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. Peter A. Lichtenberg, Ph.D., ABPP
Director and Professor of Psychology
Institute of Gerontology, Wayne State University
p.Lichtenberg@wayne.edu
Financial Exploitation:
Who is the Most Vulnerable?

3. • Originally for capacity for psychiatric treatment
and guardianship, then health decisions
• Identify four aspects of decision making.
Is the person communicating:
1) Choice
2) Understanding
4) Appreciation
4) Reasoning
Groundbreaking Work
Of Applebaum and Grisso 1988

4. Lichtenberg et al. 2013 & 2016
Psychological Vulnerability
2013: The strongest finding, however,
was the prevalence of fraud in persons with the highest depression
and lowest social-needs fulfillment (14%) compared to the prevalence
of fraud in the rest of the sample (4.1%; X2= 20.49; p < .001)
2016: Fraud prevalence among those with clinically significant depression
and the lowest 10% in social-needs fulfillment (8.7%) was more than
twice as high compared to the rest of the sample (4.1%; χ2 = 7.85, p = .005).

5. Vol. 31, No.6, pp 1-14

7. Conceptual Model for LFDRS
Integrity of
Financial
Decisional
Ability
Consistency with
Values
Contextual Factors
Financial Situational
Awareness
Psychological
Vulnerability
Undue Influence
Past Financial
Exploitation
Intellectual Factors
Express:
Choice
Rationale
Understanding
Appreciation

8. Using Person-Centered Principles for
Financial Capacity
People are more than the sum of their cognitive abilities:
Context and psychological vulnerability are key aspects too
Traditional approaches overemphasize deficits and under-emphasize strengths:
Hypothetical vignettes over-emphasize deficits
Subjective experience of person with dementia (PWD) remains important:
Analyzing the actual decision is critical

9. PETER A. LICHTENBERG, Ph.D., ABPP
Wayne State University, Detroit, Michigan, USA
Clinical Gerontologist, 2011; vol 35; pp42-56
Misdiagnosis of Alzheimer’s Disease:
Case Studies in Capacity Assessment

10. ● May 21, 2010: Recalled 2 of 3 items and demonstrated better ability to
draw small inferences about the type of information requested.
● July 26, 2010: Ms. B was not in attendance. Her nephew and niece
reported that an outsider wanted to assume power of attorney (Ms. B’s
attorney). They also reported that Ms. B had refused to shower or change
out of soiled clothes. Dr. N. concluded, “Unfortunately patient’s
dementia has advanced to a point where her judgment about important
matters including who should have power of attorney is no longer
satisfactory.”
Misdiagnosis of Alzheimer’s Disease
p. 51– Lichtenberg

11. Foundational to the
Rating Scale
Lichtenberg Financial
Decision Screening Scale (LFDSS):
Aka— “Tracker”

13. Provided support for the same financial decision-making deficits in capacity
judgments being found in APS cases of financial exploitation

15. Figure 2:
ROC Curve for the LFDSS
Score Using
Ordinal Variables
AUC=.88

17. Factor Analysis Results for LFDRS
Integrity of
Financial
Decisional
Ability
Consistency with
Values
Contextual Factors
Financial Situational
Awareness
Psychological
Vulnerability
Susceptibility
Intellectual Factors
Express:
Choice
Rationale
Understanding
Appreciation

19. AUC = .861
Figure 1
Receiver Operating Characteristics
(ROC) Curve Of RS Total Score
predicting Some/Major Concerns
about financial decisional abilities

20. Figure 2
Receiver Operating Characteristics
(ROC) Curve of RS — Total Score
Predicting Suspected
Financial exploitation
AUC =.792

21. Request an account at: OlderAdultNestEgg.com

22. Lichtenberg Interview Certification Training
WHY CONDUCT
INTERVIEWS?
WELCOME THE THREE
INTERVIEWS
INFORMED FINANCIAL
DECISIONS
COMMON
MISUNDERSTANDINGS
HOW TO
1 of 8
O V E R V I E W M O D U L E
Welcome!
How certification works
Why conduct these interviews?
Informed financial decisions
The three interviews and their purpose
Financial decision-making abilities
Common misunderstandings
Steps to conduct the interviews
FINANCIAL DECISION-MAKING
ABILITIES

23. Module 1:
Financial Decision
Tracker
Lichtenberg Interview Certification Training 2 of 8
O V E R V I E W M O D U L E
Certification
Module 2:
Financial Vulnerability
Assessment
Module 3:
Family & Friends
Overview
WHY CONDUCT
INTERVIEWS?
WELCOME THE THREE
INTERVIEWS
COMMON
MISUNDERSTANDINGS
FINANCIAL DECISION-MAKING
ABILITIES
INFORMED FINANCIAL
DECISIONS
HOW TO

24. Peter A. Lichtenberg, Ph.D., ABPP
Director and Professor of Psychology
Institute of Gerontology, Wayne State University
p.Lichtenberg@wayne.edu
Financial Exploitation:
Who is the Most Vulnerable?