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Tsiakiri A, Trypsiani I, Christidi F, Trypsianis G, Bakirtzis C, Vlotinou P, Tsiptsios D, Voskou P, Papageorgiou S, Aggelousis N, Vadikolias K, Serdari A. The testamentary capacity in acute stroke. A cross-sectional study. APPLIED NEUROPSYCHOLOGY. ADULT 2024:1-11. [PMID: 38447221 DOI: 10.1080/23279095.2024.2324126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
Succession law, which governs the creation and validity of wills, is closely tied to testamentary capacity (TC), the cognitive competence required for a valid will. This study explores TC in acute stroke patients and its connections to demographic and clinical characteristics. The research included first-time stroke patients admitted within 24 hours of symptom onset, meeting specific criteria. Data were collected, and assessment tools like the Addenbrooke's Cognitive Examination III (ACE-III) and Testamentary Capacity Assessment Tool (TCAT) were used. The study found that TCAT scores were not significantly affected by age or gender but positively correlated with education, the Barthel Index and ACE-III scores. They were negatively associated with National Institutes of Health Stroke Scale (NIHSS) and Modified Rankin Scale (mRS) scores. Specific cognitive domains, particularly memory and attention, were independent determinants of TCAT scores. This research introduces TCAT as a valuable tool for evaluating testamentary capacity in stroke patients and highlights the multifaceted nature of TC, emphasizing the need for a nuanced approach. As the population ages and complex medical conditions become more prevalent, understanding the interplay between cognitive functioning and testamentary capacity becomes increasingly crucial for both legal and medical professionals.
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Affiliation(s)
- Anna Tsiakiri
- Neurology Department, Democritus University of Thrace, Alexandroupolis, Greece
| | - Ioanna Trypsiani
- Neurology Department, Democritus University of Thrace, Alexandroupolis, Greece
| | - Foteini Christidi
- Neurology Department, Democritus University of Thrace, Alexandroupolis, Greece
| | - Gregory Trypsianis
- Laboratory of Medical Statistics, Democritus University of Thrace, Alexandroupolis, Greece
| | - Christos Bakirtzis
- B' Department of Neurology and the MS Center, AHEPA University Hospital, Central Macedonia, Thessaloniki, Greece
| | - Pinelopi Vlotinou
- Department of Occupational Therapy, University of West Attica, Athens, Greece
| | - Dimitrios Tsiptsios
- Neurology Department, Democritus University of Thrace, Alexandroupolis, Greece
| | - Panagiota Voskou
- Cognitive Disorders/Dementia Unit, 2nd Department of Neurology, National and Kapodistrian University of Athens, Athens, Greece
| | - Sokratis Papageorgiou
- Cognitive Disorders/Dementia Unit, 2nd Department of Neurology, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Aggelousis
- Department of Physical Education and Sport Science, Democritus University of Thrace, Komotini, Greece
| | | | - Aspasia Serdari
- Department of Child and Adolescent, Democritus University of Thrace, Alexandroupolis, Greece
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Chowdhry N, Dholakia UM. Know thyself financially: How financial self‐awareness can benefit consumers and financial advisors. ACTA ACUST UNITED AC 2019. [DOI: 10.1002/cfp2.1069] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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3
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Mayelle A, El Haj M, Antoine P. Awareness of Self and Disease Assessment: Development and Validation of a Subjective Measure in People with Alzheimer’s Disease. J Alzheimers Dis 2019; 71:841-850. [DOI: 10.3233/jad-190371] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Amandine Mayelle
- Univ. Lille, CNRS, CHU Lille, UMR 9193 – SCALab – Sciences Cognitives et Sciences Affectives, Lille, France
| | - Mohamad El Haj
- Univ. Nantes, EA 4638 – LPPL – Laboratoire de Psychologie des Pays de la Loire, Nantes, France
- Unité de Gériatrie, Centre Hospitalier de Tourcoing, Tourcoing, France
- Institut Universitaire de France, Paris, France
| | - Pascal Antoine
- Univ. Lille, CNRS, CHU Lille, UMR 9193 – SCALab – Sciences Cognitives et Sciences Affectives, Lille, France
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4
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Kenney LE, Margolis SA, Davis JD, Tremont G. The Screening Utility and Ecological Validity of the Neuropsychological Assessment Battery Bill Payment Subtest in Older Adults with and without Dementia. Arch Clin Neuropsychol 2019; 34:1156-1164. [DOI: 10.1093/arclin/acz033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 05/31/2019] [Indexed: 11/12/2022] Open
Abstract
Abstract
Objective
The Neuropsychological Assessment Battery Bill Payment subtest has shown strong diagnostic accuracy in dementia due to Alzheimer’s disease (AD) versus non-AD. Its relationship to mild cognitive impairment (MCI) or all-cause dementia has not been fully examined nor has its ecological validity as a proxy of financial independence.
Method
We describe 270 women (63%) and men (age = 72 ± 8.39) who completed Bill Payment during outpatient neuropsychological evaluation. Seventy-one were cognitively normal (CN), 160 had MCI, and 39 had Dementia. Two hundred fourteen were independent in money management, 31 were assisted (had oversight/some help), and 25 were dependent (relied on others). Receiver operating characteristic (ROC) curves tested Bill Payment’s utility as a dementia screen. Kruskal–Wallis tests examined whether Bill Payment differed by levels of financial independence.
Results
At a cutoff of 17, Bill Payment had strong sensitivity (0.87) and specificity (0.80) for dementia versus CN cases. A cutoff of 15 distinguished dementia from MCI (Sn = 0.64, Sp = 0.85), whereas a cutoff of 16 distinguished dementia from functionally unimpaired cases (MCI + CN) with greater sensitivity and similar specificity (Sn = 0.74, Sp = 0.81). Sensitivity attenuated in MCI versus CN cases (Sn = 0.46, Sp = 0.83). Those who were independent in money management had higher scores than assisted and dependent cases (p ≤ 0.046). Assisted and dependent cases were no different (p > 0.05).
Conclusions
Bill Payment is a valid screen of all-cause dementia. Lower Bill Payment scores may mark subtle functional decline beyond cognitive impairment alone. Specifically, results provide preliminary evidence of Bill Payment’s ecological validity as a measure related to financial independence. It may prove useful when impaired financial abilities are suspected but unreported.
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Affiliation(s)
- Lauren E Kenney
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA
| | - Seth A Margolis
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA
- Department of Psychiatry & Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Jennifer D Davis
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA
- Department of Psychiatry & Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Geoffrey Tremont
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA
- Department of Psychiatry & Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI, USA
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Ghesquiere AR, McAfee C, Burnett J. Measures of Financial Capacity: A Review. THE GERONTOLOGIST 2019; 59:e109-e129. [PMID: 28535272 DOI: 10.1093/geront/gnx045] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Indexed: 11/13/2022] Open
Abstract
PURPOSE OF THE STUDY Capacity to manage finances and make financial decisions can affect risk for financial exploitation and is often the basis for legal determinations of conservatorship/guardianship. Several structured assessments of financial capacity have been developed, but have not been compared regarding their focus, validity, or reliability. Therefore, we conducted a review of financial capacity measures to examine these factors. DESIGN AND METHODS We searched electronic databases, reference lists in identified articles, conference proceedings and other grey literature for measures of financial capacity. We then extracted data on the length and domains of each measure, the population for which they were intended, and their validity and reliability. RESULTS We identified 10 structured measures of financial capacity. Most measures could be completed in 25-30 min, and were designed to be administered to older adults with some level of cognitive impairment. Reliability and validity were high for most. IMPLICATIONS Measurement of financial capacity is complex and multidimensional. When selecting a measure of financial capacity, consideration should be made of the population of focus and the domains of capacity to be assessed. More work is needed on the cultural sensitivity of financial capacity measures, their acceptability, and their use in clinical work. Better understanding of when, and to whom, to administer different financial capacity measures could enhance the ability to accurately detect those suffering from impaired financial capacity, and prevent related negative outcomes like financial exploitation.
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Affiliation(s)
- Angela R Ghesquiere
- Brookdale Center for Healthy Aging, Hunter College of the City University of New York
| | - Caitlin McAfee
- Brookdale Center for Healthy Aging, Hunter College of the City University of New York
| | - Jason Burnett
- Texas Elder Abuse & Mistreatment Institute (TEAM) McGovern Medical School, Department of Internal Medicine, Division of Geriatric and Palliative Medicine, The University of Texas Health Science Center at Houston
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Engel LL, Beaton DE, Green RE, Dawson DR. Financial Management Activity Process: Qualitative inquiry of adults with acquired brain injury. Can J Occup Ther 2019; 86:196-208. [DOI: 10.1177/0008417419833839] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. Little is known about the financial management occupations of people living with brain injury, despite the importance of these to adult autonomy. Purpose. This work aims to develop a conceptual framework for financial management after adulthood acquired brain injury. Method. This qualitative study used grounded theory methods. Data included semistructured interviews of 10 adults living with brain injury and two close others who assist with financial management occupations. Analysis included initial and focused coding, memo writing, constant comparison, theoretical sampling of questions, and member checking. Findings. The Financial Management Activity Process conceptual framework describes a complex action process. This includes accounting for factors influencing financial choices and actions, and identifying and using a trusted personalized process, including using financial management strategies aligned with the constraints of factors. Implications. This conceptual framework may be useful to assessment and intervention development. It highlights the between-person and between-activity variability in financial management processes and strategy use.
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Gill S, Blair M, Kershaw M, Jesso S, MacKinley J, Coleman K, Pantazopoulos K, Pasternak S, Finger E. Financial capacity in frontotemporal dementia and related presentations. J Neurol 2019; 266:1698-1707. [PMID: 31011799 PMCID: PMC6586696 DOI: 10.1007/s00415-019-09317-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 04/04/2019] [Accepted: 04/09/2019] [Indexed: 11/29/2022]
Abstract
Background Changes in financial judgement and skills can herald a neurodegenerative dementia and are a common reason for referral for cognitive neurologic assessment. However, patients with neurodegenerative diseases affecting the frontal or temporal lobes may perform well on standard cognitive tests, complicating clinical determinations about their diagnosis and financial capacity. Methods Forty-five patients with possible or probable FTD or Alzheimer’s disease and 22 healthy controls completed two financial assessment batteries, the FACT and the FCAI. Patients’ performance was compared to study partner estimates of patients’ financial abilities. Results All three patient groups performed worse than controls on both the FACT and the FCAI. Study partners over-estimated the performance of patients with Alzheimer’s disease. Conclusions These initial findings suggest that accurate clinical assessment of financial skills and judgement in patients with possible neurodegenerative dementias requires performance-based assessment. Electronic supplementary material The online version of this article (10.1007/s00415-019-09317-w) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sascha Gill
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Parkwood Institute, Lawson Health Research Institute, University of Western Ontario, 550 Wellington Rd, London, ON, Canada
| | - Mervin Blair
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Parkwood Institute, Lawson Health Research Institute, University of Western Ontario, 550 Wellington Rd, London, ON, Canada
| | - Mavis Kershaw
- Australian Psychological Society, Melbourne, Australia.,International Association of Applied Psychology, New York, USA.,Australia and New Zealand Association of Psychiatry, Psychology and Law, Melbourne, Australia
| | - Sarah Jesso
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Parkwood Institute, Lawson Health Research Institute, University of Western Ontario, 550 Wellington Rd, London, ON, Canada
| | - Julia MacKinley
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Parkwood Institute, Lawson Health Research Institute, University of Western Ontario, 550 Wellington Rd, London, ON, Canada
| | - Kristy Coleman
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Parkwood Institute, Lawson Health Research Institute, University of Western Ontario, 550 Wellington Rd, London, ON, Canada
| | - Koula Pantazopoulos
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Parkwood Institute, Lawson Health Research Institute, University of Western Ontario, 550 Wellington Rd, London, ON, Canada
| | - Stephen Pasternak
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Parkwood Institute, Lawson Health Research Institute, University of Western Ontario, 550 Wellington Rd, London, ON, Canada
| | - Elizabeth Finger
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Parkwood Institute, Lawson Health Research Institute, University of Western Ontario, 550 Wellington Rd, London, ON, Canada.
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Campbell RC, Lichtenberg PA, Hall LN, Teresi JA, Ocepek-Welikson K. Assessment of financial decision making: an informant scale. J Elder Abuse Negl 2018; 31:115-128. [PMID: 30570450 DOI: 10.1080/08946566.2018.1556762] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Older adults with cognitive impairment are a population at great risk for financial exploitation. At-risk older adults often have difficulty reporting on their own financial abilities. Collecting information from trusted others is vital for professionals investigating the financial exploitation older adults. There are few reliable, valid, and standardized informant-report measures of financial capacity, and none that assess decisional abilities for an ongoing, real-world financial transaction. The present study sought to examine the psychometric properties of a new informant-report scale of financial decisional abilities in older adults. One hundred fifty participants were recruited to complete the Family and Friends and Interview regarding a known older adult's financial decisional abilities. A factor analysis identified two subscales. The full scale had adequate sensitivity and specificity to detect an informant's current concerns regarding financial exploitation. The Family and Friends Scale is a useful tool for collecting informant-report regarding an older adult's ability to make financial transactions.
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Affiliation(s)
- Rebecca C Campbell
- a Department of Psychology and Institute of Gerontology , Detroit , Michigan , USA
| | - Peter A Lichtenberg
- a Department of Psychology and Institute of Gerontology , Detroit , Michigan , USA
| | - Latoya N Hall
- b Institute of Gerontology , Detroit , Michigan , USA
| | - Jeanne A Teresi
- c Columbia University Stroud Center at New York State Psychiatric Institute , New York , New York , USA.,d Research Division , Hebrew Home at Riverdale; RiverSpring Health , New York , New York , USA.,e Department of Geriatrics and Palliative Medicine , Weill Cornell Medical Center , White Plains , New York , USA
| | - Katja Ocepek-Welikson
- d Research Division , Hebrew Home at Riverdale; RiverSpring Health , New York , New York , USA
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9
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Engel L, Chui A, Beaton DE, Green RE, Dawson DR. Systematic Review of Measurement Property Evidence for 8 Financial Management Instruments in Populations With Acquired Cognitive Impairment. Arch Phys Med Rehabil 2018. [PMID: 29524397 DOI: 10.1016/j.apmr.2018.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To critically appraise the measurement property evidence (ie, psychometric) for 8 observation-based financial management assessment instruments. DATA SOURCES Seven databases were searched in May 2015. STUDY SELECTION Two reviewers used an independent decision-agreement process to select studies of measurement property evidence relevant to populations with adulthood acquired cognitive impairment, appraise the quality of the evidence, and extract data. Twenty-one articles were selected. DATA EXTRACTION This review used the COnsensus-based Standards for the selection of health Measurement Instruments review guidelines and 4-point tool to appraise evidence. After appraising the methodologic quality, the adequacy of results and volume of evidence per instrument were synthesized. Measurement property evidence with high risk of bias was excluded from the synthesis. DATA SYNTHESIS The volume of measurement property evidence per instrument is low; most instruments had 1 to 3 included studies. Many included studies had poor methodologic quality per measurement property evidence area examined. Six of the 8 instruments reviewed had supporting construct validity/hypothesis-testing evidence of fair methodologic quality. There is a dearth of acceptable quality content validity, reliability, and responsiveness evidence for all 8 instruments. CONCLUSIONS Rehabilitation practitioners assess financial management functions in adults with acquired cognitive impairments. However, there is limited published evidence to support using any of the reviewed instruments. Practitioners should exercise caution when interpreting the results of these instruments. This review highlights the importance of appraising the quality of measurement property evidence before examining the adequacy of the results and synthesizing the evidence.
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Affiliation(s)
- Lisa Engel
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada; Rotman Research Institute, Baycrest Health Sciences, Toronto, Ontario, Canada.
| | - Adora Chui
- Rotman Research Institute, Baycrest Health Sciences, Toronto, Ontario, Canada
| | - Dorcas E Beaton
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada; Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada; Institute for Work & Health, University of Toronto, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Robin E Green
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada; Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Deirdre R Dawson
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada; Rotman Research Institute, Baycrest Health Sciences, Toronto, Ontario, Canada; Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada; Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
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Voskou P, Douzenis A, Economou A, Papageorgiou SG. Testamentary Capacity Assessment: Legal, Medical, and Neuropsychological Issues. J Geriatr Psychiatry Neurol 2018; 31:3-12. [PMID: 29251179 DOI: 10.1177/0891988717746508] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The increase in the aging population and the number of patients with dementia led to the research in older adults' capacity assessment over the last 3 decades. Many cases of contested wills occur due to lack of testamentary capacity (TC), especially in cases of dementia. AIM Purpose of the present study was to overview the legal, medical, and neuropsychological aspects of TC as well as the instruments used for TC assessment. FINDINGS The testator/testatrix with intact TC has realistic perception of his or her property value, lack of psychopathology affecting contact with reality, and intact intention of how and to whom he or she will dispose his or her assets. It is frequent for the health practitioners to serve as "gold standards assessors" by examining an individual's ability to make a valid will and giving evidence to the court to support or not a will contest. The TC assessment is a complex process of clinical and legal practice requiring usually a variety of methods, that is, interviews, evaluation of clinical records, and administration of neuropsychological instruments. CONCLUSION The evaluation of TC is a multidimensional process that integrates both the legal and medical field, requiring a collaborative approach to its definition and assessment.
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Affiliation(s)
- Panagiota Voskou
- 1 Cognitive Disorders/Dementia Unit, 2nd Department of Neurology, National and Kapodistrian University of Athens, Athens, Greece
| | - Athanasios Douzenis
- 2 2nd Department of Psychiatry, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexandra Economou
- 3 Department of Psychology, School of Philosophy, National and Kapodistrian University of Athens, Athens, Greece
| | - Sokratis G Papageorgiou
- 1 Cognitive Disorders/Dementia Unit, 2nd Department of Neurology, National and Kapodistrian University of Athens, Athens, Greece
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Marroni SP, Radaelli G, Silva Filho IGD, Portuguez MW. Instruments for evaluating financial management capacity among the elderly: an integrative literature review. REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2017. [DOI: 10.1590/1981-22562017020.160207] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Objective: To identify tools available in literature for assessing the financial management capacity of elderly persons with and without cognitive deficit or impairment. Methods: An integrative literature review was performed. Scientific publications indexed in the PubMed, LILACS (Latin American and Caribbean Health Sciences Literature), Psychology Index and Cochrane Library databases by November 2015 were evaluated. Results: Of the 609 articles obtained from the databases, 29 were considered eligible for this review, and involved 11 instruments for the evaluation of financial management capacity, the most cited of which was the Financial Capacity Instrument (FCI). Conclusion: There are several scales and instruments available which are used to investigate both daily and instrumental activities of daily living, which allow the independence and effective functioning of the elderly on a day to day basis to be verified. Non-Brazilian literature also describes specific instruments for the assessment of financial management capacity. However, no references to a specific scale that evaluates this construct and which has been validated and adapted for the Brazilian population were identified.
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Affiliation(s)
| | - Graciane Radaelli
- Pontifícia Universidade Católica do Rio Grande do Sul, Brazil; Universidade Federal de São Paulo, Brazil
| | - Irenio Gomes da Silva Filho
- Pontifícia Universidade Católica do Rio Grande do Sul, Brazil; Pontifícia Universidade Católica do Rio Grande do Sul, Brazil
| | - Mirna Wetters Portuguez
- Pontifícia Universidade Católica do Rio Grande do Sul, Brazil; Pontifícia Universidade Católica do Rio Grande do Sul, Brazil
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Engel L, Bar Y, Beaton DE, Green RE, Dawson DR. Identifying instruments to quantify financial management skills in adults with acquired cognitive impairments. J Clin Exp Neuropsychol 2015; 38:76-95. [DOI: 10.1080/13803395.2015.1087468] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Financial and testamentary capacity evaluations: procedures and assessment instruments underneath a functional approach. Int Psychogeriatr 2014; 26:217-28. [PMID: 24229806 DOI: 10.1017/s1041610213001828] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Mental health professionals are frequently involved in mental capacity determinations. However, there is a lack of specific measures and well-defined procedures for these evaluations. The main purpose of this paper is to provide a review of financial and testamentary capacity evaluation procedures, including not only the traditional neuropsychological and functional assessment but also the more recently developed forensic assessment instruments (FAIs), which have been developed to provide a specialized answer to legal systems regarding civil competencies. METHODS Here the main guidelines, papers, and other references are reviewed in order to achieve a complete and comprehensive selection of instruments used in the assessment of financial and testamentary capacity. RESULTS Although some specific measures for financial abilities have been developed recently, the same is not true for testamentary capacity. Here are presented several instruments or methodologies for assessing financial and testamentary capacity, including neuropsychological assessment, functional assessment scales, performance based functional assessment instruments, and specific FAIs. CONCLUSIONS FAIs are the only specific instruments intended to provide a specific and direct answer to the assessment of financial capacity based on legal systems. Considering the need to move from a diagnostic to a functional approach in financial and testamentary capacity evaluations, it is essential to consider both general functional examination as well as cognitive functioning.
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Yokoi T, Okamura H. Why do dementia patients become unable to lead a daily life with decreasing cognitive function? DEMENTIA 2012; 12:551-68. [PMID: 24337329 DOI: 10.1177/1471301211435193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In order to understand the words and deeds of dementia patients that we find very hard to explain or understand, we have paid attention to the self-awareness ability of dementia patients, the intellectual subject that integrates their own intellectual functions, and created 'a model for interpreting puzzling words and deeds of dementia patients from the viewpoint of self-awareness'. The purpose of this study is to explain the reasons why dementia patients become unable to successfully perform activities of daily living (ADL) with advancement of dementia, using our model to present viewpoints understandable to caregivers. We classified dementia inpatients of a geriatric health services facility into four stages, using the model of self-awareness ability (consisting of 'theory of mind', 'self-evaluation' and 'self-consciousness') that was constructed by combining 'theory of mind' and Lewis's developmental model of cognition and emotion. Furthermore, we observed and documented scenes from daily life, and we interpreted the reasons why patients become unable to seek assistance from others for ADL, based on the model. We came to understand why the patients could not seek assistance from others, because the patients who failed in the task of 'theory of mind' were unable to self-assess their own mind and the minds of others, and those having failed in the task of 'self-evaluation' could not evaluate their own situation.
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Werner P. Family physicians' perceptions and predictors regarding the competence of a person with Alzheimer's disease. Int J Geriatr Psychiatry 2007; 22:320-6. [PMID: 17066429 DOI: 10.1002/gps.1676] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The aim of the present study was to assess family physicians' perceptions about the competence of a person with AD. METHODS Telephone interviews were conducted with a representative sample of 395 family physicians using an experimental vignette methodology, varying in the severity of the disease. Participants were requested to rate the competence of the person described in the vignette in the areas of driving, health-decision making, financial decisions, and the performance of instrumental activities of daily living. RESULTS Results of the study showed that family physicians perceived the person described in the vignette to be highly incompetent in items involving safety issues. Only a small variety of factors were associated with these perceptions. The main factors were the severity of the disease as reflected in the vignette, participants' perceptions regarding the dangerousness and responsibility of the person with AD, and the percentage of patients aged 65 + with cognitive deterioration in the physician's practice. CONCLUSION The assessment of competence in persons with AD is a subtle and complex process. Future research is urgently needed to further explore the factors affecting the process, such as stigmatic views.
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Affiliation(s)
- Perla Werner
- Department of Gerontology, University of Haifa, Israel.
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Moye J, Marson DC. Assessment of decision-making capacity in older adults: an emerging area of practice and research. J Gerontol B Psychol Sci Soc Sci 2007; 62:P3-P11. [PMID: 17284555 DOI: 10.1093/geronb/62.1.p3] [Citation(s) in RCA: 215] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The convergence of the aging of our society, the increase in blended families, and an enormous intergenerational transfer of wealth has greatly expanded the incidence and importance of capacity assessment of older adults. In this article we discuss the emergence of capacity assessment as a distinct field of study. We review research efforts in two domains: medical decision-making capacity and financial capacity. Existing research in these two areas provides a first pass at many key questions related to capacity assessment, but additional studies that replicate, extend, and improve on this research are urgently needed. An agenda for future is detailed that recommends studies of a wide range of capacity constructs, focusing on clinical markers of diminished capacity, methods to improve clinical assessment, and the many intersections of law and clinical practice.
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Affiliation(s)
- Jennifer Moye
- VA Boston Healthcare System, Brockton Campus, 940 Belmont Street, Brockton, MA 02301, USA.
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Abstract
OBJECTIVE The aim of the present study was to assess lay persons' perceptions about the competence of a person with AD and its relationship to social distance. METHODS Face-to-face interviews were conducted with a total of 206 Jewish Israeli adults (mean age = 59.7) using an experimental vignette methodology, varying in the severity of the disease. Participants were requested to rate the competence of the person described in the vignette in the areas of driving, health-decision making, financial decisions, and the performance of instrumental activities of daily living. RESULTS Results of the study showed that lay persons are able to make a distinction between different types of competence, and that their perceptions about competence affect greatly their behavioral discrimination toward a person with AD. CONCLUSIONS Findings of this study stress the importance of clarifying the concept of competence among the lay public, in order to reduce the stigmatization of persons with Alzheimer's disease.
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Affiliation(s)
- Perla Werner
- Department of Gerontology, University of Haifa, Israel.
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18
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Abstract
The relations between mild cognitive impairment without dementia (MCI/CIND) and everyday functional abilities were examined using data from the Canadian Study of Health and Aging (CSHA). Individuals were identified with MCI/CIND if both caregiver report and clinician judgment agreed on the presence of cognitive impairment in the absence of dementia. Cross-sectional and longitudinal comparisons indicated that individuals with MCI/CIND demonstrated a broad range of impairment in instrumental activites of daily living (IADL) compared to individuals with no cognitive impairment (NCI). In cross-sectional analyses, neuropsychological measures of memory and psychomotor speed were significantly related to impairment in eight areas of functioning. In addition, poorer memory performance was significantly predictive of future impairment in money management.
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Affiliation(s)
- Holly Tuokko
- Department of Psychology and Centre on Aging University of Victoria, Victoria, British Columbia, Canada.
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19
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Abstract
The present study examined the relations among levels of cognitive functioning, executive dysfunction, and awareness of financial management capabilities among a sample of 42 community-dwelling persons with dementia. Financial tasks on the Measure of Awareness of Financial Skills (MAFS) were dichotomized as simple or complex based on Piaget's operational levels of childhood cognitive development. Severity of global cognitive impairment and executive dysfunction were significantly related to awareness of financial abilities as measured by informant-participant discrepancy scores on the MAFS. For persons with mild and moderate/severe dementia, and persons with and without executive dysfunction, proportions of awareness within simple and complex financial task categories were tabulated. Significantly less awareness of financial abilities occurred on complex compared with simple tasks. Individuals with mild dementia were significantly less aware of abilities on complex items, whereas persons with moderate/severe dementia were less aware of abilities, regardless of task complexity. Similar patterns of awareness were observed for individuals with and without executive dysfunction. These findings support literature suggesting that deficits associated with dementia first occur for complex cognitive tasks involving inductive reasoning or decision-making in novel situations, and identify where loss of function in the financial domain may first be expected.
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