Low scam awareness in old age may be an early sign of impending cognitive decline and dementia

1. Low scam awareness in old age may be an early sign of impending cognitive decline and dementia

Abstract: http://annals.org/aim/article/doi/10.7326/M18-2711
Editorial: http://annals.org/aim/article/doi/10.7326/M19-0907

Free Summary for Patients: http://annals.org/aim/article/doi/10.7326/P19-0003

URLs go live when the embargo lifts

Low scam awareness in older people is associated with risk for developing Alzheimer dementia or mild cognitive impairment in the future. These findings suggest that changes in social judgment occur before changes in thinking or memory are recognizable. Findings from a prospective cohort study are published in Annals of Internal Medicine.

Identifying predictors of dementia and mild cognitive impairment is critically important, but which aspects of behavior to target remains unclear. Older adults frequently are targeted by con-artists and are highly vulnerable to scams and fraud, particularly those that are financial in nature. However, little is known about whether scam awareness predicts transitions from normality to mild cognitive impairment and dementia.

Researchers from Rush Alzheimer's Disease Center in Chicago asked 935 older persons to complete a "scam awareness questionnaire" when all were free from dementia to ascertain a scam awareness score. Over an average of 6 years of follow up, participants also completed traditional neuropsychological tests every year, and the 264 participants who died had an autopsy of the brain to look for the hallmarks of Alzheimer disease. The researchers found that low scam awareness was a harbinger of adverse cognitive outcomes. Low scam awareness was also associated with Alzheimer disease pathology in the brain. According to the researchers, these findings suggest that low scam awareness is an early sign of impending mild cognitive impairment and dementia. Further, they conclude that evaluation of behaviors such as scam awareness may help to identify individuals at risk for dementia before cognitive symptoms manifest.

According to the author of an accompanying editorial, this study provides new information about social cognition as it relates to aging. The author provides an example of a patient who was scammed out of the majority of his life savings by a slick fraudster who tricked him into thinking he had won the lottery. Diminished financial capacity, financial abuse, and exploitation are major economic and public health problems. An older adult who is defrauded may end up unable to pay for medications, food, and long-term care, the author wrote. As such, the findings from this study should be a call to action for health care systems, the financial services industry, and their regulators to protect the health and wealth of our aging population.

Media contact: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org or 215-351-2653. To speak with the lead author, Patricia A. Boyle, PhD, please contact Deb Song at deb_song@rush.edu or Nancy DiFiore at Nancy_DiFiore@rush.edu.

2. ACP offers recommendations to improve the ACA, patient care

Abstract: http://annals.org/aim/article/doi/10.7326/M18-3401

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A new position paper from the American College of Physicians (ACP) examines ways to improve the Affordable Care Act (ACA), thus improving patient care. "Improving the Affordable Care Act's Insurance Coverage Provisions" provides a set of recommendations to strengthen the ACA and lay the foundation for health care reforms that will lead to universal coverage for all Americans. ACP's position paper is published in Annals of Internal Medicine.

ACP is committed to supporting policies that work to achieve universal health care coverage, and supported the passage of the ACA in 2010. However, while the ACA has made health care more accessible and affordable for millions of Americans, especially patients with pre-existing conditions, many still remain uninsured or face significant gaps in coverage. ACP's policy paper explores common-sense approaches to improve the ACA as internists continue to advocate for universal health care for all patients and consumers.

All seven of ACP's recommendations are detailed in the policy paper. At the top of the list is making sure that all patients have access to quality care. As such, ACP's paper calls for efforts to bolster the ACA, including stabilizing the health insurance market, expanding Medicaid, increasing competition in the marketplace, and amplifying awareness about how the ACA works to help patients and how to enroll in coverage plans. Additionally, ACP recommends that Congress enact legislation to develop a public insurance plan to ensure consumers have access to a variety of coverage options in their areas. The College also supports federal and state-led auto-enrollment programs to help make sure all individuals can successfully enroll in health care plans.

According to ACP's president, Robert McLean, MD, FACP, making these suggested changes could improve coverage for all Americans. He urges congressional leaders and the administration, as well as governments at the state level, to embrace patient-centered health care reform and take concrete action to ensure that the ACA continues to protect patients.

Media contact: For an embargoed PDF or to speak with an expert from ACP, please contact Jacquelyn Blaser at jblaser@acponline.org.

3. Nearly a quarter of older adults store firearms unlocked and loaded, regardless of suicide risk factors or memory loss

Abstract: http://annals.org/aim/article/doi/10.7326/M18-3698

URLs go live when the embargo lifts

Older adults may not consider age-related risk factors for firearm-related injury or death when making decisions about how to store their guns. Nearly a quarter of older adults surveyed stored their guns unlocked and loaded, regardless of memory loss or suicide risk. A brief research report is published in Annals of Internal Medicine.

Firearm access poses a danger to older persons with cognitive impairment and to those around them, as those with dementia may shoot others because of confusion or increased agitation and aggression. In addition, given that 91 percent of firearm deaths among older U.S. adults in 2017 were self-inflicted, the well-established relationship between cognitive impairment and depression is particularly concerning among this population.

Researchers from the University of Washington surveyed more than 4,400 older adults residing in firearm-owning households to characterize their gun storage practices with regard to self-reported sociodemographic features, suicide risk factors, and confusion or memory loss. They found that less than a third of respondents stored their firearms locked and unloaded, even when risk factors for harm were present. The prevalence of diagnosed depression and frequent mental distress was 17.4 percent and 6.9 percent, respectively. Memory loss in the previous year was reported by 12.2 percent of the participants and 5.6 percent reported discussing their memory loss with a clinician. According to the researchers, these findings suggest that conversations about firearm storage could be crucial to prevent injuries and save lives.

Media contact: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To interview the lead author, Erin R. Morgan, MS, please contact Laura East at eastl@uw.edu.

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