Editorial: Age-Associated Financial Vulnerability a Public Health Crisis

The 80–year-old retiree had been swindled. In a videotaped court deposition, he tearfully recounted how he had entrusted a financial advisor whom he had just met to invest his retirement checks. The retiree wasn't cognitively impaired. He didn't have dementia. So what compelled him to hand over his nest egg to a complete stranger who then deposited it into her personal bank account?

Dr. Mark Lachs
Photo credit: A. Kinloch

According to Dr. Mark Lachs, The Irene F. and I. Roy Psaty Distinguished Professor of Medicine at Weill Cornell Medicine, the man — who was not Dr. Lachs' patient but whose deposition was used to prosecute and convict the financial advisor — likely had age-associated financial vulnerability or AAFV, a newly defined pattern of imprudent financial decision-making that begins at a late age and puts older adults at risk for material losses that could decimate their quality of life. In a new commentary he co-authored for the Oct. 13 issue of the Annals of Internal Medicine, Dr. Lachs advocates framing AAFV as a possible clinical syndrome that warrants research, protective public policies and heightened awareness among physicians. Dr. Lachs serves as a paid consultant and medical expert witness on the topic of elder abuse.

"AAFV is a public health crisis for patients and families," Dr. Lachs said, because it can increase seniors' susceptibility to financial exploitation — the most common form of elder abuse and a risk factor for adverse health outcomes like depression and mortality. The National Center on Elder Abuse estimates that one in 10 Americans ages 60 and older experience some form of elder abuse during the course of a year. Self-reported financial exploitation occurred at a rate of 42.1 per 1,000 people in a 2011 survey of more than 4,000 older New Yorkers and their proxies. "Everyone I speak to has an elderly parent or friend who's had money taken from them."

A lifetime of ill-considered spending does not predict AAFV, he said. Rather, the overlap of aging-related changes in the brain, exploiters' easy access to life savings or other sources of wealth, and the onslaught of marketing schemes and financial products and services targeting older adults contribute to the condition's late onset.

Although mild cognitive impairment is a risk factor, AAFV can occur without any measurable cognitive impairment, dementing illness or other neurodegenerative diagnosis.

"We've all encountered patients who seem to be cognitively normal and have normal neuropsychological testing but continue to make very poor and unsound financial decisions," said Dr. Lachs, a geriatrician who co-directs the Division of Geriatric and Palliative Medicine at Weill Cornell Medicine, and heads Weill Cornell Medicine's Center for Aging Research and Clinical Care, as well as geriatrics for the NewYork-Presbyterian Health System.

Social isolation and medical illness are risk factors, since they feed the loneliness and desperation that can predispose older adults to financial exploitation. But Dr. Lachs and his co-author, Dr. S. Duke Han of Rush University Medical Center in Chicago, draw an important distinction between AAFV and financial exploitation: The former is a potential condition; the latter is the potential outcome.

Although there is no direct way to measure the prevalence of AAFV, Dr. Lachs found that he could indirectly quantify it by measuring the prevalence of financial exploitation, "keeping in mind that not all people with AAFV are financially exploited." In a recent telephone survey that he conducted with Cornell University in Ithaca, The New York City Department for the Aging and Lifespan of Greater Rochester, 4.7 percent of more than 4,000 New York State adults who represent a cross-section of the state's population reported having experienced some type of financial exploitation since turning 60. This result may actually underestimate the prevalence of AAFV, Dr. Lachs said, since adults with significant cognitive or other impairments did not participate in the survey. Moreover, those who may lack insight into their vulnerability for financial exploitation may be unlikely to self-report, he noted.

Establishing AAFV as a clinical syndrome will require more research to determine who is at risk and why. Research may also support the development of evidence-based tools for screening and intervention. Moreover, giving AAFV a formal clinical designation may advance policies that protect seniors from financial exploitation. In the meantime, physicians' recognition of the condition could help them prevent their older patients from making life-destroying financial decisions.

"Given the public health and policy implications of AAFV," Dr. Lachs said, "a rigorous debate must begin on how to balance protection of older adults with the autonomy afforded to all citizens."

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Editorial: Age-Associated Financial Vulnerability a Public Health Crisis