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Psychological and Functional Vulnerability Predicts Fraud Cases in Older Adults: Results of a Longitudinal Study
Abstract and Figures
Using cross sectional data Psychological vulnerability was identified as a correlate of older adult’s being defrauded. We extend that research by examining fraud prevalence using longitudinal data from the Health and Retirement Study, and to identify the best predictors of fraud longitudinally across a 4-year time frame. Whereas reported fraud prevalence was 5.0% in a 5-year look-back period in 2008, it increased to 6.1% in 2012. The rate of new-incident fraud across only a 4-year look-back was 4.3%. Being younger-old, having a higher level of education, and having more depression significantly predicted the new cases of fraud reported in 2012. Psychological vulnerability was a potent longitudinal predictor of fraud, with the most vulnerable individuals being more than twice as likely to be defrauded. Results indicate that fraud victimization among older adults is rising, and that vulnerability variables, along with some demographic variables, predict new cases of fraud.
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... Several identifiable risk factors of financial exploitation have been reported in the literature, including demographic factors (e.g. low income), cognitive impairment (James et al., 2014), and psychosocial factors such as depression and loneliness (Lichtenberg et al., 2016;Weissberger et al., 2020). According to cumulative advantage/disadvantage theory, adverse experiences during childhood may increase the risk of older adult maltreatment, including financial exploitation, later in life (Easton & Kong, 2021). ...
... The present findings show that all participants experienced expected negative emotional reactions to financial exploitation such as feelings of anger, hurt, shock, and helplessness. This is consistent with a qualitative study by Nguyen et al. (2021) that examined financial exploitation in older adults and also found the emotional impact to be a theme of their narratives, and with numerous quantitative studies on financial exploitation that have found depression, anxiety, and posttraumatic stress to be correlates of financial exploitation (Lichtenberg et al., 2016;Weissberger et al., 2020;Weissberger, 2022). In addition, one-third of participants described maladaptive coping mechanisms which were expressed through self-blame and rationalization while two-thirds presented notable adaptive coping mechanisms which were expressed through acting for the benefit of the self and offspring, helping others, and alertness and caution as preventive measures (none of the interviewees described using both mechanisms during the interview). ...
... 5 Studies focussing on the elderly have also identified cognitive impairment and psychological well-being as risk factors for abuse, including financial exploitation. 15,16 Moreover, learning disability has been highlighted as a risk factor for modern slavery and human trafficking, [17][18][19] while criminal exploitation often targets those with mental health needs, learning disabilities or substance misuse issues, sometimes manifesting as 'cuckooing'. 20 In one large-scale modern slavery case, 68% (of 60 victims) had substance misuse issues, and 20% had learning disabilities or mental health needs, with 62% of victims not receiving any support from services. ...
Background
Exploitation poses a significant public health concern. This paper highlights ‘jigsaw pieces’ of statistical evidence, indicating cognitive impairment as a pre- or co-existing factor in exploitation.
Methods
We reviewed English Safeguarding Adults Collection (SAC) data and Safeguarding Adults Reviews (SARs) from 2017 to 22. Data relevant to exploitation and cognitive impairment were analysed using summary statistics and ‘analysis of variance’.
Results
Despite estimates suggesting cognitive impairments may be prevalent among people experiencing exploitation in England, national datasets miss opportunities to illuminate this issue. Although SAC data include statistics on support needs and various forms of abuse and exploitation, they lack intersectional data. Significant regional variations in recorded safeguarding investigations and potential conflation between abuse and exploitation also suggest data inconsistencies. Increased safeguarding investigations for people who were not previously in contact with services indicate that adults may be ‘slipping through the net’. SARs, although representing serious cases, provide stronger evidence linking cognitive impairment with risks of exploitation.
Conclusions
This study identifies opportunities to collect detailed information on cognitive impairment and exploitation. The extremely limited quantitative evidence-base could be enhanced using existing data channels to build a more robust picture, as well as improve prevention, identification and response efforts for ‘at-risk’ adults.
... Samsi et al. (2014) interviewed frontline practitioners who identified that dementia was a vulnerability factor for financial exploitation. For individuals experiencing cognitive decline, Lichtenberg et al. (2013Lichtenberg et al. ( , 2016 highlighted that the presence of other mental health issues such as depression and psychological vulnerabilities (e.g., susceptibility to undue influence) increased the likelihood of exploitation occurring. While not related to intellectual/cognitive ability per se, factors such as financial decision-making capacity, ability to understand financial choices, and carrying out activities of daily living were highlighted as factors that both increase the likelihood of exploitation and as potential mitigators and points for preventative intervention (Lichtenberg et al., 2020;Namkee et al., 2000). ...
Exploitation is a form of abuse that occurs when one person unfairly manipulates another for profit or personal gain. Various individual and social characteristics have the potential to increase an individual’s risk of being exploited. Cognitive impairment is one potential vulnerability factor that has received minimal research attention. This scoping review aimed to investigate cognitive impairment as a factor that may increase an individual’s vulnerability to exploitation. Study inclusion criteria were: (a) empirical studies; (b) studies presenting extractable data related to cognitive impairment and exploitation; (c) studies exploring cognitive impairment as a vulnerability factor for exploitation; (d) studies published after 1998; and (e) studies available in English. A six-step search strategy was employed: (a) electronic searches of bibliographic databases; (b) screening reference lists of included studies; (c) forward citation tracking in Google Scholar; (d) expert recommendations; (e) website searches of relevant Non-Governmental Organizations (NGOs); and (f) a call for evidence. Twenty studies met the inclusion criteria. Three types of exploitation were reported: sexual ( n = 10), financial ( n = 8), and criminal ( n = 2). Intellectual disability ( n = 8) and mental health ( n = 8) were the most frequently described forms of cognitive impairment. The results indicate that cognitive impairment is a factor that increases vulnerability to exploitation. However, the limited number and disparate nature of the studies means that it is impossible to disentangle all the complexities in the relationship between cognitive impairment and exploitation. Further research is needed to understand if cognitive impairment increases vulnerability to all types of exploitation or if it results in varying levels of susceptibility to different types of exploitation.
... Over the recent years, there has been a steady increase in studies that have identified factors associated with increased vulnerability to financial exploitation (or financial exploitation vulnerability, FEV; for review, see [5]). Such risk factors include psychological factors such as depressive and anxiety symptoms (e.g., [6,7]) and physical health factors [8][9][10]. Poor cognitive functioning and/or the presence of underlying dementia conditions have also been demonstrated to increase financial exploitation experiences or FEV [11][12][13], though even older adults without cognitive disorders such as dementia have experienced financial exploitation or evidenced increased FEV (e.g., [12]). ...
Social support and loneliness have been identified as important correlates of financial exploitation vulnerability (FEV) in older adults. However, the potential combined effect of these social factors on FEV remains unclear. Moreover, given that social support and loneliness may become more important as age increases, age may have a moderating effect on the loneliness-social support interaction. Participants were 342 community-living Israeli older adults aged 60 or over (M age = 73.37, SD = 7.82, 69.1% female) who responded to questionnaires assessing FEV (Financial Exploitation Vulnerability Scale), perceived social support (The Multidimensional Scale of Perceived Social Support), loneliness (UCLA Three-item Loneliness Scale), and sociodemographic characteristics. Two hierarchical linear regression models covarying for demographic variables examined study hypotheses. In a first model, a significant interaction between social support and loneliness was discovered such that high levels of perceived social support attenuated the positive loneliness–FEV association. In a second model, a significant three-way interaction between social support, loneliness, and age was discovered. Probing the interaction revealed that the attenuating effect of social support on the loneliness–FEV link increased with increasing age. Findings suggest that effects of social factors on FEV may interact with each other and with age to predict FEV, and provide insights into when social support may be most relevant in mitigating FEV.
Death anxiety arousal is a common tactic in fraud targeting older adults; however, little is known about its impact on vulnerability to fraud and the moderating role of mental simulation. Two experiments were conducted using the mortality salience task. Experiment 1 employed a mortality salience manipulation to examine the causality of death anxiety arousal affecting older adults’ vulnerability to fraud using a behavioral experiment. Experiment 2 used the imaginary priming paradigm to manipulate different types of mental simulation to address whether mental simulation could moderate the relationship between death anxiety and vulnerability to fraud. The results showed that death anxiety significantly increased the vulnerability to fraud. Process and downward outcome simulation buffered this effect, while upward outcome simulation exacerbated it. Clinicians may focus on relieving death anxiety, decreasing upward outcome simulation, and enhancing process or downward outcome simulation as promising pathways to protect older adults against fraud.
With technological advancements, financial exploitation tactics have expanded into the online realm. Older adults may be particularly susceptible to online scams due to age- and Alzheimer’s Disease-related changes in cognition. In this study, 182 adults ranging from 18-90 years underwent cognitive assessment, genotyping for apolipoprotein E e4 (APOE4), and completed the lab-based Short Phishing Email Suspicion Test (S-PEST) as well as the real-life PHishing Internet Task (PHIT). Across both paradigms, older age predicted heightened susceptibility to phishing, with this enhanced susceptibility pronounced among older APOE4 allele carriers with lower working memory. Additionally, performance in both phishing tasks was correlated, in that reduced ability to discriminate between phishing and safe emails in S-PEST predicted greater phishing susceptibility in PHIT. The current study identifies older age, APOE4, and lower cognition as risk factors of phishing vulnerability and introduces S-PEST as an easy-to-administer, ecologically valid tool for assessing phishing susceptibility.
The internet has brought people closer, but it has also resulted in various cybercrimes, which can cause mental disturbances in victims. Assessing the psychological effects of cybercrimes is as important as it is for any other crime. However, the techniques used for assessing victims of cybercrimes are different from those used for common crimes like murder or domestic violence. Misusing personal information, identity theft, pornography, cyber extortion, and cyber stalking can cause mental disorders such as depression, PTSD, anxiety, and even schizophrenia. It is critical to view cybercrimes from a psychological and forensic perspective to understand their implications on victims. More research is needed to study the psychological effects of cybercrimes. This article focuses on cybercrimes, their psychological impact on human behaviour and the neglected area of cybercrimes' implications on mental health.
Financial exploitation and financial capacity issues often overlap when a gerontologist assesses whether an older adult’s financial decision is an autonomous, capable choice. Our goal is to describe a new conceptual model for assessing financial decisions using principles of person-centered approaches and to introduce a new instrument, the Lichtenberg Financial Decision Rating Scale (LFDRS). We created a conceptual model, convened meetings of experts from various disciplines to critique the model and provide input on content and structure, and select final items. We then videotaped administration of the LFDRS to five older adults and had 10 experts provide independent ratings. The LFDRS demonstrated good to excellent inter-rater agreement. The LFDRS is a new tool that allows gerontologists to systematically gather information about a specific financial decision and the decisional abilities in question.
This study examined correlates of susceptibility to scams in 639 community-dwelling older adults without dementia from a cohort study of aging. Regression models adjusted for age, sex, education, and income were used to examine associations between susceptibility to scams, measured by a five-item self-report measure, and a number of potential correlates. Susceptibility was positively associated with age and negatively associated with income, cognition, psychological well-being, social support, and literacy. Fully adjusted models indicated that older age and lower levels of cognitive function, decreased psychological well-being, and lower literacy in particular may be markers of susceptibility to financial victimization in old age.
Financial exploitation, and particularly thefts and scams, are increasing at an alarming rate. In this study we (a) determined the national prevalence of older adults who report having been a victim of fraud, (b) created a population-based model for the prediction of fraud, and (c) examined how fraud is experienced by the most psychologically vulnerable older adults. The older adults studied were 4,400 participants in a Health and Retirement Study substudy, the 2008 Leave Behind Questionnaire. The prevalence of fraud across the previous 5 years was 4.5%. Among measures collected in 2002, age, education, and depression were significant predictors of fraud. Financial satisfaction and social-needs fulfillment were measured in 2008 and were significantly related to fraud above and beyond the 2002 predictors. Using depression and social-needs fulfillment to determine the most psychologically vulnerable older adults, we found that fraud prevalence was three times higher (14%) among those with the highest depression and the lowest social-needs fulfillment than among the rest of the sample (4.1%; χ (2) = 20.49; p < .001). Clinical gerontologists and other professionals in the field need to be aware of their psychologically vulnerable clients heightened exposure to financial fraud.
We report on the development of a new cognitive screening test administered over the telephone. The Telephone Interview for Cognitive Status correlates very highly with the Mini-Mental State Examination in Alzheimer's disease. It has high sensitivity and specificity to the diagnosis of Alzheimer's disease (AD) and high test-retest reliability in this population. The instrument is acceptable to patients and has a sufficient range to be useful in follow-up and field research studies of AD and possibly other disorders associated with cognitive impairment.
(C) Lippincott-Raven Publishers.
Decision making is an important determinant of health and well-being across the lifespan but is critical in aging, when many influential decisions are made just as cognitive function declines. Increasing evidence suggests that older adults, even those without dementia, often make poor decisions and are selectively vulnerable to scams. To date, however, the factors associated with poor decision making in old age are unknown. The objective of this study was to test the hypothesis that poor decision making is a consequence of cognitive decline among older persons without Alzheimer's disease or mild cognitive impairment.Participants were 420 non-demented persons from the Memory and Aging Project, a longitudinal, clinical-pathologic cohort study of aging in the Chicago metropolitan area. All underwent repeated cognitive evaluations and subsequently completed assessments of decision making and susceptibility to scams. Decision making was measured using 12 items from a previously established performance-based measure and a self-report measure of susceptibility to scams.Cognitive function data were collected over an average of 5.5 years prior to the decision making assessment. Regression analyses were used to examine whether the prior rate of cognitive decline predicted the level of decision making and susceptibility to scams; analyses controlled for age, sex, education, and starting level of cognition. Among 420 persons without dementia, more rapid cognitive decline predicted poorer decision making and increased susceptibility to scams (p's
Recent reviews of scientific work on subjective well-being (SWB) reveal disagreements in conceptualization, measurement, and explanation of the concept. We propose Social Production Function theory as a framework to resolve them. Social Production Function (SPF) theory integrates strengths of relevant psychological theories and economic consumer/household production theories, without their limitations (namely, tradeoffs between satisfaction of different needs are not in the first, and goals or needs are not in the second). SPF theory identifies two ultimate goals that all humans seek to optimize (physical well-being and social well-being) and five instrumental goals by which they are achieved (stimulation, comfort, status, behavioural confirmation, affection). The core notion of SPF theory is that people choose and substitute instrumental goals so as to optimize the production of their well-being, subject to constraints in available means of production. SPF theory guides research measurement and explanatory models, and it integrates features of contemporary subjective well-being theories.
What are the dimensions of well-being? That is, what universal goals need to be realized by individuals in order to enhance their well-being? Social production function (SPF) theory asserts that the universal goals affection, behavioral confirmation, status, comfort and stimulation are the relevant dimensions of subjective well-being. Realization of these substantive goals and the perspective on opportunities to realize these goals in the future contributes to the affective and cognitive component of well-being. The theoretical elaboration of this theory has been published elsewhere. This paper provides a measurement instrument for the dimensions of well-being. To measure levels of affection, behavioral confirmation, status, comfort and stimulation, and empirically validate the dimensions of well-being, the SPF-IL scale was developed. This paper presents findings from a pilot study (n =145), the main study (n = 1094), a test–retest examination (n = 163), and a validation study (n = 725). The measurement model was tested by means of structural equation modeling. Confirmatory factor analysis supported the dimensional structure of well-being, indicating construct validity. The overall fit of the model was sufficient, in spite of the somewhat problematic measurement of status, and the test–retest study showed an acceptable level of stability. As for the content validity of the dimensions and their measurement, various sub-studies showed that the SPF-IL scale is a valid instrument, doing at least as well as popular measures of overall well-being but also specifying its dimensions.
The Telephone Interview for Cognitive Status (TICS) is an 11-item screening test (maximum score=41 points) that was developed for the assessment of cognitive function in patients with Alzheimer's disease who are unwilling or unable to be examined in person. To investigate the 1-month test-retest reliablility and validity of the TICS in a stroke sample, we administered it twice by telephone to 36 stroke patients (age = 72.3 ± 8.9; education = 9.7 ± 4.7) and 36 stroke-free non-demented control subjects (age = 71.8 ± 6.8; education = 13.1 ± 4.1). Dementia was diagnosed in six stroke patients based on neuropsychological and functional examinations performed during an outpatient visit and the Mini-Mental State Examination (MMSE) was also given. Multiple regression analyses determined that stroke status was significantly related to performance on the TICS (β= −0.26, p = 0.006), while adjusting for demographic variables. Among stroke patients, test-retest reliability was excellent (r = 0.90, p < 0.001) and performance was significantly correlated with MMSE score (r = 0.86, p <0.001). A TICS cutoff score <25 best distinguished between demented and non-demented patients; sensitivity (1.00) and specificity (0.83) were excellent and comparable to the sensitivity (0.83) and specificity (0.87) of the MMSE, with dementia defined as a score <24/30. We conclude that the TICS is a reliable mental status test that can provide accurate information regarding cognitive function in stroke patients who cannot be assessed in person.
The CES-D scale is a short self-report scale designed to measure depressive symptomatology in the general population. The items of the scale are symptoms associated with depression which have been used in previously validated longer scales. The new scale was tested in household interview surveys and in psychiatric settings. It was found to have very high internal consistency and adequate test- retest repeatability. Validity was established by pat terns of correlations with other self-report measures, by correlations with clinical ratings of depression, and by relationships with other variables which support its construct validity. Reliability, validity, and factor structure were similar across a wide variety of demographic characteristics in the general population samples tested. The scale should be a useful tool for epidemiologic studies of de pression.
Detection of dementia in large, geographically dispersed populations is difficult. Conventional in-person neuropsychological assessment techniques, no matter how brief, are too costly to be practical for this purpose. Telephone interviewing is an obvious alternative for cognitive screening, but its practical utility is relatively unexplored. We therefore investigated the performance characteristics of a telephone screen for dementia in elderly residents of congregate housing facilities. We interviewed 209 subjects using the Telephone Interview for Cognitive Status (TICS) and a modified version (TICS-m) that includes items sensitive to early dementia (delayed recall) and eliminates other items difficult to verify in survey work. After the subjects received a brief in-person neuropsychological assessment, TICS and TICS-m scores were compared as predictors of the resulting clinical assignment (normal, mildly impaired, or demented). Although the TICS-m yielded slightly better results, both versions of the instrument were sensitive and specific indicators of dementia in this community sample. In a separate exercise, both instruments also correctly identified 17 clinic patients with carefully diagnosed Probable AD. Telephone interviewing of cognitive function may therefore provide an economical approach to mental status screening in research studies where in-person assessment is impractical.
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