A person-centered approach to financial capacity: early memory loss, financial management and decision-making.

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.

Financial decision-making deficits in scam cases: how frequent are they?

Due to the rise in scams perpetrated against older adults, Adult Protective Service workers are more frequently involved in investigating these matters. One significant aspect of scam involvement is the assessment of informed financial decision-making. This study examined 175 consecutive scam cases APS workers investigated using a 10-item financial-decision making tool. Two-thirds of the sample displayed deficits in decision-making. The decision-making tool was effective in differentiating those rated as having deficits from those without deficits. Analysis of each scored item found differences between groups on six of the seven items. A review of the item responses illustrates the types of deficits in understanding and appreciation of the scam and its impact on the older person and their family.

Cross-Validation of the Financial Exploitation Vulnerability Scale.

OBJECTIVES: The present study is a cross-validation of the Financial Exploitation Vulnerability Scale (FEVS), a measure of contextual risk for financial exploitation. METHODS: The sample was drawn from both the community and the SAFE program, a service for older adults who have been financially scammed. FEVS was administered within a larger assessment battery. The total score ability to differentiate exploitation groups and its correlates were examined. ROC analysis and logistic regression evaluated the clinical utility of the FEVS to detect exploitation. Results were compared to the initial validation study. RESULTS: FEVS score was significantly higher for those who were exploited and correlated with age. ROC analysis revealed adequate detection of financial exploitation. FEVS total score remained a strong predictor of exploitation when compared to demographic factors and several measures of cognitive functioning. CONCLUSIONS: Cross-validation demonstrates strong evidence that the FEVS detects financial exploitation in older adults, beyond the ability of many known risk factors. CLINICAL IMPLICATIONS: FEVS is an evidence-based tool for identifying exploitation and is accessible to many professionals working with older adults. Items query contextual factors that allow professionals to support clients with the appropriate standard of care.

Perceived Financial Vulnerability, Wealth, and Wealth Change: The Health and Retirement Study.

OBJECTIVES: The 6-item Perceived Financial Vulnerability (PFV) scale assesses awareness and psychological vulnerability regarding finances. Prior findings using the Health and Retirement Study (HRS) identified significant associations of PFV with wealth, demographics, and health status. This study examines the relationship between wealth, changes in wealth, and PFV. METHODS: Data from HRS respondents were analyzed (N = 1,056). Total assets at baseline (2016) and changes in total assets over two waves (2016 to 2018) were stratified into deciles and used as primary predictors of PFV in 2018. Multiple linear regression models examined the influence of demographics, wealth change (linearly and curvilinearly), and baseline wealth on PFV. RESULTS: Wealth change and baseline wealth were associated with PFV. When controlled for baseline wealth, wealth loss linearly predicted increased PFV. CONCLUSIONS: These findings support the utility of the PFV. Findings underscore the importance of integrating multifaceted financial and demographic information when conceptualizing subjective financial welfare. CLINICAL IMPLICATIONS: Financial wellbeing is crucial in older clients and should be assessed over time. The 6-item PFV effectively evaluates contextual aspects of financial decision-making across socioeconomic statuses, making it valuable for clinical assessments.

The WALLET Study: Financial Decision Making and Key Financial Behaviors Associated with Excess Spending.

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.

Factors Associated With Healthcare and Financial Decision Making Among Older Black Adults Without Dementia.

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.

Successful Aging Through Financial Empowerment (SAFE): Financial Coaching with Older Adult Victims of Financial Exploitation.

Financial exploitation (FE) of older adults is a growing public health problem. Current estimates of financial exploitation show between 5% and 11% of older adults are victimized each year. This study examined an empowerment-centered financial coaching intervention. Program records and participant baseline and follow-up assessment data were used to detail program dynamics and investigate participant outcomes. Most SAFE participants were very satisfied or satisfied (91%) with the services they received. Participants also reported significantly less stress at the six-month follow-up. These findings demonstrate that empowerment-centered financial coaching interventions can successfully address FE in older adult populations.

Trust and betrayal in older adult financial exploitation.

OBJECTIVES: Although the knowledge base regarding the financial exploitation of older adults is expanding, work to understand the subpopulations of older adult financial exploitation victims and their experiences is greatly needed. This study uses betrayal trauma theory (BTT) as the foundation for conceptualizing the harm that arises from elder family financial exploitation. METHODS: The study uses a cross-sectional design to investigate group differences among a total sample of 95 community-dwelling older adults, 32 of the participants (33.7%) were older adult victims of family financial exploitation and the remaining 63 (66.3%) were victims of financial exploitation perpetrated by strangers. RESULTS: The group of older adults who were victims of elder family financial exploitation had significantly lower functional ability scores, higher stress and financial exploitation vulnerability scores and lost more money on average than those victimized by strangers. CONCLUSION: The present study provides support that BTT provides a valuable framework for understanding why older adult family financial exploitation victims are more vulnerable than victims of exploitation committed by strangers. Attention to this subgroup of financially exploited older adults will provide improved understanding of the unique challenges these victims face and inform prevention and intervention services.

Social connectedness in older Urban African-American adults during the COVID-19 pandemic: the roles of education and partnership.

OBJECTIVE: This study examined education, partnership status, and the moderating role of the lockdown period on social connectedness during the COVID-19 pandemic in a sample of urban African-American older adults. METHODS: Five hundred thirty-four African-American adults living in Detroit (91.0% female, Mage = 74.53) reported demographic information pre-pandemic and answered one social connectedness questionnaire between April and December 2020. RESULTS: Participants interviewed after the lockdown (post-June 2020) reported more loneliness than those interviewed during the lockdown (April-June, 2020). Married/partnered participants reported less loneliness and social isolation. Loneliness did not differ between those with high education levels interviewed during the lockdown compared to post-lockdown. However, among individuals with low education levels, those interviewed after the lockdown reported more loneliness than those interviewed during the lockdown period. CONCLUSION: Our findings suggest partnership status is associated with more social connectedness during the pandemic and education accentuates the effects of forced isolation related to loneliness among urban African-American older adults.

Illustrating a Person-Centered Approach to Financial Capacity Evaluations Through a Case Study.

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.

Cross-Validation of the Lichtenberg Financial Decision Rating Scale.

OBJECTIVES: The Lichtenberg Financial Decision Rating Scale (LFDRS) is a person-centered tool for analyzing the integrity of financial decision-making abilities. Initial studies supported its reliability and validity (Lichtenberg et al., 2020; Lichtenberg et al., 2017; Lichtenberg et al., 2015). This study examines the cross-validation of the LFDRS Scale to assess its concurrent validity with a measure of executive functioning and suspected financial exploitation (FE). METHODS: Ninety-five older adult community participants underwent an assessment session. The total LFDRS was significantly related to executive functioning. RESULTS: Trail Making Test Part B was the only significant predictor of the LFDRS total score in a regression equation. An independent sample t-test showed that victims of FE scored higher on the LFDRS than those who were not victims. CONCLUSIONS: These findings are consistent with the initial validation study of the LFDRS and the initial study on the intersection of decision-making and FE (Lichtenberg et al., 2017, 2020) and adds evidence supporting the LFDRS concurrent validity.

Clinical Implications:The LFDRS is a person-centered tool for assessing financial decision-making and can be used in clinical assessments of financial capacity.The LFDRS can be a useful tool for assessing decision-making capacity in those who have been FE.

"It Takes Some Empathy, Sympathy, and Listening": Telephone Outreach to Older Detroiters in a Pandemic as a Modality to Gain an Understanding of Challenges and Resiliency.

This manuscript describes a telephone outreach project for members of a research registry program for older adults in Detroit, Michigan. From April until December 2020, the Healthier Black Elders Center designed and implemented a telephone outreach program, calling 1204 older adults utilizing 15 staff and volunteers. The calls served to check in on registry members and collect data on mental health, coping mechanisms, access to services, masks, testing, and tele-health. This paper details the methods of developing and implementing an innovative engagement program that collected time-sensitive data from older Black adults that has directly been applied to create virtual health education programs, share resource information, and create a program to reduce social isolation.

Implementation of financial decision making scales into statewide APS practice: the Michigan experience.

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).

A Short Form of the Financial Exploitation Vulnerability Scale.

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.

Examining the Validity of the Financial Exploitation Vulnerability Scale.

Objectives: Objectives: Lichtenberg, Campbell, Hall, and Gross used a contextual framework for financial decision-making to create and provide evidence for a new scale to assess risk for financial exploitation, the Financial Exploitation Vulnerability Scale (FEVS). This study examined the criterion validity of self-reported memory complaints and living alone on FEVS risk scores.Methods: Participants were the first 258 individuals reporting as 60 years or older and who completed the FEVS on the https://olderadultnestegg.com website between December 2020 and February 2021. Correlations, multiple regression, analysis of variance, and chi-square analyses were conducted to compare groups based on risk scores.Results: FEVS risk scores were significantly correlated with years of education, self-reported memory complaints, and living alone; 18% of unique variance was accounted for by these measures in a regression analysis. The ANOVA indicated that while there was an interaction effect for memory complaints by living alone, the majority of variance accounted for was attributed to the self-reported memory complaints measure. Conclusions: Older adults with memory complaints are in need of perceived financial vulnerability assessment.Clinical Implications: The Financial Exploitation Vulnerability Scale is a valuable self-report tool that clinical gerontologists can use in their intake assessments and follow-ups.

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.

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.

A Short Form of the Lichtenberg Financial Decision Rating Scale.

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.

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.

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.

Cross-validation of the screening scale in an adult protective services sample.

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.

Assessment of financial decision making: an informant scale.

Older adults with cognitive impairment are a population at great risk for financial exploitation. At-risk older adults often have difficulty reporting on their own financial abilities. Collecting information from trusted others is vital for professionals investigating the financial exploitation older adults. There are few reliable, valid, and standardized informant-report measures of financial capacity, and none that assess decisional abilities for an ongoing, real-world financial transaction. The present study sought to examine the psychometric properties of a new informant-report scale of financial decisional abilities in older adults. One hundred fifty participants were recruited to complete the Family and Friends and Interview regarding a known older adult's financial decisional abilities. A factor analysis identified two subscales. The full scale had adequate sensitivity and specificity to detect an informant's current concerns regarding financial exploitation. The Family and Friends Scale is a useful tool for collecting informant-report regarding an older adult's ability to make financial transactions.