November 20, 2003

BIRMINGHAM, AL — A study in the November issue of the Journal of the American Geriatrics Society finds that family caregivers of patients with Alzheimer’s disease often misjudge their loved ones’ ability to manage their own finances. The study also found that the patients tended to overestimate their own financial abilities.

“Doctors rely on patient and family reports in evaluating patients’ abilities,” the study’s authors write, “but reliability and accuracy of self and informant reports of financial abilities may be compromised in the context of dementia and caregiving.”

Alzheimer’s disease is one of several disorders that cause the gradual loss of brain cells. The disease is the most common form of dementia. Because of the unpredictable nature of the disease, caregivers may be responsible for everything from helping patients with hygiene to handling legal and financial matters. Eventually patients require complete care. About 4.5 million Americans have the disease, according to the Alzheimer’s Association.

University of Alabama at Birmingham (UAB) psychologists conducted a small study involving 20 Alzheimer’s patients, 20 family caregivers, 23 controls and 23 family informants. The researchers tested the patients’ abilities to perform several tasks related to personal finance, such as identifying coins and paper money and more complex chores involving understanding a bank statement, managing bill payments and using good judgment in routine financial matters. Half of the patients later reported having more ability to manage money than was actually demonstrated.

But caregivers also made errors in their estimation of the patients’ abilities, says Virginia Wadley, Ph.D., of the UAB Department of Psychology, the lead author of the study and assistant director of the UAB Center for Research in Applied Gerontology.

Caregivers tended to overestimate their loved one’s ability to handle simple cash transactions, but underestimated their abilities to manage a checkbook, Wadley said. The caregivers also erred when asked about the patients’ ability to pay bills. Caregivers, for example, were split almost equally between underestimating and overestimating the patients’ capacity to pay bills.

“The finding is important because you want to be able to give patients responsibility for anything they can still do,” Wadley said, “but you don’t want to allow the person to continue handling bills if they can’t.”

The study underscores the need for physicians and clinicians to use objective tests to assess patients’ current level of financial capacity. Such tests could be used to augment and complement patient and caregiver reports, the study’s authors said.

We are not saying that doctors should throw out caregivers’ information,” Wadley said, “since caregivers have the most direct knowledge about the patient. But we are saying that doctors should use a caregiver’s information with caution, because there may be some estimation bias going on.”

The study’s co-authors are Lindy E. Harrell, M.D., Ph.D., and Daniel C. Marson, J.D., Ph.D., of the UAB Department of Neurology and the Alzheimer’s Disease Research Center.