Cognitive, social, and neural determinants of diminished decision-making and financial exploitation risk in aging and dementia: A review and new model

Abstract

In this article we will briefly review how changes in brain and in cognitive and social functioning, across the spectrum from normal to pathological aging, can lead to decision-making impairments that increase abuse risk in many life domains (e.g., health care, social engagement, financial management). The review will specifically focus on emerging research identifying neural, cognitive, and social markers of declining financial decision-making capacity in older adults. We will highlight how these findings are opening avenues for early detection and new interventions to reduce exploitation risk.

Keywords: Capacity assessment; decision making; elder abuse; financial capacity; financial exploitation.

Figure 1.. Social cognitive neuroscience model for assessing financial exploitation risk.

Two interacting pathways can lead to increased exploitation risk in older adulthood. Cognitive changes are associated with reduced financial skills, and increased risk of exploitation through financial mismanagement. Changes in social cognition are associated with increased exploitation risk through undue social influence, coercion or deception at the hands of others. Both pathways are associated with dissociable patterns of structural and functional brain change (see text for details).