April 27, 2018 With over 70 million Baby Boomers retiring, elder financial exploitation has been labeled the “Crime of the 21st Century.” In this half-day event, we will explore the neuroscience, psychology, and legal doctrine of financial decision-making in older adults. How does the aging brain make financial decisions, and when is it uniquely susceptible? How can courts best use science to improve their adjudication of disputes over “competency”, “capacity”, and “undue influence”? Is novel neuroimaging evidence of dementia ready for courtroom use? This conference brought together experts in medicine, science, and law to explore these important questions and chart a path forward for dementia and the law. For more information, visit our website at: http://petrieflom.law.harvard.edu/events/details/our-aging-brains

1. Overview of Financial Capacity, Financial
Exploitation, Undue Influence in Dementia
Jennifer Moye, Ph.D.
VA New England Geriatric Research Education and Clinical Center (GRECC)
Harvard Medical School

2. Financial Exploitation –
An act by one person
towards another, involving
the improper use or theft of
another’s assets
Financial Capacity –
A characteristic of a person
An individual’s ability to
receive and evaluate
information and make and
express a decision
Undue Influence –
A subtype of
Financial Exploitation
6. ABA-APA, 2008; 11. Lichtenberg, et al., 2018, Clin Gerontol.

3. TREATING
CLINICIAN
ATTORNEY
SCIENTIST
CLINICAL
EXPERT
JUDGE
FINANCIAL
SERVICES

4. 4

5. Theory Goal Method
Realist –
Social Scientist
Knowledge for
groups of persons
Content, criterion,
construct validation
Constructivist –
Judge
Justice for person(s)
in dispute
Social consensus
built on precedent
Constructive-Realist –
Clinicians
Clinical Opinion
regarding an
individual
Application of
science to individual
in light of legal
definitions

6. What Who Rate How Notes
Financial
abuse
Adults age
60+,
international
6.8% (95% CI
= 4.0-9.2)
Meta-analysis
of 40 studies,
N=45,915
1.Yon et al,
2017 Lancet
Global Health
Financial fraud
and scams
Adults age 50+
- 65+
5.6% (95%
CI=4.0-7.8)
Meta-analysis
of 12 studies
N=41,711
2. Burnes et al,
2017Am J
Public Health
Financial
Exploitation
Adults age
60+ in NY
2.7% one year;
4.7% lifetime
Random
sample
N=4156
3. Peterson et
al, 2015 J Gen
Intern Med
Financial
Exploitation
Adults age
60+ in SC
6.6% lifetime Random
sample N=902
4. Amstadter
et al, 2011 J
Interpers
Violence
* Anticipate these under-estimate as only ~1 in 25 reported (5. Dong, 2012)

8. Misusing Authority
- Misuse Guardianship
authority
- Misuse Power of Attorney
authority
- IdentityTheft
Stealing
-Theft of cash or other
valuables
- Withdrawals from bank
accounts or credit cards
-Transfer of deeds
Scamming
- Lottery, mail, telephone,
email scams
- Home repair scams
Selling
- Sale of fraudulent
investments (Ponzi or
pyramid schemes)
- Sale of unsuitable financial
products or services
Financial
Abuse (NCEA)

9. 12. Rolison, Hanoch, Wood, Liu. 2014 J Gerontol B Psychol Soc Scie.
Not Age per se, but risk factors associated with age
Dementia Yes
Decision Making Style Mixed12
Numeracy/ Financial literacy Yes
Have more assets Yes
Depend on others for care Yes

10. 2060
2040
2020
2000
98m total
6m $Abuse
82m total
5m $Abuse
56m total
3m $Abuse
13 Based on Numbers from - Colby & Ortman (2015), 2014 US Census
35m total
2m $Abuse

11. Functional Abilities
^ Cognitive Function
^ Psychiatric Symptoms
^ Diagnosis
Supports/ Supportive DM
Risks – Situation/ Context
Values
6. ABA-APACapacity Handbook, 2008.

12. Factor 8 Example
Basic Monetary Knowledge
and Calculation Skills
Calculate change due
Financial Procedural
Knowledge
Complete a check (date, amount, etc).
Financial Conceptual
Knowledge
Name two reasons for keeping your money in a
bank
Judgment Decide whether to give me your credit card
number to help under privileged children
The ability to independently manage financial affairs in a
manner consistent with personal self interest and values1.
6. APA-ABA, 2008; 7. Marson & Hebert, 2008; 8. Gerstenecker,Triebel, Eakin,
Martin, Marson, 2018

13.  FinancialCapacity impaired in dementia
 Judgment falls early and most steeply9
50
55
60
65
70
75
80
85
90
95
100
Baseline Year 6
PercentCorrect
6 year FC in MCI
Financial Judgment
Financial Conceptual
Knowledge
Knowledge of Personal
Finances
Basic Monetary Skills
9. Martin, Gerstenecker,Triebel, Falola, McPherson, Cutter, & Marson, 2018
Achives of Clin Neuropsych. (Only 4 of 9 domains shown)

14.  An act or omission by another person which causes
 substantial monetary or property loss to an elderly
person
 substantial monetary or property gain to the other
person, which gain would otherwise benefit the elderly
person …
 Such an act or omission shall not be construed as financial
exploitation if the elderly person has knowingly consented to such
act or omission unless such consent is a consequence
of misrepresentation, undue influence, coercion
or threat of force by such other person …
10. MGL 19A Sec 14

15. Financial Exploitation –
An act by one person
towards another, involving
the improper use or theft of
another’s assets
Capacity –
A characteristic of a person
An individual’s ability to
receive and evaluate
information and make and
express a decision
Undue Influence –
A subtype of
Financial Exploitation
6. ABA-APA, 2008; 11. Lichtenberg, et al., 2018, Clin Gerontol.

16.  When an exploiter (family, acquaintance or
stranger) uses their power/ relationship to
deceptively gain control over the decision
making of the other
6. ABA-APA 2008, Models from: Singer/Nievod; Blum; Bernatz;
Brandle/Heisler/Stiegel

17. Susceptibility of victim
• Cognitive - Declining judgment/ FC
• Psychosocial - isolation/ low social support +
social contacts; ADL/IADL dependency
Actions of the perpetrator
• Emotional manipulation
• Confidential relationship
• Sense of entitlement
Monetary loss
• Active procurement
• Transfer that benefit the perpetrator
3. Peterson et al, 2015. 6. ABA-APA, 2008. 11. Lichtenberg et al., 2018

18. No $ loss Early $ loss Late $ loss Post $ loss
Education/
Prevention
Early
Intervention
Intervention/
Protection
Prosecution
Neuroscience and Social Science Research
Interdisciplinary Collaboration