B (2:29)

And I'm Adrian Ma. After the break, we learn about those warning signs when they show up and why safeguarding the financial health of seniors is falling through the policy cracks.

E (2:42)

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A (3:57)

when Sanda Balaban discovered her father's mental state. She moved him into her one bedroom apartment in New York. Then she began the arduous process of trying to reconstruct what had happened to her father's finances.

B (4:10)

For example, she realized that her father had lost essentially all of the retirement money and savings he had in his brokerage account. She estimates it was between 1 and 2 million dollars. Sanda got the brokerage to send her 10 years worth of financial statements.

D (4:26)

I could not make sense of them. I and it turns out part of the reason I could not make sense of them is that there is no sense to be made of them. It was an extremely erratic, you know, sort of pattern of investments.

A (4:40)

This is the kind of anecdote that Lauren Nicholas has seen before. Lauren is a health economist and professor of geriatrics at the University of Colorado. She's heard of older adults with dementia doing things like compulsively shopping or moving their entire investment portfolio into a single stock.

C (4:56)

Dementia is one of the diseases where you lose a lot of cognitive capabilities over time that are unfortunately closely tied to our ability to manage our own money. We actually see that some of the earliest signs show up in your financial portfolio, in your checkbook, and kind of not in the standard tests your doctors are doing.

B (5:21)

These are the kinds of tests where patients might draw an analog clock showing a specific time or memorize a list of three unrelated words. Someone could pass those tests while also missing credit card payments or responding to scam text messages.

A (5:35)

Lauren had done previous research indicating that a person's wealth can decline before the actual onset of dementia, but she wanted to know how early this starts and why it Happens.

B (5:46)

So Lauren and several colleagues got nearly two decades of data from a national survey, and it tracks the health and retirement of older adults and their spouses over time. The researchers used this data set for a working paper that was published in January.

A (5:59)

And for that first question, how early does wealth start declining? The researchers found that it's about six years before a dementia diagnosis or symptoms that are recognizable as dementia.

C (6:10)

That both surprises and worries me a lot. Right. It's like, how do you protect yourself from future you who might make these mistakes and be totally unaware of it?

B (6:23)

The second question Lauren and her colleagues tackled was why people with dementia see their wealth deteriorate. For example, is it because they have to stop working and give up their income? Is it because they're purposely spending down their money in their twilight years? Or is it because dementia is an expensive disease to treat?

A (6:39)

It turns out none of these were the case. The researchers found that the decline in wealth comes from impaired financial decision making, and they believe this is unique to dementia. That's because people with other diseases like cancer or arthritis do not see the same kind of drop in household wealth.

C (6:57)

Some personality changes happen early in the course of cognitive decline, which can include propensity to trust people, your risk tolerance. What happens commonly is like, even though you're losing these capabilities, starting to forget about making your bill payments or something, you. You're actually getting more confident in your abilities and, like, you think you're crushing it.

A (7:24)

Oh, that's such a cruel aspect of the disease.

C (7:27)

Yeah, it's really like it does all of the worst things to you.

B (7:31)

Sanda Balaban, who discovered her father's drained accounts, says she thinks he was able to mask his cognitive and financial issues for a long time. For example, when she started going through his papers, she discovered he hadn't paid income tax since 2014. That's four years before she found all the credit card bills and scam products in his office.

D (7:51)

He was a very intelligent man, and at various neurologist assessments afterwards, I was told that sort of like the higher your cognition, you know, the more you can cover. And so there was sort of like the residue of his former intelligence for a while.

A (8:07)

Sanda's father had a medical degree and a master's in public health. He had trained as an epidemiologist and a family practice physician. He retired in the early 2000s.

D (8:17)

You know, my father was all about preventive care, medical care, and I wish that there had been financial preventative care for him and his well being.

B (8:28)

For example, Sanda says she wished her father's brokerage had a way to flag his erratic investment transactions. This is something economist Lauren Nicholas has thought about as well. That's because brokerages or financial advisors are often the ones who are privy to these decisions around money.

A (8:45)

However, Lauren says it's tricky to put financial advisors in the position of first responder. They're obligated to do what the client asks. They're not qualified to diagnose dementia. And privacy regulations prevent a financial advisor from calling someone's doctor to say, hey, this person might be in trouble.

B (9:03)

And this same dilemma applies to companies like banks. They have anti money laundering and fraud systems that can detect suspicious activity. But should they use similar technology to try to predict whether a client has dementia? That's not their business.

A (9:17)

Financial services companies are aware of this problem. Back in 2009, Fidelity surveyed financial advisors and found that most of them had dealt with a client with Alzheimer's disease. But many also reported they didn't feel comfortable raising the issue because they were afraid of being wrong or didn't have the proper expertise.

B (9:37)

Lauren says one idea for linking the financial and healthcare industries is to give doctors access to some personal data, like information from a credit report.

C (9:46)

We're sort of hoping that we can get models that pick up enough signal in something like your credit report data where we could give physicians offices the ability to say, oh, do you also want us to pull your financial dementia score? And you use that to determine whether you need more screening. I think we're still a few years out from that on the research horizon, but sort of seems like a promising way.

A (10:15)

As for Sanda, she was able to get her father enrolled in Medicaid. He spent his last few years at a memory care center in New York. Sanda said he was well cared for there. He passed away in August. She's still dealing with the financial aftermath of her father's illness.

B (10:30)

Meanwhile, another one of Sanda's family members has received an Alzheimer's diagnosis. This time, though, Sanda and her brother were able to make a plan. They set up a power of attorney and got themselves added to the family members financial accounts. These are safeguards that Sanda hopes will prevent her father's experience from happening again.

A (10:51)

This episode was produced by Cooper Katz McKimmon, engineered by Jimmy Keeley. It was fact checked by Sierra Juarez. Julia Ritchie edited this episode. Katy Cannon is our editor and the indicator is a production of npr. This message comes from Capella University.

D (11:09)

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pace without putting life on pause.

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Learn more at capella.

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Edu.

E (11:21)

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