Clinical and Ethical Aspects of Financial Capacity in Dementia: A Commentary

Abstract

In contrast to issues like treatment and research consent capacity, financial capacity has received relatively little clinical and ethical attention in the dementia literature. Yet issues of financial capacity emerge frequently in patients with Alzheimer's disease (AD), Parkinson's disease (PD) and related dementias, and commonly present ethical and clinical challenges for clinicians treating these patients. These issues include whether a patient with possible dementia has sufficient capacity independently to manage their financial affairs, needs referral for financial capacity assessment, and/or is being financially exploited or abused by others. The accurate identification, assessment and successful handling of such financial capacity issues can have a substantial impact on the financial and psychological well-being of patients and their family members. The present commentary presents an overview of financial capacity and associated clinical and ethical issues in dementia, and describes a set of possible clinician roles regarding these issues as they arise in clinical practice. The commentary concludes with a section describing educational resources available to clinicians and bioethicists seeking additional guidance in handling financial capacity issues. The ultimate goal of the paper is to focus clinical and ethical attention on a neglected capacity that is of fundamental importance for patients, families, and health care and legal professionals.

Instruments for evaluating financial management capacity among the elderly: an integrative literature review

“…These results will provide health professionals and researchers in the field of gerontology with information regarding the choice of instruments for the evaluation of this construct, as well as knowledge of the studies that support the instruments in populations of elderly people with or without cognitive impairment. It should be noted that deficits in the ability to manage one's own finances may be a sign of cognitive impairment and should be considered in the clinical evaluation of the elderly 7,[36][37][38][39] .…”

“…Financial management capacity is mediated by higher cognitive functions and includes a broad set of basic skills (identifying and counting money, accounting) as well as complex skills (such as checkbook and bank statement management and investment decisions, among other tasks) 5,15,21,24,39 . Specific instruments that include the greatest possible amount of relevant information are necessary for an effective understanding of this function in the elderly.…”

Dementia, Decision Making, and Capacity

“…The capacity for financial decision making can be defined as “the capacity to manage money and financial assets in ways which meet a person’s needs and which are consistent with his/her values and self-interest” 41 . The process can be assessed using structured tools targeting both procedural and decision-making aspects of financial management 42 .…”

Older adults and fraud: Suggestions for policy and practice

“…This education should help older adults identify common scams, how and when they occur, and how to avoid them. Families should also be educated about common warning signs of financial incapacity in their loved ones, which can itself be a sign of dementia or general cognitive decline (Marson, 2013;Sabatino, 2011;Widera et al, 2011). All of this information should also be distributed in the financial advising industry to make advisors aware of how to help combat fraud for their clients.…”