Money and Cognitive Impairment

Eric Widera and colleagues have an interesting paper in JAMA this week on the role of the primary care physician in assessing and addressing financial competence among older patients with cognitive impairment. Older persons with dementia eventually lose their ability to comprehend and weigh the impact of financial decisions, and physicians may be uniquely situated to identify when such patients can no longer make such decisions, and they are increasingly looked to by patients and families for help in such cases. This has not historically been seen as the role of the physician, and most physicians are not be trained to address these issues.

Widera and colleagues note several roles of the primary care physician in assessing and addressing the degree to which cognitively impaired patients need assistance in dealing with money and the making of similar important decisions. 3 key roles noted for primary care physician in the patient with dementia stand out to me:

• educating patients about the need to plan ahead for such eventualities
• recognizing signs of financial incapacity
  
• knowing where and when to refer patients for other services, be they medical or legal

The key point seems to be the need of primary care physicians to plan ahead and anticipate the eventual loss of financial decisionmaking at the first signs of cognitive decline and dementia. These issues are best dealt with earlier in the disease process than later. In an accompanying editorial, Charles Sabatino, JD says,

"In an aging society, all professionals serving older adults have an obligation to understand diminished decisional capacity, especially with respect to financial issues, and to acquire the basic skills to identify it and respond constructively to it. Failure to meet the challenge will only increase the potential for financial abuse and exploitation."