Since April 2003 the UK government has been phasing out paper pension books. Previously, many older people received their pension benefits by using paper slips which were exchanged for cash at the Post Office. Now, the state pension is transferred directly into a bank account and cash obtained by using a bank card, keypad and a four digit personal identification (PIN) number. The system is believed to be more secure and mirrors wider changes in the UK retail sector. People with dementia or early memory problems are likely to have difficulty remembering their four-digit PIN number, however, there has been little research into the level of cognitive ability a person requires to be able to manage their financial affairs.This cross-sectional study was conducted on 35 consecutive attendees at a medical day hospital, and 15 from a local community centre. All were community dwelling, aged over 65 with no acute medical or psychiatric illness, gave consent and were fluent in English. Ethical committee approval was obtained. Our main hypothesis was that cognitive impairment could be associated with difficulty in using a PIN number and keypad.Cognitive impairment was measured using the Mini-Mental State Examination (MMSE;Folstein et al., 1975). Participants were asked to identify a bank debit card, supermarket loyalty card, a PIN keypad (identical to those used in UK Post Offices) and a pension book. They then generated a four-digit PIN number of their choice and immediate recall of this was checked. The researcher returned 2-4 h later (mean 3.2 h) and asked the participant to enter the number into a keypad. Correct input (after a maximum of three attempts) of the chosen PIN number into the keypad was the main outcome. We documented the use of glasses or hearing aids and participants' current banking arrangements. Functional impairment was rated on the Barthel Index (BI; Mahoney and Barthel, 1965).We chose a high cut-off on the MMSE ( 26) as we hypothesised that this is a complex task requiring a high level of cognitive functioning. The BI was used as a dichotomous variable cut at the median. The relationship between cognitive impairment and categorical variables was investigated using the chi-squared test and the t-test used for continuous variables.The sample was predominantly female (62%) and all were over the age of 70 years (mean 82.6, range 70-90). The mean MMSE score was 25 (range 12-30) and mean BI score 81.3 (range 21-100). Most participants (92%) used glasses and 20% a hearing aid. Two-thirds (64%) were able to enter their number correctly into the keypad. Table 1 demonstrates how INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY Int J Geriatr Psychiatry 2007; 22: 492-493. Published online in Wiley InterScience (www.interscience.wiley.com)an MMSE score of 26 was significantly associated with inability to use the keypad.There were no significant associations between age, gender, functional ability (BI) or the use of spectacles/ glasses and the ability to correctly use the keypad. Subjects who could not use the keypad h...
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