Which Items of the Financial Decision Tracker Differentiate Those with Decision-making Deficits from Those with No Deficits? Data from the Michigan APS Implementation Project

ABSTRACT

Objectives: Lichtenberg et al. reported on the implementation of a 10-item financial decision-making screening scale (Financial Decision Tracker–FDT) in a state-wide Adult Protective Services (APS) project. This study examined which of the seven scored items, reflecting the Appelbaum & Grisso decisional abilities model, were most sensitive to decision-making deficits.

Methods: The Financial Decision Tracker was administered to 445 adults aged 60 years of older during APS investigations of financial exploitation. APS workers administered the FDT as part of their financial exploitation investigation. Overall, seven scored FDT items were compared using T tests.

Results: Six of the seven risk-scored items were significantly different between those with and without decision-making deficits. Two of the items had small effect sizes, and four items had moderate effect sizes. The larger, moderate effect sizes were related to risk to financial well-being (appreciation), impact on finances (understanding), and who benefits most from the decision (understanding).

Conclusions: The main findings of the study supported the Appelbaum and Grisso’s decision-making model and the ability of specific items related to understanding and appreciation to differentiate between individuals with and without financial decision-making deficits.

Clinical Implications: The FDT is a clinically reliable and validated tool for older adults.

KEYWORDS:

• Adult protective services
• financial exploitation
• decision-making capacity
• implementation
• vulnerable older adults

Clinical implications

• Study results support the use of the FDT in assessing Appelbaum and Grisso’s model of informed decision-making for financial decisions and transactions.

• The risk scoring system for the FDT provides an evidence-based tool that can be used in capacity assessments with older adult clients.

• The online training and certification process via olderadultnestegg.com enables non-mental health practitioners to screen for decision-making deficits in vulnerable older adults.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

National Institutes of Health P30 AG015281, Michigan Center for Urban African American Aging Research, American House Foundation, Retirement Research Foundation 2014-024, Michigan Alzheimer’s Center Core grant #P30AG053760.State of Michigan Department of Health and Human Services and the Michigan Health Endowment Fund.