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Cognitive Impairment, Undue Influence and Elder Abuse

Chris Saccente
May 16, 2016

This month I was one of three presenters to address an industry group of fellow compliance officers about how to recognize cognitive impairment, undue influence and elder financial exploitation, and what to do about it when an advisor suspects something in a client’s life is going terribly wrong. My co-presenters are knowledgeable professionals who care for and provide services to older people and their families.

It occurred to me that this is information that should be shared.

According to a 2015 global impact report by Alzheimer’s Disease International, 46.8 million people worldwide were living with dementia in 2015 (9.4 million on the American continent alone) with 1 new case every 3 seconds, costing $818 billion. If global dementia care were a country, it would be the 18th largest economy, exceeding the market value of Apple!

Professionals such as investment advisors, attorneys, bankers and accountants are very often the first people to detect a problem.

Sadly, family members and physicians often minimize the signs, or miss them altogether. People who are developing a cognitive disease such as Alzheimer’s or dementia can be quite functional for several years, and will often cover up their condition as it advances. They can still drive, but find they get lost more often, even in familiar places, or forget where they’ve left the car. They still socialize, but can become picky about food, critical of friends and family members, and may seem to have a hard time following conversations. Family relationships get confused – grandchildren mistaken for children, adult children for siblings, etc. Sometimes this is attributed to hearing impairment or other symptoms of aging – and these are often valid reasons, but they should at least be noted and monitored.

Strokes, TIA’s (also called mini-strokes) and traumatic brain injuries can also be the culprit, even prescription medications can play a part, so a physical exam would be in order.

Undue influence and elder exploitation can be even less obvious. The perpetrators can be friends, caregivers, neighbors or family members. Abuse varies in degrees of severity, from advantage-taking to grand theft. The victim is often unaware they are being abused and might be convinced that anyone who tries to interfere is a meddler. The abusers carefully groom victims, and might try to isolate their victim from friends and family. The victim "circles the wagons" – they narrow their social circle to only those they can "trust."

Both situations can be devastating if not recognized early, and often the two go hand-in-hand as the victim’s judgement deteriorates – people with "functioning" dementia (now known as mild neurocognitive disorder) are most at risk.

As one who has experienced the consequences of both dementia and elder exploitation in clients and in my own family, I can verify first hand that denial is the initial reaction. When a client or family member digs their heels in and insists they are "fine” and are perfectly able to make their own decisions, it’s very easy to back down. Actually, it’s too easy.

Here are just a few common signs of developing and advancing cognitive impairment: Does the person struggle with simple life tasks like going to the grocery store, cleaning, dressing, personal hygiene or doing laundry? Is the excuse that the washer is “broken?” Have they lost a purse, wallet or other valuables? Do they claim they were "stolen?" Do they insist someone has come into their home and moved things around? Do they forget to pay bills, file tax returns, or other routine obligations they handled well before? Can they manage cash, or do they need to rely on someone to count cash & change? Have they lost weight? Have they forgotten how to prepare a meal, or are unable to determine when they need to eat? Are the contents of their pantry and refrigerator safe to consume? Are pets well cared for? Do the pets seem healthy and not over or under-fed? Will the person allow you to enter their home? Do they talk about arguments they have had with others that seem inconsequential or out of character? Do they seems generally confused or paranoid?

Believe it or not, this is a short list. Because cognitive impairment is progressive, any or all of the above questions could be a "yes" at different times. The key is to be aware of changes in personality, attitude and character.

Ask how old the person will be on their next birthday. If they don’t know, ask how old they feel! The sense of humor does endure.

Undue influence and exploitation can be harder to detect. I was fortunate to have worked for a bank as my first job – 40 years ago. Part of our training was to protect our elderly customers from financial predators. We were trained to recognize uncharacteristic behavior, forgetfulness, new "friends" who would accompany customers to the bank, large or frequent cash withdrawals. Now, I imagine that would include monitoring ATM and online activity.

As I mentioned earlier, the predator who is targeting a victim does not want outsiders to interrupt their plans. They go to great lengths to earn the victim’s trust and turn them against friends and family members. They will try to isolate the victim, because to allow them access to others would invite suspicion and detection. Their best chance of success is a victim with little or no immediate family, or family that does not live nearby. This is where friends and neighbors can play an active role in protecting a potential target.

Pay attention to reports of "gifts" or "loans" made to strangers, household employees, or casual acquaintances. Pay attention if it’s to bail someone out of jail, or to prevent someone from going to jail, usually in another country. This is a scam, it has been around forever – even before email - and I know people who should have known better to fall for it. Expect the victim to be defensive when challenged, so choose your words carefully – you want to be able to get the information you need to take action.

Also be alert for reports or hints of changes in wills or trusts, and title changes for real property, or changing professional advisors like accountants, attorneys or asset managers. You may have to read between the lines – has the person complained about signing a lot of papers or visiting a notary?

Make a point to know your neighbors, especially older folks. Meet their children and friends so you can see who visits. Make sure they know they can come to you for help. Offer to roll out their trashcans. Be observant. You don’t have to be nosy to be an advocate.

If you have a parent who lives alone or parents who might be struggling to care for each other, introduce yourself to their neighbors. Give them your contact information and get theirs.

We all want to age gracefully and remain in our homes as long as possible. Let’s admit that we all have a role in making that a reality for ourselves and others. And yes, it may mean spending the night in the emergency room with someone you don’t know very well just so they don’t have to be there alone.

If you suspect someone in your family or social circle is suffering from cognitive impairment, abuse or undue influence and needs help, please do not hesitate to contact me (chrissaccente@maxnoll.com). I have many resources I can refer you to.

That said, if you suspect a friend or family member is in immediate danger, please contact your local law enforcement agency (preferably their Elder Abuse Division if they have one), and/or Adult Protective Services for the appropriate county.

Anyone can ask for a "welfare check." It might save a life.

Chris