Sunday Times

Banks should in­ter­vene when clients are im­paired

- By ALI­SON BENZIMRA Mental Health · Psychiatry · Health Conditions · Mary I of Scotland · World Health Organization · University of Pennsylvania · Pennsylvania · United States of America · Monitor · Aging · Neurology · Lee Miller · Lee · Kate Brown

● Mary* lived in­de­pen­dently in a re­tire­ment vil­lage. She man­aged her house and en­joyed an ac­tive so­cial life.

Sarah*, Mary’s niece, started to no­tice that her aunt’s be­hav­iour had be­come pe­cu­liar. Mary bought a new red couch when her ex­ist­ing one was still new. Then she de­cided to buy a power-lift mas­sag­ing arm­chair cost­ing R38,000. Mary had never be­fore made such rash pur­chases.

Sarah was per­plexed by Mary’s de­ci­sions, but rea­soned that Mary had a right to buy a red couch and an arm­chair. How­ever, when Sarah found out Mary’s phar­macy ac­count was five months in ar­rears, she knew some­thing was wrong. Mary had al­ways been fas­tid­i­ous about keep­ing her fi­nan­cial af­fairs in order.

Shortly af­ter­wards, Mary was di­ag­nosed with de­men­tia.

Mary is one of an es­ti­mated 2-mil­lion South Africans liv­ing with de­men­tia. The num­ber of such peo­ple in Sub-Sa­ha­ran Africa could swell to 7.62-mil­lion by 2050, ac­cord­ing to the World Health Or­gan­i­sa­tion, yet no de­men­tia ini­tia­tives have been es­tab­lished by any coun­try in the re­gion.

De­men­tia is a gen­eral term for mem­ory loss due to dam­age or dis­ease of parts of the brain used for learn­ing, rea­son­ing, de­ci­sion-mak­ing and lan­guage. It is a de­gen­er­a­tive con­di­tion which in­ter­feres with a per­son’s daily life. Alzheimer’s dis­ease is the most com­mon form of de­men­tia. It is a pro­gres­sive con­di­tion which ini­tially im­pairs a per­son’s abil­ity to man­age com­plex tasks, such as work or man­ag­ing fi­nances, to ul­ti­mately re­sult­ing in a per­son re­quir­ing help in daily tasks such as bathing, dress­ing and feed­ing.

The risk of de­vel­op­ing de­men­tia dou­bles roughly every five years. It is es­ti­mated that de­men­tia af­fects one in 14 peo­ple over 65 and one in six over 80. De­spite ad­vanced old age be­ing one of the big­gest risk fac­tors for de­men­tia, it is not a nor­mal part of age­ing.

One of the first signs of de­men­tia is a de­cline in fi­nan­cial ca­pac­ity. Some in­di­vid­u­als may have the dis­ease for three to five years be­fore be­ing clin­i­cally di­ag­nosed. They and their fam­i­lies may not be aware that their de­ci­sion-mak­ing ca­pac­ity is im­paired. Red flags in­clude large ATM with­drawals, trans­fers of large sums, re­peat­edly for­get­ting PIN num­bers and non­pay­ment of bills.

Dr Lee Miller, a GP serv­ing Ron­de­bosch’s older pop­u­la­tion, says she sees such be­hav­iour all the time. “Most of my pa­tients who have de­men­tia show it through the fi­nan­cial stuff. I would say at least 70%.”

As a re­sponse to this phe­nom­e­non, Dr Ja­son Kar­law­ish at the Univer­sity of Penn­syl­va­nia in the US, de­vel­oped the con­cept of “whealth­care”, which pro­poses that not only doc­tors but the bank­ing and fi­nan­cial ser­vices in­dus­try should be alert to pick­ing up signs of cog­ni­tive im­pair­ment.

Kate Brown, a fi­nan­cial ad­viser with a spe­cial in­ter­est in late-stage re­tire­ment plan­ning, says fi­nan­cial plan­ners who meet their clients reg­u­larly may no­tice not only a ret­i­cence to deal with fi­nan­cial matters but also other changes in the af­fected clients’ out­look and abil­i­ties. If her team mem­bers feel that a client is ex­hibit­ing signs of cog­ni­tive im­pair­ment, they en­cour­age the client’s adult child or trusted fam­ily mem­ber or friend to ac­com­pany the older client to their next re­view.

“Our aim is for the client to re­main as in­de­pen­dent as pos­si­ble for as long as pos­si­ble but to ease the tran­si­tion to ac­cept­ing help from a fam­ily mem­ber.”

It is es­sen­tial at this stage that power of at­tor­ney, cu­ra­tor­ship and ad­min­is­tra­tion are dis­cussed. “Men­tal ca­pac­ity of­ten de­clines in waves,” Brown says. “The per­son may un­der­stand the mat­ter in hand and be able to dis­cuss pref­er­ences and make a de­ci­sion, but they may not be able to re­call this the next day.

“As ca­pac­ity de­creases it be­comes im­por­tant to en­sure that all the rel­e­vant in­for­ma­tion and con­se­quent de­ci­sions are writ­ten down.”

Those work­ing with de­men­tia suf­fer­ers have rec­om­mended that the bank­ing and fi­nan­cial sec­tors:

● Use fi­nan­cial data and an­a­lyt­ics for early de­tec­tion. Mon­i­tor trans­ac­tion ac­tiv­ity that is not con­sis­tent with reg­u­lar be­hav­iour.

● Train staff to de­tect and re­spond. Train­ing should cover warn­ing signs that may sig­nal fi­nan­cial ex­ploita­tion, in­clud­ing be­hav­iour and trans­ac­tions that are red flags, and steps to pre­vent ex­ploita­tion.

● En­able older ac­count hold­ers to pro­vide ad­vanced con­sent to shar­ing ac­count in­for­ma­tion with a des­ig­nated, trusted third party. Of­fer opt-in ac­count fea­tures such as cash with­drawal lim­its, ge­o­graphic trans­ac­tion lim­its, alerts for spec­i­fied ac­count ac­tiv­ity, and view-only ac­cess for au­tho­rised third par­ties.

● Pro­vide con­sumers with in­for­ma­tion about plan­ning for in­ca­pac­ity. Out­line pow­ers of at­tor­ney, cu­ra­tor­ship and ad­min­is­tra­tion.

● Ed­u­cate older ac­count hold­ers and the pub­lic about de­men­tia and par­tic­i­pate in mul­ti­dis­ci­plinary net­work ini­tia­tives.

De­men­tia is not just an in­di­vid­ual, fam­ily or health-sys­tem chal­lenge. It af­fects the fab­ric of so­ci­ety and re­quires ac­tion by many and var­ied stake­hold­ers.

‘Whealth­care’ pro­poses that banks should be alert to odd be­hav­iour in cus­tomers

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