How science and law can unite to reduce crimes against this vulnerable population.
By Bruce H. Price, M.D. and Ekaterina Pivovarova, Ph.D.
Written with Judith G. Edersheim, J.D., M.D.
High-profile schemes to defraud the elderly of their lifetime savings have headlined top newspapers and tabloids alike. There was Brooke Astor, whose son and attorney were convicted of criminal fraud, Anna Nicole Smith and the fight over J. Edgar Marshall's inheritance, and Huguette Clark, a multi-billionaire who lived for years in a hospital and whose death prompted a criminal investigation into her donations and inheritance. Unfortunately, these notorious cases are merely the tip of a vast and growing iceberg of financial fraud against the elderly. In 2011, Metlife Mature Market Institute estimated an annual loss of $2.9 billion in fraud against elders. Recent surveys indicate that more than 7.3 million Americans over 65 have been victims of financial fraud. As crime rates -- and vulnerable populations -- increase, the scientific and legal communities must pool our ever-increasing knowledge and resources to protect elderly family members.
The crimes themselves can range from bilking nursing-home residents of their savings to online dating scams, phony charities, home-repair or investment schemes, video gambling, bank-teller swindles, fake police hoaxes and most recently, enrollment in health insurance plans. Perhaps the most heartless gambit is the "grandparent scam," when someone claiming to be a relative calls to say a grandchild or family member is in trouble and instructs the target to wire money to rescue them. The scammers back their claims by offering specific information about the "kidnapped" party that's easily obtained on the Web or building upon facts inadvertently provided by the victim while on the telephone.
Women and older seniors, particularly those with cognitive impairment as well as those who live alone, are most likely to be victimized, and some research has suggested that African-Americans are almost three times more likely to be targeted. But who are these perpetrators? Although some are family members, friends or even victims' own lawyers, estimates indicate that more than half are not well known to the victim and may include internet scammers, nursing home or hospital personnel, financial advisors, and even landlords. Most of these crimes go unreported due to embarrassment, fear of retaliation, or not knowing where to turn.
Scammers don't target the elderly because they are more vulnerable to sympathetic stories -- if that were true, they might also target nurses, teachers or therapists. They prey upon them because many have difficulty sorting through information, making complex decisions, and resisting pressure -- difficulties that increase exponentially as the elderly begin to exhibit symptoms of dementia. Scammers have discovered a growth market: an estimated 24 million people worldwide currently suffer from some form of dementia, and with no medical breakthroughs evident in the near future, that number that could reach 84 million by 2040.
Detection and Prevention
While the scams are not new, remarkable advances in science mean that our responses can be. Over the last decade, researchers have focused on developing assessment tools to identify deficits in financial decision-making and vulnerability to undue influence long before they become apparent to family members, caregivers, and financial or legal advisors. Other approaches can detect neurological impairments even five to ten years before the formal diagnosis of dementia or other cognitive disorders. (For a review, see this article in the Journal of the American Medical Association.) Yet, these instruments, which can often be administered by primary care physicians, nurses, and occupational therapists, have not gained traction in clinical practice. We need to make these tools more readily available and ensure they are widely used.
Reporting Crimes
We also need to make sure crimes are being reported, investigated, and shut down.Some institutions have begun to move in the right direction. Three states have enacted statutes mandating bank tellers to report suspected financial abuse. Fifteen other states list bankers as a group that falls under mandatory reporting. At the federal level, the Securities and Exchange Commission (SEC), Financial Industry Regulatory Authority (FINRA), and North American Securities Administrators Association (NASAA) have issued guidelines and developed models for working with and protecting senior investors. But it is unclear whether or not commercial and investment banks have implemented these recommendations. Additionally, the U.S. Senate Special Committee on Aging has begun to identify means of warning elderly consumers and preventing fraud. Recently, the Special Committee on Aging set up a toll-free hotline to aid in the investigation and prosecution of perpetrators. Other agencies such as the Association of American Retired Persons (AARP) Fraud Fighter Call Center, National Consumers League (NCL) Fraud Center, and Federal Trade Commission (FTC) have also begun to directly address elder fraud.
Teamwork is Mandatory
Still we must go further by recruiting new allies. Currently, all states have elder abuse reporting hotlines, where anyone can call in suspected crimes of any kind against senior citizens; at least a third of all substantiated reports to Elder Services involve financial exploitation. But only 17 states have mandatory reporting statutes requiring that individuals in certain types of work, such as physicians, police officers and mental-health providers, must report any suspicion of elder abuse. In contrast, all 50 states have statutes to report child abuse and abuse of vulnerable persons such as individuals with intellectual disabilities who lack capacity to care for themselves. As scientists -- and family members -- we have a moral responsibility to protect those who helped to raise us and shape our lives. If criminals can use new technology to target and scam our elders, surely we can use the new and emerging science research to protect them.
The Center for Law, Brain and Behavior at Massachusetts General Hospital promotes the sound translation of brain-based and behavioral science into law and public policy.