Older adults may lose ability to manage money and medications

(Reuters Health) - - A large proportion of older Americans will need assistance managing their medicines and finances as they age, and they need to plan for these changes along with their families, researchers say.

Among people in their late 60s who had no trouble managing their medications, for example, one in 10 developed difficulties over the next 10 years, the study team found. Among 85 year-olds without difficulty managing finances, seven in 10 developed a problem in the next decade.

“Most older adults want to live independently for as long as possible. The problem is, it’s hard to live independently if you have difficulty managing your medications or finances,” said study coauthor Dr. Alex Smith of the University of California at San Francisco.

“Most older adults who are managing their finances and medications independently now don’t know their risk of losing their ability to manage these tasks,” he told Reuters Health by email.

The ability to manage money and medications is different from many other aspects of daily functioning because it’s complex and depends entirely on cognitive skills, the researchers write in Journal of the American Geriatrics Society.

To estimate the 10-year risk for older people without difficulties of developing problems in these areas, Smith and colleagues analyzed data from the long-term U.S. Health and Retirement Study. They focused on 9,434 men and women who answered questionnaires every two years between 2002 and 2012. Questions included “Do you have any difficulty managing medications?” and “Do you have any difficulty managing your money, such as paying your bills and keeping track of expenses?”

Over 10 years, they found that 1,427 people, or 15 percent, developed difficulty with managing medications and 2,824, or 30 percent, developed difficulty with managing finances. About one third of the original study group died before developing difficulty with either task.

Both gender and age were strong predictors of who would develop problems. About 21 percent of women and 16 percent of men developed a difficulty managing medications. With finances, 34 percent of men and 36 percent of women developed a problem.

Among people aged 65 to 69 at the start of the study, 23 percent developed problems managing money over the next decade. Among 85-year-olds, 40 percent developed difficulty managing medications.

“We don’t help people anticipate the fact that they may lose these abilities,” said Dr. Holly Holmes of the University of Texas Health Science Center at Houston, who wasn’t involved with the study.

“We assess them when the abilities are already gone, and people often don’t have a plan in place,” she told Reuters Health by email. “We rarely counsel 65-year-olds about their risk and how to plan for it.”

Other risk factors associated with developing a difficulty were stroke, low self-reported memory, low cognitive functioning and difficulty with other activities of daily living such as getting out of bed, eating, bathing, dressing or walking across a room.

“Day-to-day functioning is incredibly important. If you don’t have these abilities and don’t have someone to help you, it can threaten your life,” said Dr. Mark Lachs, director of Cornell University’s Center for Aging Research in New York City, who wasn’t involved with the study.

“The elephant in the room is that this study covers self-reported losses of function, so the rates are actually much higher for those who don’t realize they’ve lost their abilities,” he told Reuters Health.

Healthcare providers and policymakers should consider screenings for medication management and financial issues as patients age, Lachs added.

“Everybody who has an older parent has a story about scams or some type of abuse,” he said. “The cost of this is extraordinary, both medically and fiscally, and we need to develop a way to provide protections but not violate individual rights as people age.”

SOURCE: Journal of the American Geriatrics Society, online April 5, 2017.