In Focus: Supporting clients through cognitive decline

Finding it harder to concentrate or remember things is a normal part of the ageing process. But sometimes cognitive decline — a decrease in the ability to think and process information — happens at a faster rate than usual and starts affecting a person’s ability to function.

Some people go on to develop conditions such as dementia or Alzheimer’s disease, which speeds up cognitive decline further.

Spotting the signs and the extent of cognitive decline isn’t easy, but advisers need to be mindful of their responsibilities towards clients in vulnerable circumstances.

Where possible, visual examples such as pictorial explanations or diagrams should be used

So, what can they do to help those who need some extra support in understanding and processing information?

Many of us will know someone who has either experienced cognitive decline or worried about the cognitive ability of a loved one. In 2022, researchers at University College London found that cases of cognitive decline — which they described as ‘a step beyond memory concern’ — had more than doubled during the previous 10 years among people aged 65 and over. In 2009, there was one new case for every 1,000 people observed; by 2018, this had risen to three new cases.

The challenges

In the context of financial planning, clients need to understand what an adviser is recommending for them and why.

That may not sound like rocket science, given that advisers tend to be skilled in making complex ideas sound simple, but there is a lot going on in the brain to make that understanding possible.

It may be prudent to encourage repetitive meetings to ensure that information is being consolidated and retained

“Managing finances and budgeting skills require a number of cognitive skill processes, such as attention, information processing, memory and higher-level executive functioning skills,” says cognitive rehabilitation therapist and brain-injury specialist Natalie Mackenzie, founder of The Brain Injury Therapist.

“This encompasses more complex skills such as planning ahead, problem solving and organisation, as well as sound judgement.”

As the brain ages and cognitive ability declines, people can start to struggle with these things.

“The emergence of challenges in decision making and problem solving often coincides with the compromise of cognitive functions,” says Mackenzie.

You’ve got to have the conversation and do these things as early as possible

“Attention processes may also decline in an ageing brain. Many people perceive a memory problem, when often it is the process of attending to information that is compromised.”

Identifying problems

Given the complexity of what goes on in the brain, it is not surprising that cognitive decline is difficult for advisers to spot.

Jonathan Barrett, chief executive and co-founder of clinical technology provider Comentis, says people often develop coping mechanisms to disguise their short-term memory problems.

“So, when advisers do spot it, it’s not in the early stages,” he says.

Just because someone has always communicated in a certain way, it doesn’t mean that’s the right way going forward

Barrett’s aunt had vascular dementia — a condition caused by reduced bloodflow to the brain. He recalls how she kept phone calls short, which meant other people did not notice anything wrong.

Eventually, his cousin realised that something was not right and, once Barrett’s aunt had been diagnosed, the contrast between her long-term and short-term memory became striking to those around her.

“My aunt couldn’t remember what she’d had for lunch that day,” says Barrett. “But, when talking to my mum, she could remember things from 50 years ago with complete clarity.”

Given the prevalence of sufferers’ coping mechanisms, and the lengthy gaps between face-to-face meetings of adviser and client, advisers are likely to miss many signs of cognitive decline.

“They shouldn’t beat themselves up if they don’t spot it,” says Barrett.

However, he thinks advisers should be aware of the difference between cognitive decline and mental capacity.

Multiple options and choices should be limited to two or three at a push

“People often mix the two up,” he says. “When you talk about mental capacity, that’s a legal construct. Someone may have declined to the stage where they lack a threshold of understanding to make a decision — and the threshold of understanding is specific to that decision.”

However, observes Barrett, someone may have significant cognitive decline but still have mental capacity.

Medical conditions

Sometimes advisers are aware from the outset that a client has a cognitive impairment, due to a medical condition. Daniel Mellor, a wealth planner at Succession Wealth, recalls advising a couple where the wife had early-stage dementia and it was obvious that her cognitive ability was getting worse at each annual review.

“At our initial meeting, she was engaged and fully aware. Then, on the second meeting, she had become distant — she stood back and the husband did all the talking,” says Mellor.

By the third meeting, the client with dementia was doing jigsaw puzzles throughout to preserve her cognitive ability.

Advisers shouldn’t beat themselves up if they don’t spot cognitive decline

“It’s sad that now she’s got to the stage where she’s unable to recognise her husband and has started to experience the true nastiness of dementia,” he says.

Although Mellor could observe an obvious change in his client’s cognitive ability over time, he did not want to upset her by highlighting it or labelling her as vulnerable. His response to her cognitive decline was practical — limiting jargon, pausing during conversations, and asking questions to ensure she had understood what was being discussed.

Communication

As clients get older, it is important for their adviser to regularly review how they communicate with them, and many already do this.

Technical Connection and St James’s Place director Edward Grant says his late father-in-law had always written emails as if they were letters, but then struggled to use a computer after developing dementia.

“Just because someone has always communicated in a certain way, it doesn’t mean that’s the right way going forward,” says Grant.

Advisers should be aware of the difference between cognitive decline and mental capacity. People often mix the two up

“If my father-in-law had gone down the digital statement route when he didn’t turn on the computer, that wouldn’t have been appropriate for him in his last two years.”

This situation is not unusual and it presents a challenge. The pressure is on financial services firms to reduce their carbon footprint and protect the environment by going paperless.

“How would the family know what [assets] the person had if they didn’t get a bank statement through the post?” says Grant.

“We’re all trying to save the planet, which is good, but you need to have a plan in place for people in this situation.”

Tipping point

For Grant, lost capacity is the tipping point that can be a problem if the adviser has not prepared for it in advance — for example, by putting a lasting power of attorney in place for the client, and knowing which trusted third parties should be involved if the need arose.

People often develop coping mechanisms to disguise their short-term memory problems. So, when advisers do spot it, it’s not in the early stages

“My father-in-law had been clear on what he wanted and didn’t want — and what we could and couldn’t do,” says Grant.

“But in the last two years it became difficult to have a conversation with him — and he wouldn’t have remembered it anyway.

“You’ve got to have the conversation and do these things as early as possible.”

Others say that, if cognitive decline is having an impact on a client, adviser meetings should be kept short, with topics and explanations broken into manageable chunks.

“Multiple options and choices should be limited to two or three at a push and, where possible, visual examples such as pictorial explanations or diagrams should be used. This will aid with both attention and memory,” says Mackenzie.

Managing finances requires a number of cognitive skill processes, such as attention, information processing, memory and higher-level executive functioning skills

She also suggests limiting the presentation of information to 15-minute bursts, and holding meetings with the client earlier in the day when their cognitive capacity is at its peak.

“It may be prudent to encourage repetitive meetings to ensure that information is being consolidated and retained,” adds Mackenzie.

“This also allows you to notice if there may potentially be any issues with capacity, and with the ability to understand and retain information.”

This article featured in the May 2024 edition of Money Marketing. 

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