Sizing Up the Decisions of the Elderly

At a recent Zoom meeting, four adults defending California workers, using a tool called Interview for Decisional Abilities, or IDA, tried to find out if anything had happened. with an 82-year-old woman known as Ms. K.

The Centers for Disease Control and Prevention in each state receives reports of neglect, neglect, abuse or abuse of the elderly and other adults. that is problematic. But the staff of the organization is faced with an unrealistic question: Can the adults in the question make decisions about their health, lifestyle or finances? – even if it is not a decision that a family, doctor or financial advisor thinks should be made?

IDA was created by two geriatricians to help train Adult Protective Workers in solving this problem. The program helps them learn to use the interview process to gather information about the consumer’s ability to make decisions. Two of the twelve California-based staff who have taken the course have already completed 10 hours of one-on-one online tutoring; Now they are practicing their new interviews in small groups, playing with advisors.

Ms. K, a mischievous character, was played by Bess White, special director of Weill Cornell Medicine. In the incident, the bank manager reported some skepticism: Ms. K has $ 60,000 in savings but his deductions have increased, from $ 600 a month to $ 600 a week. A young man – his grandson, he said – started with him going to the bank, where the coach felt the man seemed controlling and threatening. The researcher who visited Ms. K at school knew that his debit card alone had expired and that he had little money.

But Ms. K refuses to accept financial expenses; her grandson lives with her, she said, and helps with work and rides to the doctor. He used the bank to buy food.

In the exercise, one of the APS students acknowledged that Ms. K gets the key idea of ​​spending money. Ms. K has heard stories of deception from the media, he said. And yes, he understands that a friend or relative can be the same.

Therefore, the interviewer continued: “What do you think would happen if someone took someone else’s money without permission?”

Ms. White, in the role of Ms. K, replied: “I think the person can pick it up and carry it until there is nothing left.” But when the interviewer further examined to find that Ms. K understands that he himself may face this risk, he said. She trusts her grandson, Ms. K says; he did not want to be mad at her.

IDA was developed by Dr. Mark Lachs, director of geriatrics and palliative medicine at Weill Cornell Medicine, and his colleagues, and by Dr. Jason Karlawish, a geriatrician and director of the Penn Memory Center. “People have the right to make bad decisions,” he said. Lachs said in an interview. However, he added, decision makers need to be able to understand the risks they face and the risks that may arise.

“How can you walk into a brokerage office at the age of 90 and say, ‘I’re had a fortune for 50 years but now I want to put my last $ 200,000 in Bitcoin ‘- and no one raised an eyebrow? ” Dr. Lachs said. “We’re going to look at this and say, ‘What do we think?”

With the application of IDA for incidents of financial neglect or abuse, California APS staff have used it to assess a wide range of issues including personal neglect, dietary questions health and safety, denial of physical or medical care, and physical or mental abuse or sexual harassment. .

Dr. “It’s not about replacing a psychiatrist, but it tells you when to call a psychiatrist,” Lachs said. Lachs said. Consumers whose ITA interviews indicate an inability to understand the risks or outcome should be fully evaluated, he added.

To date, approximately 500 APS employees – in New York City, Massachusetts and two states in California – have been trained and certified. Kansas APS staff will receive training this summer.

But Dr. Lachs and Karlawish think IDA could be used more widely. Lawyers for real estate and real estate companies have asked them about it.

Outpatient plans can use IDA to determine if a patient can be asked to return home rather than be rehabilitated. A living support service can call Dr. Lachs, would like to know if IDA can help ensure that newcomers understand the complex agreements they have signed.

The IDA interview tries to answer three important questions about a problem or risk, Dr. Karlawish said: “Did you know that this is happening? Do you think this will happen to you? Can you come up with an idea to solve it, consider and measure the pros and cons?

Depending on the severity of the problem, people who are diagnosed with a disability or even dementia may still have insufficient understanding to deal with it.

Someone who finds that our understanding during the IDA interview may be able to make decisions – including decisions that do not solve the problem. A person who does not understand needs more evaluation, perhaps including consultation with family members or social services agencies. In extreme cases, it may result in end-of-life care or supervision.

Financial solutions are often an early warning of inefficiency, says Dr. Daniel Marson, a neuropsychologist at the University of Alabama at Birmingham who has been studying for 25 years.

“Financial capacity is the primary higher function that is affected by neurodegenerative diseases and by natural aging,” he said. Spending money to make a profit can be a daunting task, from “something as simple as using an ATM for something more difficult, such as ‘How can I get a call?’ is this from a telephone business? ‘”The benefits of reduced investment – poor living conditions, poverty, homelessness. , institutionalization – can cause damage.

Although the incidence of dementia has declined in the United States and Europe, the aging of these people means that more people will develop it.

Moreover, in research for years, Dr. Marson and colleagues found that adults who underwent minor diagnoses – often a precursor to dementia – were also finding it harder. He said “there was a sense of financial decline over time,” he said.

Other organizations have tried to address the issue of reduced ability to make decisions. The American Bar Association last year revised its “Assessing the Elderly with Poverty: A Guide for Lawyers.” The Bar Association and the American Psychological Association have also published a guidebook for judges and psychiatrists.

The Financial Services Commission, or FINRA, has published online courses on the finances of seniors and other affected investors. Its rules allow a company to engage in temporary handling of transactions and payments when it believes there is a risk. It also allows company members to ask investors for a “trustworthy person” to discuss what might be considered a concern.

The IDA program is focusing on the current APS staff because “the agency has always had understaffed, incompetent and hostile staff,” Dr. Karlawish said. California APS agencies care about 30,000 patients a month, according to state records, and “have been asked to determine the capacity of the chair of the department. Mental hospitals can be difficult, ”Dr. Lachs said.

California staff at Training Zoom, gently asked Ms. White – According to Ms. K – how he would respond to the bank president’s skepticism, finally concluding that he did not need professionalism. It turns out that he understands his options.

Giving his grandson access to his savings account may not be the best option. But the decision is his.

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