Coping with Clients Suffering from Cognitive Deficits

> Posted by Joshua Goldstein, Principal Director for Economic Citizenship & Disability Inclusion, CFI

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Age Invaders” is the cover story of a recent issue of The Economist. Today, 8 percent of the global population is over 65. This figure will increase dramatically in the coming years and, with low and declining birth rates in many developed and developing countries, respectively, it is projected that by 2050 the global population 65 years and older will be 2.5 times that of 0 to 4 year olds. This is an exact reversal of the situation in 1950 and is a proportionality unseen since the hominids began to walk upright.

All human institutions will be affected by the greying demographic, but I would like to narrow my scope to just one area: the implications for providing financial services to those customers who fall prey to age-related cognitive decline.

Dr. Jerome Groopman, in the May 22 edition of The New York Review of Books, reports on an important new study of persons who reached 65 without any signs of dementia. He indicates that for these individuals, the chance of their developing Alzheimer’s disease over their ensuing 10 years is more than 35 percent. Groopman describes, “This sobering statistic translates into a cascade of symptoms by the persons struck down by the disease, beginning with short-term problems, and then gradually long-term memory, in conjunction with difficulties in cognition including confusion, disorientation, and poor emotional control.”

Families everywhere are trying to cope with a loved one who is experiencing some kind of life altering dementia resulting from Alzheimer’s or from another cause – perhaps a multitude of silent micro-infarctions (tiny undetected strokes).

Families like mine.

My mother still manages to live on her own with almost no support. She usually bristles when we suggest help.   She does her own housekeeping, volunteers at a hospital, and takes a mile walk everyday—an enviably spry 87.

But during the last couple of years she has shown increasing signs of short-term memory loss, and all signs indicate reversal is out of question. So her children have all reached the reluctant consensus that senility is here to stay. Though disagreement on the extent of decline and whether it is accelerating or has at least temporarily plateaued is a topic of endless debate among her children.

As for my mother, she both admits and denies what is happening to her – a symptom in itself. Self-consciously, she now opens many conversations with “I may have told you this before.” And usually her children think to themselves “Yes Mom, many times.” It is a kindness not to keep a tally of such repetitions, but on days when our endorphins are at low tide, it is inevitable that we get impatient with her.

Mom has made some concessions to advanced age: after having a minor accident with a school bus—if any accident with a school bus can be considered minor—we were able to wrestle her driver’s license away from her and get her to accept a part-time driver. We made the argument that while she might live with being a danger to herself, she would never want to be a danger to others. A winning argument as it turned out—but it might not have been if her executive function (the mental processes that allow understanding of causal relationships, and enable organizing and planning) had been further impaired.

And just last week, she asked for some support with paying bills and keeping track of bank accounts. We are blessed that she is still compos mentis enough to ask – and that we were not forced to go to court to seek power of attorney in an effort to protect her assets from the kind of con men who prey on the elderly.

In this twilight world of slow decline, as executive function waxes and wanes, older people like my mother are at great risk of being taken advantage of due to their diminished state.

The point of this autobiographical detour has been to give a sense of the confusing human reality behind the statistics about aging and dementia I discussed above.

When it comes to financial services, the cognitive effects of aging can affect nearly every banking activity. Impediments in memory, learning, language, and judgment can make it very difficult to effectively manage spending and saving, pay bills accurately and on time, and fulfill the steps involved in positioning oneself to bank – e.g. compiling the necessary personal/account information, transportation to a bank, communication with bank staff. According to the Alzheimer’s Society, about three-quarters of people with dementia have trouble using banks.

Fortunately, some banks are beginning to take the first steps to provide thoughtful services to their aging clientele who are having trouble managing their affairs due to cognitive decline. In the U.K., Lloyds Banking Group, Barclays, and the Alzheimer’s Society came together to create the “Dementia Friendly Financial Services Charter.” As Pina D’Intino of Scotiabank reports in a recent  CFI blog post,“This charter is intended to help financial services institutions recognize, understand, and respond to the needs of customers living with dementia and their caretakers and is an example of an institution that identified an obstacle in access by current and potential clients, conducted research within that client segment, and found a way to address it.”

Among many other commitments, the Charter stipulates that organizations will make it easy for people affected by dementia to tell them and discuss their specific customer service needs. Satisfying this will expand the opportunity for banks to appropriately serve this client segment. With this information, banks can offer tailored products that incorporate features like reductions to the possibility of unnecessary withdrawals or amendments to policy, alternative security methods to PINs and passwords, and increased bank attention to the possibility of financial abuse or crime. To ensure clients’ unique needs are consistently met, the Charter outlines that organizations should work towards ensuring that clients’ communication and service needs can be recorded for incorporation in future service.

Product terms and conditions, or external circumstances like legal regulation, can limit the services available to those with dementia. For client interactions where service is denied, the Charter specifies that organizations will ensure that their staff can confidently explain why and provide any relevant information on how and where help may be available. It’s important that such a moment doesn’t result in potential clients writing off the option of formal banking. Clients should be offered sources of advice or alternative products and services that may be available. For additional guidance laid out in the Charter, click here.

Of the Charter, Elaine Draper, Director of Process Transformation at Barclays, said, “It was fantastic to see the scale of commitment to creating and signing the charter. The important thing now will be to ensure that across the industry it is clearly visible how in response to the charter we have improved the way that we support and serve our customers.”

To be sure, in many poor countries where microfinance institutions work, living past 65 is not the norm. Nevertheless it makes good sense that at least one staff member of each branch has some training in recognizing dementia. Moreover dementia can strike earlier in life as well. Such basic training will also help staff provide services to customers with a range of intellectual or psycho-social conditions or disabilities.

Fortunately, my mother, to date, has not had any confusing or upsetting experiences when doing her banking business. If she does, I hope she meets a friendly face who will have the training to patiently answer her questions and concerns.

I am convinced that the Dementia Friendly Charter or some similar framework should be adopted by banks and microfinance institutions around the world. It makes good business sense and is the right thing to do.

Image credit: Ryan McVay / Getty Images

Have you read?

Expanding Service Accessibility for Older Persons and PWDs

Aging and Financial Services: With and Without Employment

Microfinance as a Tool for Active Aging