Angela Reynolds knew her mother鈥檚 memory was slipping, but she didn鈥檛 realize how bad things had gotten until she started to untangle her mom鈥檚 finances: unpaid bills, unusual cash withdrawals, and the discovery that, oddly, the mortgage on the family home had been refinanced at a higher interest rate.
Looking back, Reynolds realizes her mother was in the early stages of Alzheimer鈥檚 disease: 鈥淏y the time we caught on, it was too late.鈥
Reynolds and her mother are among a large group of Americans grappling with the financial consequences of cognitive decline.
A shows are a possible warning sign 鈥 rather than only a product 鈥 of certain neurological disorders. This includes a of more than 81,000 Medicare beneficiaries that found people with Alzheimer鈥檚 and related dementias became more likely to miss bill payments up to six years before a formal diagnosis.
The reach of these conditions is enormous. One found nearly 10% of people over age 65 have dementia; more than twice as many are living with .
Missing the Signs of Declining Cognition
One weekday in the spring of 2018, Reynolds sat next to her 77-year-old mother, Jonnie Lewis-Thorpe, in a courtroom in downtown New Haven, Connecticut. She listened in discomfort as strangers revealed intimate details of their own finances in a room full of people waiting their turn to come before the judge.
Then it hit her: 鈥淲ait a second. We鈥檙e going to have to go up there, and someone鈥檚 going to be listening to us.鈥
That鈥檚 because the family home was in foreclosure. The daughter hoped if she explained to the judge that her mother had Alzheimer鈥檚 disease, which had caused a series of financial missteps, she could stop the seizure of the property.
Reynolds can鈥檛 pinpoint when Alzheimer鈥檚 crept into her mother鈥檚 life. A widow, Lewis-Thorpe had lived alone for several years and had made arrangements for her aging, including naming Reynolds her power-of-attorney agent. But Reynolds lived a 450-mile drive away from New Haven, in Pittsburgh, and wasn鈥檛 there to see her mom鈥檚 incremental decline.
It wasn鈥檛 until Reynolds began reviewing her mother鈥檚 bank statements that she realized Lewis-Thorpe 鈥 once a hospital administrator 鈥 had long been in the grip of the disease.
Financial problems are a common reason family members bring their loved ones to the office of , a neuropsychologist at the University of Texas at Austin Dell Medical School who specializes in cognitive issues.
鈥淭he brain is really a network, and there are certain parts of the brain that are more involved with certain functions,鈥 said Hilsabeck. 鈥淵ou can have a failure in something like financial abilities for lots of reasons caused by different parts of the brain.鈥
Some of the reasons are due to normal aging, as Reynolds had assumed about her mother. But when a person鈥檚 cognition begins to decline, the problems can grow exponentially.
Dementia鈥檚 Causes 鈥 And Sometimes Ruthless Impact
Dementia is a syndrome involving the loss of cognitive abilities: The cause can be one of several neurological illnesses, like Alzheimer鈥檚 or Parkinson鈥檚, or brain damage from a stroke or head injury.
In most cases, an older adult鈥檚 dementia is progressive. The first signs are often memory slips and changes in high-level cognitive skills related to organization, impulse control, and the ability to plan 鈥 all critical for money management. And because the causes of dementia vary, so do the financial woes it can create, said Hilsabeck.
For example, with Alzheimer鈥檚 comes a progressive shrinking of the hippocampus. That鈥檚 the catalyst for memory loss that, early in the course of the disease, can cause a person to forget to pay their bills.
Lewy body dementia is marked by fluctuating cognition: A person veers from very sharp to extremely confused, often within short passages of time. Those with frontotemporal dementia can struggle with impulse control and problem-solving, which can lead to large, spontaneous purchases.
And people with vascular dementia often run into issues with planning, processing, and judgment, making them easier to defraud. 鈥淭hey answer the phone, and they talk to the scammers,鈥 said Hilsabeck. 鈥淭he alarm doesn鈥檛 go off in their head that this doesn鈥檛 make sense.鈥
For many people older than 65, mild cognitive impairment, or MCI, can be a precursor to dementia. But even people with MCI who don鈥檛 develop dementia are vulnerable.
鈥淔inancial decision-making is very challenging cognitively,鈥 said , a specialist in geriatrics and memory care at the University of Pennsylvania鈥檚 Penn Memory Center. 鈥淚f you have even mild cognitive impairment, you can make mistakes with finances, even though you鈥檙e otherwise doing generally OK in your daily life.鈥
Some mistakes are irreversible. Despite Reynolds鈥 best efforts on behalf of her mother, the bank foreclosed on the family home in the fall of 2018.
Property records show that Lewis-Thorpe and her husband bought the two-bedroom Cape Cod for $20,000 in 1966. Theirs was one of the first Black families in their New Haven neighborhood. Lewis-Thorpe had planned to pass this piece of generational wealth on to her daughters.
Instead, U.S. Bank now owns the property. A 2021 tax assessment lists its value as $203,900.
Financial Protections Are Slow to Come
Though she can鈥檛 prove it, Reynolds suspects someone had been financially exploiting her mom. At the same time, she feels guilty for what happened to Lewis-Thorpe, who now lives with her: 鈥淭here鈥檚 always that part of me that鈥檚 going to say, 鈥楢t what point did it turn, where I could have had a different outcome?'鈥
Karlawish often sees patients who are navigating financial disasters. What he doesn鈥檛 see are changes in banking practices or regulations that would mitigate the risks that come with aging and dementia.
鈥淎 thoughtful country would begin to say we鈥檝e got to come up with the regulatory structures and business models that can work for all,鈥 he said, 鈥渘ot just for the 30-year-old.鈥
But the risk-averse financial industry is hesitant to act 鈥 partly out of fear of getting sued by clients.
2018鈥檚 , the most recent major federal legislation to address elder wealth management, attempts to address this reticence. It gives immunity to financial institutions in civil and administrative proceedings stemming from employees reporting possible exploitation of a senior 鈥 provided the bank or investment firm has trained its staff to identify exploitative activity.
It鈥檚 a lackluster law, said Naomi Karp, an expert on aging and elder finances who spent eight years as a senior analyst at the Consumer Financial Protection Bureau鈥檚 Office for Older Americans. That鈥檚 because the act makes training staff optional, and it lacks government oversight. 鈥淭here鈥檚 no federal agency that鈥檚 charged with covering it or setting standards for what that training has to look like,鈥 Karp said. 鈥淭here鈥檚 nothing in the statute about that.鈥
One corner of the financial industry that has made modest progress is the brokerage sector, which concerns the buying and selling of securities, such as stocks and bonds. Since 2018, the Financial Industry Regulatory Authority 鈥 a nongovernmental organization that writes and enforces rules for brokerage firms 鈥 has required agents to make a reasonable effort to get clients to name a 鈥.鈥
A trusted contact is similar to the emergency contact health care providers request. They鈥檙e notified by a financial institution of concerning activity on a client鈥檚 account, then receive a basic explanation of the situation. Ron Long, a former head of Aging Client Services at Wells Fargo, gave the hypothetical of someone whose banking activity suddenly shows regular, unusual transfers to someone in Belarus. A trusted emergency contact could then be notified of that concerning activity.
But the trusted contact has no authority. The hope is that, once notified, the named relative or friend will talk to the account holder and prevent further harm. It鈥檚 a start, but a small one. The low-stakes effort is limited to the brokerage side of operations at Wells Fargo and most other large institutions. The same protection is not extended to clients鈥 credit card, checking, or savings accounts.
A Financial Industry Reluctant to Help
When she was at the Consumer Financial Protection Bureau, Karp and her colleagues put out a set of recommendations for companies to better protect the wealth of seniors. The included proposals on employee training and changes to fraud detection systems to better detect warning signs, such as atypical ATM use and the addition of a new owner鈥檚 name to an existing checking account. 鈥淲e would have meetings repeatedly with some of the largest banks, and they gave a lot of lip service to these issues,鈥 Karp said. 鈥淐hange is very, very slow.鈥
Karp has seen some smaller community banks and credit unions take proactive steps to protect older customers 鈥 such as instituting comprehensive staff training and improvements to fraud detection software. But there鈥檚 a hesitancy throughout the industry to act more decisively, which seems to stem in part from fears about liability, she said. Banks are concerned they might get sued 鈥 or at least lose business 鈥 if they intervene when no financial abuse has occurred, or a customer鈥檚 transactions were benign.
Policy solutions that address financial vulnerability also present logistical challenges. Expanding something as straightforward as use of trusted contacts isn鈥檛 like flipping a light switch, said Long, the former Wells Fargo executive: 鈥淵ou have to solve all the technology issues: Where do you house it? How do you house it? How do you engage the customer to even consider it?鈥
Still, a trusted contact might have alerted Reynolds much sooner that her mom was developing dementia and needed help.
鈥淚 fully believe that they noticed signs,鈥 Reynolds said of her mother鈥檚 bank. 鈥淭here are many withdrawals that came out of her account where we can鈥檛 account for the money. 鈥 Like, I can see the withdrawals. I can see the bills not getting paid. So where did the money go?鈥
This article is from a partnership that includes , , and 麻豆女优 Health News.