Good New Idea: Age-Associated Financial Vulnerability (AAFV)
We believe that AAFV is a problem with serious effects on patients, their families, and society. Its roots reside in the curious intersection of several trends, including a rapidly aging society, age-associated changes in the human brain, shifts in the concentration of wealth to older demographic groups, and industry’s adoption of marketing strategies that are increasingly becoming rooted in behavioral economics and cogni-tive neuroscience.
Given the public health and policy implications of AAFV, a rigorous debate must begin on how to balance protection of older adults with the autonomy afforded to all citizens.
Various processes common in the aging brain may affect an older adult’s ability to manage personal finances, the most recognized of which are dementing illnesses. These conditions can affect cognitive abilities, which may jeopardize an older adult’s financial well-being over their longitudinal course. However, recent studies suggest that even cognitively intact older adults can have “functional” changes that may render them financially vulnerable.
“…age-associated financial vulnerability (AAFV) …considering AAFV a clinical syndrome may be advantageous to further critical research, promote public policy work, and encourage physicians to recognize it.
AAFV as a pattern of financial behavior that:
- places an older adult at substantial risk
- for a considerable loss of resources
- such that dramatic changes in quality of life would result and
- that is inconsistent with previous patterns of financial decision making during younger adult life.
This condition can occur in the absence of dementia or other neurodegenerative diagnoses and may or may not be the presenting manifestation of such illnesses.
First, it emphasizes that clinically relevant AAFV behaviors must affect quality of life.
Second, the requirement that these behaviors be of recent onset and differ from previous financial decision-making patterns excludes patients who had poor premorbid financial literacy and decision making in the same way that dementia diagnoses require that cognitive impairment be “acquired.”
The stipulation that AAFV need not be the presenting manifestation of new or established dementia likens it to such conditions as mild cognitive impairment, in which impairment is measurable. However, AAFV differs from this condition because cognitive impairment is not necessary for AAFV, as government case reports of financial exploitation among older adults have documented.
The stipulation that AAFV need not be associated with cognitive impairment differentiates research on this condition from previous work that has focused on cognitive impairment as the driving force for financial vulnerability. Age-associated financial vulnerability and financial exploitation can be linked—AAFV may predispose an older adult to financial exploitation—however, we perceive them as conceptually different.
Age associated financial vulnerability focuses on a potential condition that may have multiple causes and ultimately may or may not lead to exploitation. We view financial exploitation as focusing on specific mechanisms that drive a particular outcome, often consisting of intentional or forceful methods of exploitation. In this sense, persons who do not show AAFV can be victims of financial exploitation. More is known about the effects of financial exploitation; less is known about AAFV because we believe that this concept is new.
EPIDEMIOLOGY OF AAFV: PREVALENCE AND RISK FACTORS
… 4.7% …reported experiencing some form of financial exploitation since turning age 60 years. This estimate is probably conservative…In addition, although not all financially vulnerable older adults are exploited, those with AAFV may lack insight into their vulnerability and are therefore unlikely to self-report…. In addition to cognitive impairment, social isolation is a risk factor because isolated persons may engage exploiters in a misguided attempt to cultivate social connections and these persons lack friends or family who could recognize evolving AAFV to mitigate or report it. Illness can also contribute to AAFV because desperate patients may be rendered susceptible to sham