I Mind My Own Business and Expect Others to Do the Same: Conversations About Declining Financial Capacity

Abstract Introduction One of the smartest ways to prepare for declines in financial decision making capacity is to appoint an agent under power of attorney for finances and to share important financial information and preferences with trusted family or friends. Yet only 12% of older Americans with children think that they’ll need help with their finances as they age, and more than half are uncomfortable talking about their finances with children. Method: We conducted four in-depth interviews with older adults and four focus groups with Black, Latino, low income, and low-middle income adults aged 65 and older. An average of 9 participants were in each 2-hour focus group. Results Barriers included lack of awareness, denial of future changes in capacity, lack of trustworthy surrogate decision-makers, shame about one’s financial situation, desire for privacy, fear of being a burden, and resistance to overtures by children. Barriers differed by ethnicity and socioeconomic status, with lower income older adults having less knowledge of advance planning and Powers of Attorney. Implications: Significant education is needed around Powers of Attorney and how to begin the advance planning process. Study findings informed the Thinking Ahead Roadmap, a guide to facilitate planning and communication around future money management. The Roadmap uses an empowerment framework to motivate individuals to appoint trusted financial advocates and prepare them for a smooth transition in money management, thereby reducing risk of exploitation, costly mistakes, and family conflict.

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Prevalence of frailty and prefrailty among community-dwelling older adults in low-income and middle-income countries: a systematic review and meta-analysis

BMJ Open ◽

10.1136/bmjopen-2017-018195 ◽

2018 ◽

Vol 8 (3) ◽

pp. e018195 ◽

Cited By ~ 68

Author(s):

Dhammika D Siriwardhana ◽

Sarah Hardoon ◽

Greta Rait ◽

Manuj C Weerasinghe ◽

Kate R Walters

Keyword(s):

Older Adults ◽

Low Income ◽

Meta Analysis ◽

Community Dwelling ◽

Low Income Countries ◽

Middle Income ◽

Middle Income Countries ◽

Pooled Prevalence ◽

Registration Number ◽

Community Dwelling Older Adults

ObjectiveTo systematically review the research conducted on prevalence of frailty and prefrailty among community-dwelling older adults in low-income and middle-income countries (LMICs) and to estimate the pooled prevalence of frailty and prefrailty in community-dwelling older adults in LMICs.DesignSystematic review and meta-analysis. PROSPERO registration number is CRD42016036083.Data sourcesMEDLINE, EMBASE, AMED, Web of Science, CINAHL and WHO Global Health Library were searched from their inception to 12 September 2017.SettingLow-income and middle-income countries.ParticipantsCommunity-dwelling older adults aged ≥60 years.ResultsWe screened 7057 citations and 56 studies were included. Forty-seven and 42 studies were included in the frailty and prefrailty meta-analysis, respectively. The majority of studies were from upper middle-income countries. One study was available from low-income countries. The prevalence of frailty varied from 3.9% (China) to 51.4% (Cuba) and prevalence of prefrailty ranged from 13.4% (Tanzania) to 71.6% (Brazil). The pooled prevalence of frailty was 17.4% (95% CI 14.4% to 20.7%, I2=99.2%) and prefrailty was 49.3% (95% CI 46.4% to 52.2%, I2=97.5%). The wide variation in prevalence rates across studies was largely explained by differences in frailty assessment method and the geographic region. These findings are for the studies with a minimum recruitment age 60, 65 and 70 years.ConclusionThe prevalence of frailty and prefrailty appears higher in community-dwelling older adults in upper middle-income countries compared with high-income countries, which has important implications for healthcare planning. There is limited evidence on frailty prevalence in lower middle-income and low-income countries.PROSPERO registration numberCRD42016036083.

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Race/Ethnicity, Socioeconomic Status, and Polypharmacy among Older Americans

Pharmacy ◽

10.3390/pharmacy7020041 ◽

2019 ◽

Vol 7 (2) ◽

pp. 41 ◽

Cited By ~ 2

Author(s):

Assari ◽

Bazargan

Keyword(s):

Older Adults ◽

Marital Status ◽

Low Income ◽

Healthy Aging ◽

Female Gender ◽

Education Attainment ◽

Older Americans ◽

Racial And Ethnic Differences ◽

Race Ethnicity ◽

Nationally Representative

Background: Very few studies with nationally representative samples have investigated the combined effects of race/ethnicity and socioeconomic position (SEP) on polypharmacy (PP) among older Americans. For instance, we do not know if prevalence of PP differs between African Americans (AA) and white older adults, whether this difference is due to a racial gap in SEP, or whether racial and ethnic differences exist in the effects of SEP indicators on PP. Aims: We investigated joint effects of race/ethnicity and SEP on PP in a national household sample of American older adults. Methods: The first wave of the University of Michigan National Poll on Healthy Aging included a total of 906 older adults who were 65 years or older (80 AA and 826 white). Race/ethnicity, SEP (income, education attainment, marital status, and employment), age, gender, and PP (using 5+ medications) were measured. Logistic regression was applied for data analysis. Results: Race/ethnicity, age, marital status, and employment did not correlate with PP; however, female gender, low education attainment, and low income were associated with higher odds of PP among participants. Race/ethnicity interacted with low income on odds of PP, suggesting that low income might be more strongly associated with PP in AA than white older adults. Conclusions: While SEP indicators influence the risk of PP, such effects may not be identical across diverse racial and ethnic groups. That is, race/ethnicity and SEP have combined/interdependent rather than separate/independent effects on PP. Low-income AA older adults particularly need to be evaluated for PP. Given that race and SEP have intertwined effects on PP, racially and ethnically tailored interventions that address PP among low-income AA older adults may be superior to universal interventions and programs that ignore the specific needs of diverse populations. The results are preliminary and require replication in larger sample sizes, with PP measured directly without relying on individuals’ self-reports, and with joint data collected on chronic disease.

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INCREASING VULNERABILITY AMONG OLDER AMERICANS ACT HOME-DELIVERED NUTRITION SERVICE CLIENTS

Innovation in Aging ◽

10.1093/geroni/igz038.3432 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S944-S944

Author(s):

Kristen N Robinson ◽

Heather L Menne

Keyword(s):

Older Adults ◽

Low Income ◽

Living Arrangements ◽

Food Stamps ◽

Demographic Shift ◽

Poverty Level ◽

Older Americans ◽

Nutrition Services ◽

Older Americans Act ◽

Nutrition Service

Abstract Older Americans Act (OAA) programs are designed to help frail and vulnerable older adults remain in their homes through the provision of long-term services and supports. Administrative data from the Administration for Community Living (ACL) show that older adults receiving OAA services are three times more likely to live below the poverty level (33.0%) as compared with all older adults (9.2%). In addition, they are almost twice as likely to be living alone (45%) as compared with the general population (28%). Using data from the recently released 2018 National Survey of Older Americans Act Participants, we examine the largest program administered by ACL, the OAA Nutrition Program, to see if the economic vulnerability of home-delivered nutrition service clients has changed over the past 10 years. Results from this study show that recipients of home-delivered nutrition services are more in need of low-cost or free meals in 2018 than they were in 2008 due to a 24% increase in Medicaid eligibility, 41% increase in those who report not having enough money or food stamps to buy food, and 101% increase in those who report receiving food stamps. This increase in economic need may be due to a demographic shift in the marital status and living arrangements of older adults, specifically the 75-84 age group. The increase in the percentage of older adults who are divorced, live alone, and have low income has made the home-delivered nutrition services program even more important today than it was a decade ago.

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Abuse of Vulnerable Older Adults by Designated Surrogate Decision Makers

Innovation in Aging ◽

10.1093/geroni/igaa057.2467 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 702-703

Author(s):

Cory Bolkan ◽

Pamela Teaster ◽

Holly Ramsey-Klawsnik ◽

Kenneth Gerow

Keyword(s):

Older Adults ◽

Reliable Data ◽

Decision Makers ◽

Community Settings ◽

Power Of Attorney ◽

Protective Services ◽

Adult Protective Services ◽

Surrogate Decision Makers ◽

Surrogate Decision ◽

Vulnerable Adults

Abstract Abuse perpetrated by designated surrogates has become highly visible nationally, yet no reliable data exist on its nature or extent. Because vulnerable older adults needing surrogate decision makers typically rely upon others for care, they may be unable to advocate for themselves and are susceptible to abuse. We prospectively gathered Adult Protective Services (APS) data from six geographically diverse counties on over 400 substantiated cases of abuse by perpetrators (53% non-surrogates; 47% documented or claimed surrogate) of vulnerable adults 65+ living in community settings. Most perpetrators (85%) were designated power of attorney, while approximately 8% were guardians, and 7% were representative payees; most perpetrators were family members. Polyabuse occurred frequently. Almost 25% of cases involved a prior substantiated APS report. This presentation highlights how surrogates perpetuate abuse and outcomes on older adult victims. Our findings inform practice and policy for better prevention, detection, investigation, and intervention in these challenging cases.

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Pathways to and Consequences of Surrogate Decision-Making for Older Adults

Innovation in Aging ◽

10.1093/geroni/igaa057.2466 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 702-702

Author(s):

Pamela Teaster ◽

Cory Bolkan ◽

Shawn Meyers

Keyword(s):

Older Adults ◽

Decision Making ◽

Elder Abuse ◽

Decision Makers ◽

Surrogate Decision Making ◽

Protective Services ◽

Older Americans ◽

Adult Protective Services ◽

Surrogate Decision Makers ◽

Surrogate Decision

Abstract With a burgeoning aging population, there is a growing need for surrogate decision makers, yet oversight of and guidance for them remains inadequate. People needing surrogate decision makers are an especially vulnerable population because they rely on others for care and/or are unable to advocate for themselves. Their vulnerability leaves them susceptible to elder abuse (e.g., physical, sexual, psychological abuse; active and passive neglect; financial exploitation), which affects approximately five million older Americans each year. Personal, financial, and societal impacts can be devastating and are estimated to cost billions annually. The issue of abuse, neglect and exploitation by surrogates has been highly visible nationally, evidence indicates that some surrogate decision makers perpetrate abuse. One purpose of this symposium is to discuss ways in which surrogates do and do not make decisions for older adults. Ramsey-Klawsnik and Burnett present data at the systemic level to illustrate how self-neglect sequelae can result in placement under surrogate decision-making authority of either well-intended or opportunistic others. Bolkan, Teaster, Ramsey-Klawsnik, and Gerow present findings from a six-state study on surrogate decision maker victims and perpetrators who were substantiated in Adult Protective Services cases. Zhao, Katz, and Teaster show, using a survey of M-Turk participants, how a general population makes and is comfortable with surrogate decisions. Discussant Shawn Meyers will pull together the findings by exploring their translation to judicial best practices for making determinations regarding surrogate decision makers and the effects of their decisions on the surrogate as well as collaterals.

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