F short subtests were compared among groups. Additionally, the relationship between the scores at the FDM subtest and the performance obtained in other financial subtests of the NADL-F short were investigated for each group of participants. MCI patients performed worse than HC in FDM and in several FA domains. Conversely, FDM was relatively preserved in our sample of PD and stroke patients. In HC, FDM was associated with numeracy and financial knowledge applied to everyday situations, whereas this was true with some basic FA in both MCI and PD patients. No significant association was observed in stroke patients. Our results suggest that FDM is a complex ability, only partially inferable from other FA.
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12
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Sunderaraman P, Gazes Y, Ortiz G, Langfield C, Mensing A, Chapman S, Joyce JL, Brickman AM, Stern Y, Cosentino S. Financial decision-making and self-awareness for financial decision-making is associated with white matter integrity in older adults. Hum Brain Mapp 2022; 43:1630-1639. [PMID: 34984770 PMCID: PMC8886641 DOI: 10.1002/hbm.25747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 10/28/2021] [Accepted: 11/14/2021] [Indexed: 11/11/2022] Open
Abstract
Financial decision-making (FDM) and awareness of the integrity of one's FDM abilities (or financial awareness) are both critical for preventing financial mistakes. We examined the white matter correlates of these constructs and hypothesized that the tracts connecting the temporal-frontal regions would be most strongly correlated with both FDM and financial awareness. Overall, 49 healthy older adults were included in the FDM analysis and 44 in the financial awareness analyses. The Objective Financial Competency Assessment Inventory was used to measure FDM. Financial awareness was measured by integrating metacognitive ratings into this inventory and was calculated as the degree of overconfidence or underconfidence. Diffusion tensor imaging data were processed with Tracts Constrained by Underlying Anatomy distributed as part of the FreeSurfer analytic suite, which produced average measures of fractional anisotropy and mean diffusivity in 18 white matter tracts along with the overall tract average. As expected, FDM showed the strongest negative associations with average mean diffusivity measure of the superior longitudinal fasciculus -temporal (SLFT; r = -.360, p = .011) and -parietal (r = -.351, p = .014) tracts. After adjusting for FDM, only the association between financial awareness and average mean diffusivity measure of the right SLFT (r = .310, p = .046) was significant. Overlapping white matter tracts were involved in both FDM and financial awareness. More importantly, these preliminary findings reinforce emerging literature on a unique role of right hemisphere temporal connections in supporting financial awareness.
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Affiliation(s)
- Preeti Sunderaraman
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Irving Medical Center, New York, New York, USA.,Gertrude. H. Sergievsky Center, Columbia University Irving Medical Center, New York, New York, USA.,Department of Neurology, Columbia University Irving Medical Center, New York, New York, USA
| | - Yunglin Gazes
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Irving Medical Center, New York, New York, USA.,Gertrude. H. Sergievsky Center, Columbia University Irving Medical Center, New York, New York, USA.,Department of Neurology, Columbia University Irving Medical Center, New York, New York, USA
| | - Gema Ortiz
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Irving Medical Center, New York, New York, USA.,Gertrude. H. Sergievsky Center, Columbia University Irving Medical Center, New York, New York, USA
| | - Christopher Langfield
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Irving Medical Center, New York, New York, USA.,Gertrude. H. Sergievsky Center, Columbia University Irving Medical Center, New York, New York, USA
| | - Ashley Mensing
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Irving Medical Center, New York, New York, USA.,Gertrude. H. Sergievsky Center, Columbia University Irving Medical Center, New York, New York, USA
| | - Silvia Chapman
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Irving Medical Center, New York, New York, USA.,Gertrude. H. Sergievsky Center, Columbia University Irving Medical Center, New York, New York, USA
| | - Jillian L Joyce
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Irving Medical Center, New York, New York, USA.,Gertrude. H. Sergievsky Center, Columbia University Irving Medical Center, New York, New York, USA
| | - Adam M Brickman
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Irving Medical Center, New York, New York, USA.,Gertrude. H. Sergievsky Center, Columbia University Irving Medical Center, New York, New York, USA.,Department of Neurology, Columbia University Irving Medical Center, New York, New York, USA
| | - Yaakov Stern
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Irving Medical Center, New York, New York, USA.,Gertrude. H. Sergievsky Center, Columbia University Irving Medical Center, New York, New York, USA.,Department of Neurology, Columbia University Irving Medical Center, New York, New York, USA
| | - Stephanie Cosentino
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Irving Medical Center, New York, New York, USA.,Gertrude. H. Sergievsky Center, Columbia University Irving Medical Center, New York, New York, USA.,Department of Neurology, Columbia University Irving Medical Center, New York, New York, USA
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13
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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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14
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OUP accepted manuscript. Arch Clin Neuropsychol 2022; 37:1091-1102. [DOI: 10.1093/arclin/acac015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2022] [Indexed: 11/13/2022] Open
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15
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Sullivan K, Purser K. Developing and piloting the Consumer Experience of Capacity Assessment Tool (CECAT). PSYCHIATRY, PSYCHOLOGY, AND LAW : AN INTERDISCIPLINARY JOURNAL OF THE AUSTRALIAN AND NEW ZEALAND ASSOCIATION OF PSYCHIATRY, PSYCHOLOGY AND LAW 2021; 29:752-764. [PMID: 36148387 PMCID: PMC9487957 DOI: 10.1080/13218719.2021.1976300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Autonomy in personal decision-making (DM) is a fundamental human right. Yet, DM can be impaired for many reasons, including poor health. If impairments are suspected, they may be formally investigated via a capacity assessment. The 'consumer' experience of such assessments is largely unexplored. The Consumer Experience of Capacity Assessment Tool (CECAT) was developed to address this gap. Fifteen individuals pilot tested the CECAT. The CECAT was found to be quick to complete, and easily understood. The results showed a wide range of perceptions about capacity assessment and suggestions for improvement (e.g., better communication to consumers about what to expect). With further development, the CECAT could be adopted as a standardised method for understanding the consumer experience of capacity assessment. This perspective could then be integrated into future capacity assessment guidelines so that appropriate human rights-based approaches are incorporated into capacity assessments.
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Affiliation(s)
- Karen Sullivan
- Australian Centre for Health Law Research, Faculty of Business and Law, Queensland University of Technology, Brisbane, QLD, Australia
- School of Psychology and Counselling, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Kelly Purser
- Australian Centre for Health Law Research, Faculty of Business and Law, Queensland University of Technology, Brisbane, QLD, Australia
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16
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Abstract
INTRODUCTION The syndromes of mild cognitive impairment (MCI) or mild neurocognitive disorder (MiND), often prodromal to dementia (Major Neurocognitive Disorder), are characterized by acquired clinically significant changes in one or more cognitive domains despite preserved independence. Mild impairment has significant medicolegal consequences for an affected person and their care system. We review the more common etiologies of MiND and provide a systematic review of its medicolegal implications. METHODS We conducted a systematic review of the peer-reviewed English literature on medicolegal aspects of MCI or MiND using comprehensive search terms and expanding our review to include sources cited by these reports. RESULTS Impairment of memory, executive function, social cognition, judgment, insight or abstraction can alter an individual's abilities in a variety of areas that include decision making, informed consent, designation of a surrogate decision-maker such as a health care proxy, understanding and management of financial affairs, execution of a will, or safe driving. CONCLUSION Even mild cognitive impairment can have significant behavioral consequences. Clinicians can assist care partners and persons with MCI or MiND by alerting them to the medicolegal concerns that often accompany cognitive decline. Early recognition and discussion can help a care system manage medicolegal risk more effectively and promote thoughtful advance planning.
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Affiliation(s)
- Anca Bejenaru
- Department of Psychiatry and Behavioral Health, Christiana Care, Wilmington, DE, USA
| | - James M Ellison
- Department of Psychiatry and Behavioral Health, Christiana Care, Wilmington, DE, USA.,Department of Family and Community Medicine, Christiana Care, Wilmington, DE, USA.,Department of Psychiatry & Human Behavior, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
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17
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Campbell RJ, Lichtenberg PA. A Short Form of the Financial Exploitation Vulnerability Scale. Clin Gerontol 2021; 44:594-603. [PMID: 33124959 DOI: 10.1080/07317115.2020.1836108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The purpose of the present study was to develop a short form of the Financial Exploitation Vulnerability Scale (FEVS) with good psychometric properties to detect contextual risk exploitation. METHODS The sample included community volunteers who were 60 years and older, as well as elders who were referred to the SAFE program after being the victim of a financial scam or identity theft. All participants completed the FEVS as part of a larger test battery. Factors analysis was used to explore the underlying structure of the FEVS and eliminate items. ROC analysis and logistic regression were used to evaluate the clinical utility of the Financial Exploitation Vulnerability Scale - Short Form (FEVS-SF) to detect exploitation. RESULTS The resulting FEVS-SF was unidimensional, contained nine items, and had comparable internal consistency to the full FEVS. Sensitivity and specificity were good at a cut score of five or greater. FEVS-SF was a better predictor of exploitation than demographic factors and several measures of cognitive functioning. CONCLUSIONS The FEVS-SF can detect the experience of financial exploitation among older adults better than other known risk factors, and equally as well as a measure of executive functioning. CLINICAL IMPLICATIONS This tool serves a need in many professional settings (e.g., doctor's offices and Adult Protective Services) for a brief, standardized assessment measure of financial exploitation risk. This measure also provides actionable information for professionals to follow up with the standard of care for their clients.
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Affiliation(s)
- Rebecca J Campbell
- Institute of Gerontology and Department of Psychology, Wayne State University, Detroit, Michigan, USA
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18
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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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19
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Sousa L, Baptista N, Gomes C, Peixoto M, Baeta É, Rocha JC, Lopes E, Peixoto B. Assessment of the Financial Capacity in the Context of Normal and Pathological Cognitive Aging. Preliminary Analysis of the Portuguese Version of the Numerical Activities of Daily- Living- Financial (NADL-F). Exp Aging Res 2021; 48:261-273. [PMID: 34542026 DOI: 10.1080/0361073x.2021.1974269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Financial capacity (FC) is conceptualized as a dimension that encompasses a wide range of basic aptitudes and the capacity to judge and assess situations and make decisions according to one best interests. The Numerical Activities of Daily-Living-Financial (NADL-F) is an instrument of FC for clinical use developed in Italy. This study aims to perform a preliminary analysis on the psychometric characteristics of the Portuguese version of NADL-F. NADL-F as well as other neuropsychological instruments were administered to three groups: Healthy Control (n = 11); Mild Neurocognitive Disorder group (n = 19); Major Neurocognitive Disorder group (n = 19). NADL-F and its tasks were considered acceptable, showed good reliability for the entire sample (α = .808) and the majority of the domains correlated significantly with each other and with the total scale. Between group comparisons showed significant differences regarding all domains. Arithmetic, schooling and executive functioning accounted for 54.1% of the variance on the test. The Portuguese version of NADL-F proved to be an acceptable and valid instrument of assessing FC in the context of cognitive aging. NADL-F is an instrument that emulates real life financial situations, and it can be used in a second level of evidence in the clinical model of FC assessment.
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Affiliation(s)
- Luísa Sousa
- CESPU, Instituto De Investigação E Formação Avançada Em Ciências E Tecnologias Da Saúde, Gandra, Portugal
| | - Nicole Baptista
- CESPU, Instituto De Investigação E Formação Avançada Em Ciências E Tecnologias Da Saúde, Gandra, Portugal
| | - Carina Gomes
- CESPU, Instituto De Investigação E Formação Avançada Em Ciências E Tecnologias Da Saúde, Gandra, Portugal
| | - Miguel Peixoto
- CESPU, Instituto De Investigação E Formação Avançada Em Ciências E Tecnologias Da Saúde, Gandra, Portugal
| | - Élia Baeta
- Hospital CUF Descobertas, Lisboa, Portugal
| | - J C Rocha
- CESPU, Instituto De Investigação E Formação Avançada Em Ciências E Tecnologias Da Saúde, Gandra, Portugal.,Cespu, Instituto Universitário De Ciências Da Saúde, Gandra, Portugal
| | - Emanuela Lopes
- Hospital Senhora Da Oliveira Guimarães, Guimarães, Portugal
| | - Bruno Peixoto
- Cespu, Instituto Universitário De Ciências Da Saúde, Gandra, Portugal
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20
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Koerts J, Bangma DF, Fuermaier ABM, Mette C, Tucha L, Tucha O. Financial judgment determination in adults with ADHD. J Neural Transm (Vienna) 2021; 128:969-979. [PMID: 33709182 PMCID: PMC8295146 DOI: 10.1007/s00702-021-02323-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 03/01/2021] [Indexed: 11/27/2022]
Abstract
ADHD has a debilitating influence on everyday functioning, including the capability to make financial decisions. The capability to make financial decisions is a multidimensional construct that includes financial knowledge, financial judgment, financial performance and related contextual factors. So far, the majority of studies in adults with ADHD focused on financial performance, while the other aspects of financial capability were less explored. The current study aims to partly bridge this gap by examining the ability of financial judgment in adults with ADHD. Thirty-nine adults with ADHD and 83 adults without ADHD were included. All participants were assessed with the Financial Competence Assessment Inventory (FCAI) and Financial Decision-Making Interview (FDMI) which both assess the four abilities of financial judgment, i.e., understanding, appreciation, reasoning and communication. The results show that adults with ADHD, compared to adults without ADHD, obtained significantly lower scores on understanding (according to the FCAI and FDMI). Furthermore, adults with ADHD showed a significantly lower appreciation, reasoning and communication (according to the FCAI) than adults without ADHD. In conclusion, adults with ADHD have difficulties with financial judgment especially with the ability to understand information that is relevant for a financial situation or transaction. Furthermore, adults with ADHD were found to have problems with appreciating, reasoning and communicating about practical information that partly relates to their own financial situation (as assessed with the FCAI). A careful assessment of financial capability in adults with ADHD, therefore, appears warranted in clinical practice.
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Affiliation(s)
- Janneke Koerts
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, The Netherlands.
| | - Dorien F Bangma
- Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Anselm B M Fuermaier
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, The Netherlands
| | - Christian Mette
- Department of Social Work and Education, Protestant University of Applied Sciences Bochum, Bochum, Germany
- LVR Hospital Essen, Essen, Germany
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Duisburg-Essen, Duisburg-Essen, Germany
| | - Lara Tucha
- Department of Psychiatry and Psychotherapy, University Medical Center Rostock, Rostock, Germany
| | - Oliver Tucha
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, The Netherlands
- Department of Psychiatry and Psychotherapy, University Medical Center Rostock, Rostock, Germany
- Department of Psychology, Maynooth University, National University of Ireland, Maynooth, Ireland
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21
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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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22
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Sunderaraman P, Ho S, Chapman S, Joyce JL, Colvin L, Omollo S, Pleshkevich M, Cosentino S. Technology Use in Everyday Financial Activities: Evidence from Online and Offline Survey Data. Arch Clin Neuropsychol 2020; 35:385-400. [PMID: 31696205 PMCID: PMC7244884 DOI: 10.1093/arclin/acz042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 06/18/2019] [Accepted: 07/18/2019] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE Internet use and mobile devices permeate every aspect of our lives and are changing our financial habits. Assessment of financial decision-making (FDM) has not yet caught up to apparent changes in financial behavior. To modernize assessment methods and create current and comprehensive FDM frameworks, we first need to establish the most commonly used and most preferred methods of performing specific financial activities. METHOD Cross-sectional survey data were collected using an online platform and offline approaches (in person and by mail) (N = 234). The frequency of using technological (e.g., laptop) and non-technological (e.g., in-person banking) means of completing seven financial activities was assessed first, including Depositing checks, Reviewing bank statements, Keeping track of money spent, Transferring funds, Withdrawing cash, Paying bills, and Purchasing products online. Second, preference for technological versus non-technological methods was assessed. Finally, linear regression models examined associations between demographics and preference for technological methods for each financial activity. RESULTS The majority of respondents (77% online, 74% offline) used technology to perform various financial activities and preferred technological to non-technological methods for completing five out of the six financial activities. Increased preference for technological methods was associated with younger age for all the financial activities, and higher education was associated with reviewing bank statement and transferring funds. CONCLUSIONS Our survey findings provide empirical evidence for the changing nature of our financial habits. We discuss the implications of this change for researchers, clinicians, and the individuals themselves and emphasize the importance of modernizing FDM tools.
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Affiliation(s)
- Preeti Sunderaraman
- Cognitive Neuroscience Division, Taub Institute for Research on Alzheimer’s Disease and the Aging Brain Columbia University Medical Center, New York, NY, USA
- G.H. Sergievsky Center, Columbia University Medical Center, New York, NY, USA
- Department of Neurology, Columbia University Medical Center, New York, NY, USA
| | - Sarah Ho
- Cognitive Neuroscience Division, Taub Institute for Research on Alzheimer’s Disease and the Aging Brain Columbia University Medical Center, New York, NY, USA
| | - Silvia Chapman
- Cognitive Neuroscience Division, Taub Institute for Research on Alzheimer’s Disease and the Aging Brain Columbia University Medical Center, New York, NY, USA
- G.H. Sergievsky Center, Columbia University Medical Center, New York, NY, USA
| | - Jillian L Joyce
- Cognitive Neuroscience Division, Taub Institute for Research on Alzheimer’s Disease and the Aging Brain Columbia University Medical Center, New York, NY, USA
- G.H. Sergievsky Center, Columbia University Medical Center, New York, NY, USA
| | - Leigh Colvin
- Cognitive Neuroscience Division, Taub Institute for Research on Alzheimer’s Disease and the Aging Brain Columbia University Medical Center, New York, NY, USA
| | - Shalom Omollo
- Cognitive Neuroscience Division, Taub Institute for Research on Alzheimer’s Disease and the Aging Brain Columbia University Medical Center, New York, NY, USA
| | - Maria Pleshkevich
- Cognitive Neuroscience Division, Taub Institute for Research on Alzheimer’s Disease and the Aging Brain Columbia University Medical Center, New York, NY, USA
- G.H. Sergievsky Center, Columbia University Medical Center, New York, NY, USA
| | - Stephanie Cosentino
- Cognitive Neuroscience Division, Taub Institute for Research on Alzheimer’s Disease and the Aging Brain Columbia University Medical Center, New York, NY, USA
- G.H. Sergievsky Center, Columbia University Medical Center, New York, NY, USA
- Department of Neurology, Columbia University Medical Center, New York, NY, USA
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23
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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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24
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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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25
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Forensic Neuropsychological Aspects of Competency Evaluations: Financial and Legal Competency in Older Adults. PSYCHOLOGICAL INJURY & LAW 2019. [DOI: 10.1007/s12207-019-09364-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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26
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Morin RT, Gonzales MM, Bickford D, Catalinotto D, Nelson C, Mackin RS. Impaired Financial Capacity in Late-Life Depression: Revisiting Associations with Cognitive Functioning. J Int Neuropsychol Soc 2019; 25:1088-1093. [PMID: 31383048 PMCID: PMC9187218 DOI: 10.1017/s1355617719000705] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Impairment in financial capacity is an early sign of cognitive decline and functional impairment in late life. Cognitive impairments such as executive dysfunction are well documented in late-life major depression; however, little progress has been made in assessing associations of these impairments with financial incapacity. METHODS Participants included 95 clinically depressed and 41 nondepressed older adults without dementia. Financial capacity (assessed with the Managing Money scale of the Independent Living Scale), cognitive functioning (comprehensive neuropsychological evaluation), and depression severity (Hamilton Depression Rating Scale - 24) were assessed. T tests were used to assess group differences. Linear regression was used to analyze data. RESULTS Depressed participants performed significantly lower on financial capacity (t = 2.98, p < .01). Among depressed participants, executive functioning (B = .24, p < .05) was associated with reduced financial capacity, controlling for age, gender, education, depression severity, and other cognitive domains. CONCLUSIONS Our results underscore the importance of assessing financial capacity in older depressed adults as they are likely vulnerable to financial abuse even in the absence of dementia. It will be valuable to assess whether treatment for depression is an effective intervention to improve outcomes.
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Affiliation(s)
- Ruth T. Morin
- San Francisco VA Health Care System; San Francisco, CA
| | | | - David Bickford
- University of California, San Francisco; San Francisco, CA
| | | | - Craig Nelson
- University of California, San Francisco; San Francisco, CA
| | - R. Scott Mackin
- San Francisco VA Health Care System; San Francisco, CA
- University of California, San Francisco; San Francisco, CA
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Big Data Analytical Approaches to the NACC Dataset: Aiding Preclinical Trial Enrichment. Alzheimer Dis Assoc Disord 2019; 32:18-27. [PMID: 29227306 DOI: 10.1097/wad.0000000000000228] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Clinical trials increasingly aim to retard disease progression during presymptomatic phases of Mild Cognitive Impairment (MCI) and thus recruiting study participants at high risk for developing MCI is critical for cost-effective prevention trials. However, accurately identifying those who are destined to develop MCI is difficult. Collecting biomarkers is often expensive. METHODS We used only noninvasive clinical variables collected in the National Alzheimer's Coordinating Center (NACC) Uniform Data Sets version 2.0 and applied machine learning techniques to build a low-cost and accurate Mild Cognitive Impairment (MCI) conversion prediction calculator. Cross-validation and bootstrap were used to select as few variables as possible accurately predicting MCI conversion within 4 years. RESULTS A total of 31,872 unique subjects, 748 clinical variables, and additional 128 derived variables in NACC data sets were used. About 15 noninvasive clinical variables are identified for predicting MCI/aMCI/naMCI converters, respectively. Over 75% Receiver Operating Characteristic Area Under the Curves (ROC AUC) was achieved. By bootstrap we created a simple spreadsheet calculator which estimates the probability of developing MCI within 4 years with a 95% confidence interval. CONCLUSIONS We achieved reasonably high prediction accuracy using only clinical variables. The approach used here could be useful for study enrichment in preclinical trials where enrolling participants at risk of cognitive decline is critical for proving study efficacy, and also for developing a shorter assessment battery.
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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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Demakis GJ, Szczepkowski KV, Johnson AN. Predictors of Financial Capacity in Young Adults. Arch Clin Neuropsychol 2019; 34:503-510. [PMID: 30059960 DOI: 10.1093/arclin/acy054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 06/08/2018] [Accepted: 06/21/2018] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To examine several predictors of financial capacity as assessed via the Independent Living Scales Money Management (ILS-MM) subtest in a regression correlational design. METHOD One hundred and five college students were administered measures of financial literacy and financial experience, as well as multiple neuropsychological measures assessing language, processing speed, executive functioning, and arithmetic. Using hierarchical regression analyses, we sought to predict performance on the two subscales of the ILS-MM-Problem Solving and Performance/Information. The former assesses financial knowledge (e.g., defining financial terms such as health insurance) whereas the latter assesses financial abilities (e.g., computing a financial balance). RESULTS After controlling for demographic variables, financial literacy and experience predicted the Problem Solving subscale, but not the Performance subscale. Neuropsychological measures did not account for additional variance. In contrast, after controlling for demographic variables and financial literacy and financial experience, neuropsychological measures predicted the Performance but not the Problem Solving subscale. The key predictor was the Arithmetic subtest of the Wide Range Achievement Test4, which is not surprising given the mathematical demands of the task. Measures of executive functioning were not related to this measure. CONCLUSIONS Financial capacity is a broad construct, encompassing many financial abilities and concepts. To predict these, a variety of measures is necessary: financial literacy and experience predict knowledge-based items, whereas neuropsychological measures, especially arithmetic, predict performance-based items. Clinical and research implications of these findings are discussed as well as directions for future investigation.
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Engel LL, Beaton DE, Green RE, Dawson DR. Financial Management Activity Process: Qualitative inquiry of adults with acquired brain injury. Can J Occup Ther 2019; 86:196-208. [DOI: 10.1177/0008417419833839] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. Little is known about the financial management occupations of people living with brain injury, despite the importance of these to adult autonomy. Purpose. This work aims to develop a conceptual framework for financial management after adulthood acquired brain injury. Method. This qualitative study used grounded theory methods. Data included semistructured interviews of 10 adults living with brain injury and two close others who assist with financial management occupations. Analysis included initial and focused coding, memo writing, constant comparison, theoretical sampling of questions, and member checking. Findings. The Financial Management Activity Process conceptual framework describes a complex action process. This includes accounting for factors influencing financial choices and actions, and identifying and using a trusted personalized process, including using financial management strategies aligned with the constraints of factors. Implications. This conceptual framework may be useful to assessment and intervention development. It highlights the between-person and between-activity variability in financial management processes and strategy use.
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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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Sunderaraman P, Cosentino S, Lindgren K, James A, Schultheis MT. An examination of financial capacity and neuropsychological performance in chronic acquired brain injury (CABI). Brain Inj 2019; 33:991-1002. [PMID: 30712402 DOI: 10.1080/02699052.2019.1570340] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
PRIMARY OBJECTIVE Financial Capacity (FC) is known to be impaired in the acute and subacute stages of brain injury. The current study sought to examine FC in the context of chronic, moderate to severe acquired brain injury (CABI). RESEARCH DESIGN The Financial Competence Assessment Inventory (FCAI), developed in Australia, was adapted to examine the integrity of FC in an American sample. METHODS AND PROCEDURES Healthy comparison (HC) participants were recruited from the community, whereas participants with CABI were recruited from a community-based rehabilitation center. Participants completed the FCAI and a neuropsychological battery. FCAI performance in the current study was compared against previously published Australian data. Multiple regression analyses examined group (CABI vs. HC) as a predictor of FC. Bivariate correlations examined the cognitive correlates of FCAI in the CABI group. MAIN OUTCOMES AND RESULTS The HC group in the current study obtained similar mean scores as those in the Australian sample. CABI group membership predicted lower performance on each FCAI dimension. In the CABI group, attention, working memory, delayed verbal memory, abstract reasoning and impulsivity were uniquely associated with FCAI dimensions. CONCLUSIONS Findings underscore the importance of continued monitoring of FC even after the subacute stage of injury, and identify cognitive impairments that may be particularly detrimental for specific dimensions of FC.
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Affiliation(s)
- Preeti Sunderaraman
- a Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain, G.H. Sergievsky Center, and Department of Neurology , Columbia University Medical Center , New York , New York , USA
| | - Stephanie Cosentino
- a Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain, G.H. Sergievsky Center, and Department of Neurology , Columbia University Medical Center , New York , New York , USA
| | - Karen Lindgren
- b Bancroft Brain Injury Services , Cherry Hill, New Jersey , USA
| | - Angela James
- c Psychology Department , Drexel University , Philadelphia , Pennsylvania , USA
| | - Maria T Schultheis
- c Psychology Department , Drexel University , Philadelphia , Pennsylvania , USA
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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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Medetsky H, Sunderaraman P, Cosentino S. Investing: the case for recognition as an independent capacity. J Elder Abuse Negl 2018; 30:320-331. [PMID: 29932845 DOI: 10.1080/08946566.2018.1487894] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
In this article, we provide support for the need to recognize investing as an independent capacity. A comparison of the definitions and models of financial and investing capacities revealed significant differences between them. A review of the status of investing capacity assessment revealed that there are currently no investing capacity specific assessment instruments (ICSAIs). Implications for researchers and clinicians resulting from the lack of recognition of investing as an independent capacity are discussed and used as a rational for the need to develop ICSAIs. The benefits of ICSAI development for financial, legal, and clinical professionals as well as for investors are discussed, and a direction for future investing capacity research is proposed.
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Affiliation(s)
- Herbert Medetsky
- a Psychiatric Consultation Service , New York Community Hospital , Brooklyn , NY , USA
| | - Preeti Sunderaraman
- b Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain , New York , NY , USA.,c The Gertrude H. Sergievsky Center , New York , NY , USA
| | - Stephanie Cosentino
- b Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain , New York , NY , USA.,c The Gertrude H. Sergievsky Center , New York , NY , USA.,d Department of Neurology , Columbia University Medical Center , New York , NY , USA
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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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Gerstenecker A, Triebel K, Eakin A, Martin R, Marson D. Exploring the Factor Structure of Financial Capacity in Cognitively Normal and Impaired Older Adults. Clin Gerontol 2018; 41:33-41. [PMID: 29182443 PMCID: PMC6501188 DOI: 10.1080/07317115.2017.1387211] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To investigate the factor structure of financial capacity using a direct-performance measure of financial skills (The Financial Capacity Instrument [FCI]) as a proxy for the financial capacity construct. METHODS The study sample was composed of 440 older adults who represented the cognitive spectrum from normal cognitive aging to mild cognitive impairment (MCI) to mild dementia: 179 healthy older adults, 149 participants with MCI, and 112 participants with mild Alzheimer's dementia (AD). RESULTS Both Velicer's Minimum Average Partial test and Horn's parallel analysis supported a four-factor solution which accounted for 46% of variance. The four extracted factors were interpreted as: (1) Basic Monetary Knowledge and Calculation Skills, (2) Financial Judgment, (3) Financial Conceptual Knowledge, and (4) Financial Procedural Knowledge. CONCLUSIONS The study findings represent an important first step in empirically articulating the financial capacity construct in aging. The four identified factors can guide both clinical practice and future instrument utilization and development. CLINICAL IMPLICATIONS Cognitively impaired older adults with MCI and mild AD dementia are likely to show financial changes in one or more of the four identified financial factors. Clinicians working with older adults should routinely examine for potential changes in these four areas of financial function.
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Affiliation(s)
- Adam Gerstenecker
- a Department of Neurology , University of Alabama at Birmingham , Birmingham , Alabama USA
| | - Kristen Triebel
- a Department of Neurology , University of Alabama at Birmingham , Birmingham , Alabama USA.,b Alzheimer's Disease Center , University of Alabama at Birmingham , Birmingham , Alabama , USA
| | - Amanda Eakin
- a Department of Neurology , University of Alabama at Birmingham , Birmingham , Alabama USA
| | - Roy Martin
- a Department of Neurology , University of Alabama at Birmingham , Birmingham , Alabama USA.,b Alzheimer's Disease Center , University of Alabama at Birmingham , Birmingham , Alabama , USA
| | - Daniel Marson
- a Department of Neurology , University of Alabama at Birmingham , Birmingham , Alabama USA
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Marroni SP, Radaelli G, Silva Filho IGD, Portuguez MW. Instruments for evaluating financial management capacity among the elderly: an integrative literature review. REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2017. [DOI: 10.1590/1981-22562017020.160207] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Objective: To identify tools available in literature for assessing the financial management capacity of elderly persons with and without cognitive deficit or impairment. Methods: An integrative literature review was performed. Scientific publications indexed in the PubMed, LILACS (Latin American and Caribbean Health Sciences Literature), Psychology Index and Cochrane Library databases by November 2015 were evaluated. Results: Of the 609 articles obtained from the databases, 29 were considered eligible for this review, and involved 11 instruments for the evaluation of financial management capacity, the most cited of which was the Financial Capacity Instrument (FCI). Conclusion: There are several scales and instruments available which are used to investigate both daily and instrumental activities of daily living, which allow the independence and effective functioning of the elderly on a day to day basis to be verified. Non-Brazilian literature also describes specific instruments for the assessment of financial management capacity. However, no references to a specific scale that evaluates this construct and which has been validated and adapted for the Brazilian population were identified.
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Affiliation(s)
| | - Graciane Radaelli
- Pontifícia Universidade Católica do Rio Grande do Sul, Brazil; Universidade Federal de São Paulo, Brazil
| | - Irenio Gomes da Silva Filho
- Pontifícia Universidade Católica do Rio Grande do Sul, Brazil; Pontifícia Universidade Católica do Rio Grande do Sul, Brazil
| | - Mirna Wetters Portuguez
- Pontifícia Universidade Católica do Rio Grande do Sul, Brazil; Pontifícia Universidade Católica do Rio Grande do Sul, Brazil
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Abstract
BACKGROUND The assessment of everyday functioning in dementia is currently very global and in most cases fails to provide an in-depth overview of specific areas of deficits. Every activity comprises different sub-tasks which may be impaired to different degrees. Performance of some sub-tasks might be maintained and could thus be the foundation for remaining independent for longer. Thus, the objective of this study was to explore the benefits of breaking down everyday activities into sub-tasks. METHODS A total of 183 family carers of people with mild dementia completed the revised Interview for Deteriorations in Daily Living Activities in Dementia 2 (R-IDDD2) rating their relative's everyday functioning. Each of the 20 activities comprised three sub-tasks. Data were analyzed using ANOVA with Bonferroni corrections, and sub-tasks were clustered in relation to different forms of cognition. RESULTS The majority of activities showed at least one major area of impairment. Sub-tasks could be clustered based on different types of cognition. Several sub-tasks had a focus on memory (forgetting it is time to do the cleaning; forgetting previously known telephone numbers), whereby short-term, long-term, and prospective memory could be distinguished further. Other sub-tasks were clustered into attention (getting more distracted when driving) and executive function (sorting out bills). CONCLUSIONS The R-IDDD2 and its analysis of sub-task performance offers a novel platform to examine impairments comprehensively. This can help both in aiding timelier diagnosis by recognizing subtle deficits, but also in care management planning, whereby family and paid carers should only care for those sub-tasks that are most impaired and thus encourage remaining independent for longer.
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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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