anking and medicine have little in common. One is for creating and managing wealth, the other for managing health. Yet together they could help detect and fight the growing burden of Alzheimer’s disease and related dementias. I call this partnership of banking and medicine whealthcare.
Thanks to decades-long advances in personal and public health, the average 65-year-old American can expect to live another 19 years. This remarkable progress presents a challenge: Many people might not have enough money to live that long.
The monthly pension check has gone the way of the electric typewriter and calculator. Retirement funds, if we have any — half of American families have saved less than $5,000 for retirement — are ours to manage, and we really need that cash to pay for our living expenses and most of our long-term care. Aging Americans are also taking on more debt, such as their children’s and grandchildren’s student loans. Since 1992, the proportion of Americans 75 and older carrying debt has increased from one-third to one-half.
These age-related financial challenges often coincide with the emergence of troublesome health events, particularly age-related declines in memory and thinking skills. They put older adults at risk of needing long-term care and of being vulnerable to financial fraud, exploitation, or their own financial errors. Once money is lost, a cognitively impaired adult can’t go back to work. Someone else — the family or the state — has to step in to pay.
“This is a set of circumstances ripe to balloon,” said Patrick Harker, president of the Federal Reserve Bank of Philadelphia, in his opening address at “Aging, Cognition and Financial Health: Building a Robust System for Older Americans,” a two-day conference hosted by the bank in collaboration with the Penn Memory Center, which I co-direct. The problem isn’t just a money problem, he explained, it’s one that affects the health and well-being of older adults and their families.
It’s a problem I see often in the care of my patients.
Arthur Packel lost much of his family’s fortune before his wife, Renee, brought him to the Penn Memory Center, where I diagnosed him with Alzheimer’s disease. Joseph Donahue is participating in a study I’m running to test a drug to reduce his risk of developing Alzheimer’s disease. He realized that while he’s actively managing his retirement funds, such as trading equities, he has no system set up to detect an error in these transactions or his other financial transactions.
Our day-to-day use of our money provides signals of brain function that can be far more real-world and meaningful than the results of online cognitive tests and brain scans. This is where the banking and financial services industries can help achieve our national “moonshot” goal of preventing Alzheimer’s disease by 2025.
In the pencil, paper, and dial-up telephone days, tracking a family’s finances over multiple institutions was a challenge, even for individuals whose brains were healthy. Today, it’s been made easier by volumes of financial data that can be rapidly aggregated and analyzed, along with automated communication of real-time alerts.
At the conference, participants discussed how the banking and financial services industries could provide Alzheimer’s “early warnings” using a system that sees older adults’ health as enmeshed in the maintenance of their wealth. Such as system could adopt tried-and-true methods of public health: surveillance, monitoring, and intervention.
A representative from EverSafe, a financial technology company, demonstrated how financial data across accounts can be aggregated and analyzed, and how the company can send out automated alerts when an account has an unusual transaction suggesting fraud or error. With such a system, Renee could have learned about her husband’s problem the first time he forgot to pay a bill. Joseph could continue to manage his accounts knowing that a mistake would be detected and that would be alerted — along with his doctor and other trusted advocates.
Casey Greene, a Penn professor and expert in machine learning, showed how we could benefit from studying health and wealth data with the same methods he uses to study genetic and other biological data. Financial information such as credit card purchases and ATM use, as well as voice records from call centers and medical records, could be subjected to methods that learn and predict who’s likely to experience cognitive decline or become a victim of fraud.
Technology, of course, is only as good as the people who use it. The financial services industry is built on trust, and trust is about human interactions. The conference discussed how interactions between brokers and their clients are set to undergo a big change in 2018. Just as doctors must ask their patients for the name of an emergency contact and call that person in the event of an emergency, the Financial Industry Regulatory Authority’s rule 4512 mandates that brokers and dealers ask for similar contacts. This requires brokers and dealers to have the kinds of breaking-bad-news and planning-for-the-future conversations that I train medical students and residents to have.
Most people spread their funds across multiple institutions. Scammers know this and so adeptly steal a little bit here and a little there. A recurring question was how to get one financial institution to talk to another.
Larry Santucci, senior industry specialist at the Federal Reserve Bank of Philadelphia, offered an answer. He closed the conference describing a visionary proposal for a federally operated system that collects alerts from across financial institutions. Bankers, brokers, and doctors like me could use this “eldernet” to identify problems before they spread like a cancer throughout a person’s accounts.
That’s the vision of whealthcare.
Jason Karlawish, M.D., is a professor of medicine and medical ethics at the University of Pennsylvania and co-director of the Penn Memory Center.