January 21, 2016

Financial Exploitation of the Elderly is on the Rise

Looking for signs and helping to avert problems

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By Ronan Factora, MD

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As geriatricians, our ultimate goal is to keep a person residing in the community as independently as possible. Financial strains or a decline in financial management can threaten this ability, leading to significant stress on older persons. All of this can add to the effects of chronic illness on our patients. By paying attention to patients’ functional status and possible financial concerns, geriatricians can recognize clues that a person’s independence is at risk.

Since the Great Recession, retirees have become frequent targets for those who see them as easy prey. In fact, financial exploitation has become the most common form of reported elder abuse. Recent national surveys have found that around 5 percent of older adults have experienced some form of financial exploitation. This prevalence is similar to that of heart attacks and even higher than that of systolic hypertension. Considering the number of patients we are used to treating for hypertension, we have to wonder how many of these patients are missed in practice.

Many physicians have reported in surveys that their training in the area of elder abuse was poor or nonexistent, particularly when compared with their training in recognition of child abuse or domestic violence. Given the prevalence of this problem, disseminating any information that could increase the detection of financial exploitation could help preserve the quality of life of our older population.

Identifying patients

There are several characteristics we can look for to help identify those patients most vulnerable to exploitation. Older persons who are socially isolated, who suffer from bereavement or depression or any mental illness, or who have a history of alcohol or drug abuse could be at risk. Detection of any new impairments in ability to perform basic activities of daily living, change in appearance or hygiene, or accompaniment of the patient by a caregiver who seems overly protective or domineering should also be “red flags” prompting a closer look.

Patients who have been diagnosed with mild cognitive impairment have been observed to have higher risk-taking behavior, and as cognitive impairment advances to clinical dementia, risk also increases. People suffering from dementia may provide personal financial information such as credit card numbers, Social Security numbers and bank account information to strangers or callers masquerading as friends or family. They may also withdraw large amounts of cash only to misplace it or leave the monies in unsecured areas.

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The physician’s role

We can be proactive. As physicians, we can help facilitate discussions with patients to help them plan for the future. We can detect subtle differences in our patients’ behaviors and begin the discussion about seeking financial guidance when and if necessary. Often we can refer patients to a number of community resources that are available to help formalize assignment of responsibilities in the form of financial powers of attorney or a conservator, including:

The consequences for victims of financial exploitation can be long lasting and in the worst of circumstances can lead to the inability to pay for food, medications and housing expenses. But very frequently, physicians only see the later ramifications of financial exploitation in the form of progressive weight loss, uncontrolled chronic illness, recurrent emergency department visits or hospitalizations. In retrospect, the risk factors that brought the patient to this point may be more apparent.

A proactive approach

Much like addressing many of the other geriatric syndromes encountered in clinical practice, a proactive and collaborative approach to dealing with this problem can be effective in identifying, investigating and, when necessary, prosecuting financial exploitation.

Everyone from the bank teller to the pharmacist to a patient’s volunteer organization needs to step up today. But often individuals in the community have such brief encounters with a victim of elder fraud or they say “it is not my problem.” More often than not, the problem goes on without anyone taking responsibility until it is too late. As physicians, we can help change this.

All states have a list of mandated reporters who are tasked with reporting suspicions of elder abuse to the local adult protective services for investigation. The mistake that many people make is believing that proof is required in order to file a report. The truth is that a report can be made even if there is just a suspicion that abuse is occurring, as long as the report is made in good faith.

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Once the process gets started, social workers at adult protective services can work with physicians, attorneys and law enforcement to investigate a report. Physicians are often tasked with evaluating the victims of elder abuse and financial exploitation to determine whether the individual had risk factors for abuse/exploitation, particularly if there is any sign of significant cognitive impairment.

Increasing attention

Beyond caring for the individual and understanding the resources available, physicians can assist in increasing the attention of practicing clinicians to this problem by discussing cases of elder abuse and exploitation with trainees. We can also participate in didactics or workshops with colleagues in practice to increase our knowledge and awareness of the topic.

Dr. Factora is on staff at the Center for Geriatric Medicine, Program Director for the Geriatric Medicine Fellowship and Co-Director of the Aging Brain Clinic. He can be reached at 216.444.8091 or factor@ccf.org.

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