Long before people develop dementia, they often begin to fall behind on mortgage payments, credit card bills and other financial obligations, a new study suggests.
A team of economists and medical experts from the Federal Reserve Bank of New York and Georgetown University combined Medicare records with data from Equifax, the credit bureau, to study how borrowing behavior of people has changed in the years before and after a diagnosis of Alzheimer’s disease or similar. mess.
What they found was striking: The credit scores of people who later develop dementia begin to drop sharply long before their illness is formally identified. A year before diagnosis, these people were 17.2 percent more likely to be behind on their mortgage payments than before the onset of the disease, and 34.3 percent more likely to be behind on their mortgage payments. credit card bills. The problems start even earlier: the study reveals that people are behind on their debts five years before diagnosis.
“The results are striking in both their clarity and consistency,” said Carole Roan Gresenz, an economist at Georgetown University and one of the study’s authors. Credit scores and defaults, she said, “consistently get worse over time as diagnosis approaches, and so that literally reflects the changes in cognitive decline that we’re seeing.”
The research adds to a growing body of work documenting what many Alzheimer’s patients and their families already know: decision-making, including financial ones, can begin to deteriorate long before a diagnosis is made or even suspected. People who begin to experience cognitive decline may miss payments, make impulsive purchases, or invest in risky investments that they would not have considered before illness.
“It’s not just about forgetting, but our risk tolerance changes,” said Lauren Hersch Nicholas, a professor at the University of Colorado School of Medicine who has studied the impact of dementia on people’s finances. “It may suddenly seem like a good idea to move a diversified financial portfolio toward stocks someone recommends.”
People in the early stages of the disease are also vulnerable to scams and fraud, added Dr. Nicholas, who was not involved in the New York Fed study. In a paper published last year, she and several co-authors found that people at risk of developing dementia saw their household wealth decline in the decade before diagnosis.
The problems will likely only get worse as the U.S. population ages and more people develop dementia. The New York Fed study estimates that 600,000 crimes will occur over the next decade due to undiagnosed memory disorders.
This likely underestimates the impact, researchers say. Their data only includes issues that show up on credit reports, such as late payments, and not the much broader range of financial impacts that illnesses can cause. Wilbert van der Klaauw, a New York Fed economist and another author of the study, said that after his mother was diagnosed with Alzheimer’s disease, his family discovered parking tickets and traffic violations. highway code that she had hidden.
“If anything, it’s kind of an underestimate of the kind of financial difficulties people can experience,” he said.
Shortly before being diagnosed with Alzheimer’s disease, Jay Reinstein bought a BMW that he couldn’t afford.
“I walked into a showroom and came home with a BMW,” he said. “My wife was not happy.”
At the time, Mr. Reinstein had recently retired as deputy city manager of Fayetteville, North Carolina. He had been noticing memory problems for years, but dismissed them due to his demanding job. Only after his diagnosis did he learn that his friends and colleagues had also noticed the changes but said nothing.
Mr. Reinstein, 63, is lucky, he added. He has a government pension and a wife who can monitor his spending. But for those with fewer resources, financial decisions made in the years before diagnosis can have serious consequences, leaving them without money when they need it most. The authors of the New York Fed study noted that the financial effects they found predated most of the costs associated with the disease, such as the need for long-term care.
The study expands on previous research in part because of its scale: Researchers had access to health and financial data on nearly 2.5 million older Americans with chronic illnesses, including about half a million have been diagnosed with Alzheimer’s disease or related disorders. (The records were anonymized, allowing researchers to combine the two data sets without having access to the identifying details of individual patients.)
The large amount of data allowed researchers to slice the data more finely than in previous studies, examining the impact of race, gender, household size and other variables. Black people, for example, were twice as likely as white people to have financial problems before diagnosis, perhaps because they had fewer resources to begin with, and also because black patients are often diagnosed more late in the course of the disease.
The researchers hoped the data could eventually allow them to develop a predictive algorithm that could identify people who might suffer from impaired financial decision-making associated with Alzheimer’s disease – although they stressed that there remained Unresolved questions about who would have access to this information. and how it would be used.
Until then, the researchers say, their findings should serve as a warning to older Americans and their families to prepare for the possibility of an Alzheimer’s diagnosis. This may involve taking steps such as granting financial power of attorney to a trusted person or simply paying attention to signs that someone might be behaving in an unusual way.
Dr. Nicholas agreed.
“We should think about the possibility of financial hardship related to an illness we don’t even know exists,” she said. “Knowing this, people should be on the lookout for these symptoms among their friends and family members. »
Pam Belluck reports contributed.
News Source : www.nytimes.com
Gn Health
