Abstract
Background: Evaluation of a social support network, including the need for support in managing finances independently is an essential component of Comprehensive Geriatric Assessment (CGA). Safeguarding of finances (e.g. third party authorities, enduring power of attorney, will) should be encouraged in all order adults, particularly those with cognitive decline to provide security and protection of their wishes should they lose capacity to manage financial decisions. We sought to evaluate financial competency and preparedness in a population attending our integrated care for older persons service (ICPOP).
Methods: Participants included were new patients referred to ICPOP between January and May 2023 with completed CGAs. A retrospective analysis was conducted of patient demographics, ability to independently manage finances, dependency on personal and instrumental activities of daily living.
Results: Of our analytic cohort (n=85), 56% (n=48) were female, median age was 81. The most common reason for referral was new change in cognition which accounted for 48% (n=41/85) of patients. Median Rockwood Clinical Frailty Scale was 5. Median Barthel score was 17. Median Lawton- Brody score was 4/8 with 80% (n=68) patients scoring 1 in the financial section which indicates their ability to manage their finances partially or completely. 60% (n=51) of patients collected their own pensions and on specific questioning reported managing their finances independently. No patient had an advanced care directive, 90% (n=77/85) did not have EPoA and 41% (n=35/85) did not have a will.
Conclusion: We identified that in those attending our service, very few had and enduring power of attorney (EPoA) in place with no person having a documented advanced care directive. Over half required some if not total assistance with financial matters. There is new legislation in Ireland, the Assisted Decision Making Act 2015, aiming to empower people to make supported decisions as per their enduring wishes. Supported decision making is essential to uphold the rights of the older person to make choices on their welfare, property and affairs and CGA provides opportunity for intervention in this remit. We should be mindful of enquiring about financial setup and financial planning as part of the CGA to best protect and empower our older adults in the community that may encounter issues with their cognition.