If you haven’t yet dealt with the challenge of a client showing signs of diminished mental capacity, you will. And now is the time to prepare for that event, before you see the signs.
Amy Florian can deliver the alarming statistics on the likelihood that your clients — and you — will face that dreaded development associated with aging, but in an interview with ThinkAdvisor she also provided the steps an advisor should take, and when to take action, well before diminished capacity becomes a problem for your client and her family and your compliance department.
First, the sobering statistics. Florian, CEO of the consulting firm Corgenius, which specializes in educating businesspeople on death and dying, ‘transitions’ and how to serve older clients, reports that one in nine people age 65 or older have some form of dementia, as do almost half of people age 85 or older. There are 18 different diseases that can lead to dementia, with Alzheimer’s disease by far the leading cause, followed by vascular dementia. However, one common misconception is that Alzheimer’s and dementia are the same thing. They are not; you can have dementia and not have Alzheimer’s, but if you suffer from Alzheimer’s you do have dementia.
“We don’t know the cause,” says Florian, and “if we knew, then we’d have a better idea on how to prevent or treat” dementia. Some people can get early onset Alzheimer’s in their 40s, and the "familial" variety of Alzheimer’s, she says, “is definitely genetic, but that’s a small percentage” of those affected by the disease.
One thing we do know about dementia, Florian says, it that it “strikes as we get older.” Moreover, “we can’t predict who will get it,” but Alzheimer’s in particular “literally shrinks the brain.”
The Challenges and Strategies for Advisors
The symptoms of dementia can start 10 to 12 years before a diagnosis, Florian says, but one important point for advisors is that “not every cognitive difficulty is due to dementia.” The symptoms common to dementia might be caused by medications interacting with each other, she says, like antidepressants. Even a fairly common condition like a urinary tract infection “can wreak havoc with cognition,” she says, as can a vitamin B-12 deficiency.
Look for evidence of short-term memory loss, she counsels, along with changes in personality, such as when a person becomes “uncharacteristically inappropriate or angry.” Symptoms include changes in depth perception, so sufferers “when driving around a corner may hit the curb,” or they start tripping when walking up stairs. They might also mix up the names of common items, such as calling a toothbrush a “mouth cleaner,” or mistakenly use a similar-sounding word when they can’t remember the proper word, such as saying “amphibious” when they mean to say “ambidexterous.”
Math functioning also “seems to be affected very soon” by dementia, Florian says, which advisors might notice when discussing a performance percentage or an investment product and the client no longer can figure a percentage in their heads or understand concepts they previously did, such as how an annuity works.
So what should an advisor do?
“What I recommend is that before there are any signs, have all clients complete a diminished capacity letter,” which Florian says is “basically a permission form to call certain people if you [the advisor] see anything wrong. The letter might say, ‘I, Amy Florian, give Joe Smith and Jane Doe of Smith-Doe Financial permission to call my powers of attorney and the following people if they notice any diminishment in my physical, cognitive, mental, or psychological capacity.’” The letter, she warns, should also be updated every year.
Then, if there are concerns, the advisor can raise it with the client first. Florian says it’s important not to use freighted words like “Alzheimer’s” in doing so. Instead, the advisor can explain that any signs of cognitive deficiency could be caused by one of the physical conditions mentioned above.
For instance, the advisor could say, "'I noticed that you asked the same question three times even though I already answered it completely, and it’s been taking you a lot longer to remember names'” or whatever is the specific symptom. Then the advisor could say “'It could be a medical cause. What about your medications or a vitamin deficiency? If I’m noticing these signs, before your family notices, how about if you go see your doctor, get it checked out, and maybe even get it cured?'”
She also recommends that advisors document “every single time” a client shows symptoms of cognitive decline. When signs build up or become troublesome, advisors should share that concern with their compliance officers or compliance department so everyone is working together to protect the client.
Florian will be speaking twice during the Financial Planning Association’s annual conference in Baltimore Sept. 14-16; One session is titled “Advising Clients through the Toughest Times of Life," and another focuses on how advisors can help clients who are “suddenly single,” due to a spouse's death or divorce.