As the population ages and increasing numbers of older adults lose everyday capabilities as a result of Alzheimer’s disease and dementia, physicians and other clinicians are being increasingly called upon to evaluate the financial competency of their patients, something most health professionals are not trained to do.

Researchers at UAB have developed a 25-minute clinical interview, known as SCIFC (Structured Clinical Interview for Assessing Financial Capacity), to assess financial capacity in dementia patients.
It was introduced on July 19 in Madrid at the 10th International Conference on Alzheimer’s Disease and Related Disorders.

 “Impairment and eventual loss of financial abilities are an important and often devastating consequence of Alzheimer’s disease and related dementias,” said Daniel Marson, interim director of the UAB Alzheimer’s Disease Center, who led the team that developed the SCIFC. “As the disease progresses, patients lose arithmetic and other basic money management skills and the ability to make both complex and simple financial decisions. They also become highly vulnerable to financial exploitation by others.”

The SCIFC assesses eight areas of financial activity – basic monetary skills, conceptual knowledge, cash transactions, checkbook management, bank statement management, judgment, bill payment and knowledge of personal assets/estate arrangements – and also overall financial capacity.

“Judgments of a person’s financial competency have important ethical and legal implications,” Marson said. “They can seriously restrict or even remove a patient’s freedom to make personal financial decisions, but also can help protect patients and their families from making poor financial decisions and from exploitation by others.

“We believe this relatively brief interview can reduce physician concerns about their ability to assess financial competency, an area in which they generally have little training.”

Five physicians used the SCIFC to examine financial skills in a study group of 248 people including 69 healthy older persons.

Financial capacity outcomes differed across the study groups, with abilities in all areas decreasing as the severity of the disease increased.

Compared to normal participants and mild cognitive impairment patients, mild Alzheimer’s patients were significantly impaired in all financial areas and overall. In turn, moderate Alzheimer’s patients showed much greater impairment than mild AD patients in all financial areas.

“The findings suggest that financial capacity first becomes mildly impaired in the MCI period and then rapidly deteriorates in the mild and moderate stages of Alzheimer’s. We recommend that people diagnosed with MCI, along with their families, proactively engage in financial and estate planning in anticipation of developing Alzheimer’s and accelerated loss of financial abilities,” Marson said.