DOCTORS with older patients hear clues all the time. Elderly people mention, in passing, that they are missing money or that they signed forms they did not understand. Or maybe they can’t find a treasured possession like a watch or a wedding ring.
But doctors traditionally have not been trained to recognize that confusion or forgetfulness can be signs that the patient is at financial risk, said Dr. Robert W. Parker, chief of community geriatrics in the family medicine department at the University of Texas Health Science Center in San Antonio.
“We give them another pill, device or test. We don’t always spend time with patients so we get to know their concerns,” said Dr. Parker. “And medical doctors have not wanted to mix medicine and money.”
But now he, along with thousands of other doctors and medical professionals across the country, are taking part in a new effort to screen older patients for financial vulnerability as well as indications they are being exploited financially by family members, friends or strangers.
Although the case of Brooke Astor, the New York philanthropist whose son was convicted of misusing her financial assets alerted people that exploitation can occur at any level of society, most still think of elderly abuse as physical harm. But losing savings or a home to the unscrupulous also can be a severe blow to health and well-being. Three out of five older Americans fear death less than they fear running out of money before they die, according to a study last year by the AARP, the lobby for older Americans.
“Of course, I’ve routinely heard hints from my patients over the years,” said Dr. Parker, “but it wasn’t until I participated in the training that I put those together with early signs of memory loss or confusion.”
Red flags for investment swindles or other financial fraud can be social isolation, bereavement, alcohol or drug abuse or depression, according to the education program being introduced this year in 25 states, the District of Columbia and Puerto Rico. It is modeled after a 2008 pilot project at the Baylor College of Medicine in Texas and is being paid for by the Investor Protection Trust, a nonprofit organization that is financed by fines levied against companies for financial misconduct.
After spotting elderly people at risk, doctors can refer them to state securities regulators and adult services providers for help. The North American Securities Administrators Association and the National Adult Protective Services Association, the group for social workers who handle abuse cases, are backing the program, which provides medical professionals with specific resources to aid their patients.
Each doctor receives a laminated four-page pocket guide listing the names and Web sites for groups including the National Center on Elder Abuse and the National Academy of Elder Law Attorneys.
Bilking old people is not new, said Steve Irwin, commissioner of the Pennsylvania Securities Commission, which is participating in the program. “Financial fraud is abuse, but it is less recognized and less reported.”
Among the signs listed in the guide of potential financial abuse are overly protective caregivers, changes in ability to take medications, cognitive problems and being fearful, distressed or excessively suspicious.
Some form of cognitive impairment afflicts one-third of people over age 71 in the United States, according to a 2008 Duke University study. Mental impairment makes people more likely to make financial errors and more willing to gamble with their money, said Dr. Robert E. Roush, director of the Texas Consortium Geriatric Education Center at the Baylor College of Medicine.
“People become less risk-averse and become victims of unscrupulous family, friends, people they know from church or real estate agents,” said Dr. Roush, who spearheaded the program.
Dr. Parker agreed, noting that “about half the patients referred to us are cognitively impaired. They may come across as having normal social skills, but when we look more closely, we find they have lost their executive function, or their ability to plan, organize and remember details.”
That loss, according to the National Institute on Aging, can be a precursor of Alzheimer’s disease, the most common cause of dementia, where thinking, memory and reasoning deteriorate.
A result of the training, Dr. Parker said, is that “the first thing we now ask on our patient questionnaire is who is managing the money every day and who is paying the bills. Those are important patient signs.”
In Texas, 130 doctors participated in the pilot — with a guarantee that neither they nor their patients would be identified — and found that 55 percent of their patients displayed signs of financial vulnerability and needed a follow-up by other professionals. Dr. Roush cautioned, however, that “we do not know if fraud actually occurred.”
The program encourages doctors to ask patients whether they have trouble paying bills, feel confident about making big financial decisions, give loans or gifts they can not afford or believe their money is dwindling.
Also, the pocket guide lists other indicative questions, like whether the patient runs out of money at the end of the month, whether he or she regrets or worries about recent financial decisions, whether the patient has been asked to change a will or sign over power of attorney to someone else. Patients are provided with a brochure listing concerns and questions to help assess themselves.
While few elders like to admit they have been scammed, victims of telephone, mail or Internet schemes are numerous. An Investors Protection Trust survey last year found that one in five Americans over 65 years old had been defrauded. Nearly 40 percent said they had received phone call solicitations or letters asking for money, but only 19 percent said their adult children knew about it.
Dr. Parker was among those who missed signs of financial misadventures involving his mother, Rosalee, who sent $40,000 to enter a lottery in Jamaica, at the behest of friendly phone sales representatives. He discovered the swindle just as his mother, who died last September, was about to send an additional $70,000 to receive her “prize” of a Mercedes-Benz automobile.
She was furious, he noted, when he stepped in to take control of her finances.
Mr. Irwin, at the Pennsylvania Securities Commission, said fraud cases involving elderly people were not uncommon, especially in his state, which has a large number of Social Security recipients.
“We often step in get the cease-and-desist orders,” he said. “But now we are trying to get people alerted earlier, and this program casts the net wider.”
