February 16, 2023

The Case for Signing a Power of Attorney

The best reason to set up a power of attorney for yourself or an elderly family member is to avoid a far more contentious and expensive alternative later: guardianship.

A power of attorney becomes urgent if an elderly family member is showing early signs of dementia. “You want to run, not walk, to get that done because capacity tends not to get better,” said Jonathan Williams, an attorney with the Clarity Legal Group in the Raleigh-Durham, N.C., area.

“Having good legal documents in place, if the person has the ability to execute them, can be helpful later on,” he said.

In a power of attorney, the person signing the document agrees to name an agent, usually a trusted family member or caregiver, who can take care of legal and financial matters in the event she can no longer do so herself. A power of attorney does not put any constraints on what the signer is currently able to do. She can continue to write checks, enter into real estate transactions, and make investment decisions.

During a recent webinar sponsored by the Duke Dementia Family Support Program, Williams explained some of the legal “gray areas” that can crop up around powers of attorney.

Even if someone is showing cognitive decline, a power of attorney may still be possible if an attorney “can be convinced in a conversation that the person we’re working with has an adequate understanding of the consequences of their signing it, even if that understanding is later lost or forgotten,” he said.

“Just because someone has been diagnosed with a cognitive impairment doesn’t mean they lack the legal capacity to act for themselves.” In this case, the attorney might have to consult with the person’s medical provider or review medical records before deciding what to do about a power of attorney.

But convincing an attorney in these situations isn’t a sure bet, and time is of the essence. Once someone becomes fully incapacitated, the only option may be guardianship, which Williams called a “blunt force tool with a lot of collateral effects.” …Learn More

October 14, 2021

Caregivers Lament Elderly’s COVID Isolation

The magnitude of the tragedy is unfathomable: Americans have lost nearly 187,000 family members living in nursing homes to COVID-19.

Even when residents survive outbreaks in the facilities, their family caregivers experience trauma. Barred from visiting residents during the lockdowns, caregivers observed – on Zoom, over the phone, or from the other side of a nursing home window – loved ones suffering from the devastating impact of isolation.

“To think in her final year[s] when she is most vulnerable and most in need of love and support from her children and was denied this for 6 months is in my opinion devastating,” one caregiver said in a survey of 518 caregivers, the vast majority of them women and mainly daughters.

Granted, nursing homes – and the entire country – were not prepared for a once-in-a-century pandemic that has been difficult to control, given that COVID-19 is often asymptomatic. The lockdowns were a health precaution. Many nursing homes were also put in an untenable position when COVID-19 created staff shortages as nursing assistants and other workers took time off after contracting the disease or simply quit their jobs. And perhaps better communication between nursing home staff and family members would have eased some of the concerns.

Nevertheless, the caregivers’ perceptions of what unfolded inside nursing homes are alarming. “Anger,” “helplessness” and “heartbreak” were common reactions, conveyed in the survey compiled in the Journal of Aging & Social Policy.

The situation became so untenable for 30 of the caregivers surveyed that they pulled their parent or family member out of a facility and brought them home to live with them.

Four themes pervaded their descriptions of what their loved ones were going through: social isolation, cognitive and emotional decline, inhumane care, and a lack of oversight at the long-term care facilities.

The source of many caregivers’ concerns were nursing homes’ decisions to confine residents to their rooms to prevent contagion. But one caregiver said that while her mother’s facility went to great lengths to keep her healthy, the staff did little to ease her isolation: “Almost no effort has been made to ensure [her] mental health due to the isolation. Staff rarely stay and visit with Mom, no special in-room activities or stimulation has been attempted.” …Learn More

September 28, 2021

Retirees Can’t Afford Hearing, Dental Care

Hearing loss can amplify cognitive decline by isolating retirees and forcing them to divert precious brain power to participate in a conversation. People who lose teeth have trouble eating, sacrificing their health. And poor vision, uncorrected by cataract surgery or the proper magnification in eyeglasses, is dangerous when driving at night.

These problems are facts of aging. But Medicare doesn’t cover their often-expensive solutions such as hearing aids, dental implants, or eyeglasses. A report by the Kaiser Family Foundation identified a gap between need and access is wide.

Among the 16 percent of Americans over 65 who said in a survey that they couldn’t get hearing, dental or vision services, nearly three out of four couldn’t afford them.

Three charts, based on Kaiser’s analysis of the survey data, show the average out-of-pocket spending for hearing and dental care was around $900 for the Medicare beneficiaries who used the services in 2018. The cost of vision care was significantly less, averaging $230.

Retirees usually don’t need all three services in a single year. For example, dental implants cost thousands of dollars, and an individual might get one or two in a lifetime. But when retirees do get the expensive dental care, a new Kaiser report shows the bill can really pack a wallop – and become an obstacle to getting the necessary care. …Learn More

August 3, 2021

Video: Secrets to Protect Your Aging Brain

Just a few weeks after my 64^th birthday, I discovered an interesting video. The timing couldn’t have been better.

The topic: maintaining brain health as we age. This video has tips, based on research, for preserving or improving memory and reducing brain inflammation, which is a culprit in cognitive decline.

“Daily lifestyle habits have a much bigger impact on your longevity than your genes,” Dr. Gary Small, former director of UCLA’s Semel Institute for Neuroscience and Human Behavior, explains in the video.

Did you know that Indian people have less dementia, because they eat so much turmeric in their curries? Or that a brisk 20-minute walk every day lowers the risk of Alzheimer’s disease? Most people know that yoga, meditation and tai-chi reduce stress, but did you know that stress is, according to Dr. Small, “the enemy of healthy aging”?

His message is encouraging: there are things you can control to help you live a good life in old age. “It’s easier to protect a healthy brain than to repair the damage,” he said. …Learn More

April 15, 2021

First, Money Woes. 6 Years Later, Dementia

My 85-year-old mother is on top of her bills. She pays several of them online, which is impressive enough, and she knows which bill is due when.

So, we should both take some comfort in the fact that she is not having difficulty managing her money, which is an early sign of dementia.

The connection between poor money management and declining cognitive capacity was established in research years ago. An obvious next question – when does this early warning system kick in? – is answered in The Journal of the American Medical Association.

The researchers followed more than 81,000 men on Medicare for more than a decade and linked their medical records to their Equifax credit reports. The men who would eventually be diagnosed with Alzheimer’s disease or dementia started missing the due dates on their bills about six years before the diagnosis.

There are many reasons for the gap between signs of trouble and an actual diagnosis. If family don’t detect a decline in cognitive ability, they won’t ask a doctor to administer a dementia test. Family might confuse early-stage dementia with memory loss, which is a natural part of aging. One financial manager said some of her clients try to hide that they’re having trouble handling their finances – or “do not want to admit the problem to themselves.”

If dementia goes undiagnosed, the financial problems get worse. A second finding in the study was that about 2½ years prior to a dementia diagnosis, retirees’ credit scores were much more likely to slip to subprime levels, or below 620 points. …Learn More

March 18, 2021

Retirees Who Tested Well Added More Debt

A new study finds that debt burdens have grown for older workers and retirees in recent decades. But this isn’t the first research to reach that conclusion.

What is new is whose debt burden is increasing the most: the people who score higher on simple memory and math tests.

Across the three age groups the researchers examined – 56-61, 62-67, and 68-73 – the high scorers on the cognitive tests were more likely to have debts exceeding half of their assets in 2014 than the high scorers who were the same ages back in 1998.

They also added disproportionately more mortgage debt than people with lower cognition during the study’s time frame, a period when house prices were rising.

The upshot of this study is that people who have retained more of their memory and facility with numbers are “more financially fragile” than the high scorers were in the past, the University of Southern California researchers said.

The findings run counter to a common belief that financial companies in recent years have had more success selling their increasingly complex products to unwitting borrowers – a belief perhaps fostered by the subprime mortgages targeted to risky borrowers in the mid-2000s that triggered the global financial collapse.

The share of the older people in the study who were carrying debt increased between 1998 and 2014 regardless of their cognitive ability. The biggest jump occurred after 62 – a popular retirement age pegged to Social Security eligibility.

The heart of the analysis, however, is exploring the connection between cognitive ability and financial vulnerability. The researchers found the opposite of what one might expect: debt problems have loomed larger over time for those with higher scores on survey questions testing word recall and cognitive ability using simple subtraction and backward-counting exercises. …
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November 10, 2020

Does Retiring Cause Memory Loss?

After four or five decades of work, retirement is liberating! It’s gonna be great! Right?

Well, not necessarily. It depends on how you retire.

In this video, Ross Andel, director of the School of Aging Studies at the University of South Florida, warns that a risk to retiring is that it can “speed up the aging of our brain. It could make us slower and more forgetful.”

His research demonstrates how work and retirement influence brain functioning. He tested the memories of people in their early 60s living in Canberra, Australia. Every four years, they were asked to remember as many random and unrelated words in a list as they could.

Naturally, they couldn’t remember as many words at 74 as at 62. “This is quite normal,” he said.

More interesting was what Andel found when he separated the test results for the retirees from the results for the older individuals who were still working. The decline in memory was almost exclusively among the retirees.

“Something seems to happen around the time of retirement to make people more forgetful,” he said.

Andel isn’t recommending that you work until you drop. He does provide a roadmap for limiting memory loss so you can enjoy retirement.

To find out what he has in mind, you’ll have to watch the video. …Learn More