Doctors can play a vital role in protecting their elderly patients from financial abuse and fraud by assessing them for financial capacity using a range of tools, according to the authors of a Clinical Focus published in the Medical Journal of Australia.
Financial capacity refers to the "ability to satisfactorily manage one's financial affairs in a manner consistent with personal self-interest and values".
"Older people with cognitive impairment and/or dementia may be particularly vulnerable to diminished financial decision-making capacity", the authors, led by Professor Nancy Pachana from the University of Queensland, wrote.
Financial abuse is estimated to affect 1.1% of older Australians, and was found to be the most common form of elder abuse in a Western Australian study, particularly for older women and very old people, Pachana et al wrote.
Additionally, consumer fraud - such as when a person claiming to be a tradesman demands payment for services supposedly carried out at an earlier time - affects up to 5% of older Australians.
Given the ageing population, financial capacity is a growing problem, the authors wrote, and it is "likely that more questions of capacity will present in primary and community health care settings". There is currently no universal standard for testing an elderly patient's financial capacity, although there are instruments - such as Addenbrooke's Cognitive Examination and the Semi-Structured Clinical Interview for Financial Capacity - which can be used by primary care providers.
Pachana et al suggested five roles clinicians could adopt to assist their elderly patients:
- educating patients and families about the need for advance financial planning;
- recognising signs of possible impaired financial capacity;
- assessing financial impairment, financial abuse or both;
- recommending interventions to help patients maintain financial independence;
- and making timely and appropriate medical and legal referrals.
"Assessment of financial capacity should include formal objective assessment in addition to a clinical interview and gathering of contextual data", the authors concluded.
"There is no one instrument that can be used in isolation; use of multiple sources of data, objective performance-based tests, neuropsychiatric assessments and self-report clinical interview data is recommended.
"The decisions that result from an assessment of capacity can have far-reaching consequences. "In order to better meet the needs of patients, their families and their carers, as well as clinicians involved in such assessments, standards and guidelines for the assessment of capacity are needed."