Regular Research ArticleClinical and Ethical Aspects of Financial Capacity in Dementia: A Commentary
Section snippets
What is Financial Capacity?
Financial capacity is a medical–legal construct that represents the ability to independently manage one’s financial affairs in a manner consistent with one’s personal self-interest and values.1, 2, 3 For purposes of this commentary, financial capacity may be viewed and understood from clinical, legal, and ethical vantage points in the area of neurodegenerative disease.
Construct of Financial Capacity
The capacity to manage financial affairs comprises a broad range of conceptual, pragmatic, and judgment abilities across a range of everyday settings that are critical to the independent functioning of adults in our society.4, 19, 20 Studies have suggested that financial capacity is an “advanced” or instrumental activity of daily living (IADL).19, 21 Advanced ADL are mediated by higher cognitive functions and can be distinguished from “household” ADL (e.g., meal preparation, shopping, and
Growing Challenges for Clinicians
Adults age 65 and older currently comprise 13% of the population24 and 21.4% of family households in the United States25, 26 but hold 34% of the nation’s wealth.25, 26 Given that overall household wealth in the United States in 2009 was estimated at $53.1 trillion, the amount of wealth currently held in older adult households amounts to a staggering $18.1 trillion.26 With the continued aging of our society, and the tidal wave of Alzheimer and related dementias descending in the next few
Educational Resources on Financial Capacity in Older Adults
As noted earlier, until recently there has been very little scientific or clinical work in the area of financial capacity. Beginning in 2000, Marson and his group6, 18, 20, 27, 33, 34 at the University of Alabama at Birmingham have published a series of scientific articles addressing issues of financial capacity in patients with AD and its precursor stage MCI. Using a clinical conceptual model of financial capacity and associated informant report,27 psychometric,5, 28 and clinician interview34
Summary
Financial capacity has been a neglected topic in dementia ethics and clinical research. Issues of financial incapacity emerge frequently in patients with AD, PD, FTD, and related neurodegenerative dementias and commonly present ethical and clinical challenges for clinicians treating these patients. Physicians in particular are increasingly being called upon by families to identify, assess, and help handle financial capacity issues, and their actions can have a substantial impact on the
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Cited by (41)
Financial decision-making and capacity in older adults
2021, Handbook of the Psychology of AgingTransitions in financial autonomy and risk for financial elder abuse
2020, Evidence-informed Approaches for Managing Dementia Transitions: Riding the WavesCapacity assessment and estate planning - the therapeutic importance of the individual
2019, International Journal of Law and PsychiatryCitation Excerpt :Little research exists mapping the requirements for testamentary capacity against specific mentally disabling conditions, particularly dementia, and how this can affect the examinee's experience of the assessment process (Lonie & Purser, 2017). Financial capacity is a person's capability to administer her or his own property, including finances, in keeping with that individual's own interests, morals, beliefs, and general approach to life (Marson, 2013). It underpins many estate planning mechanisms, such as wills, enduring powers of attorney, trusts, superannuation, corporate structuring and property transactions.
A Medical Incapacity Hold Policy Reduces Inappropriate Use of Involuntary Psychiatric Holds While Protecting Patients From Harm
2019, PsychosomaticsCitation Excerpt :Use of IPHs to detain patients with no mental disorder other than a major neurocognitive disorder is permissible in some states (e.g., Wisconsin), whereas other states (e.g., Delaware, Washington state) explicitly prohibit this. Further compounding the problem is that in many states, including California, the probate conservatorship process for a patient with a major neurocognitive disorder is separate and distinct from the conservatorship process for a patient with a mental disorder.28–33 Clinical experience tells us that patients with an acute behavioral disturbance related to a major neurocognitive disorder are frequently treated in both medical and psychiatric facilities.34,35