MONEY Aging

As You Age, You Need to Protect Your Money — From Yourself

Piggy Bank Locked Up
Andy Roberts—Getty Images

A financial planner explains why he couldn't stop his client from making irrational decisions.

After three decades as a financial planner, I’m seeing more and more clients reach, not just retirement, but their final years. An issue that becomes especially important at this stage of life is how to help clients protect their financial resources from an unexpected threat — themselves.

One of my saddest professional experiences came several years ago when one of my long-time clients, a woman in her late 80s with no family and few close friends, abruptly fired me. Because Mary had no one else, I had helped her in many ways beyond the usual client/planner relationship and even reluctantly agreed to serve as her trustee and power of attorney in case she became incapacitated.

At what proved to be our final quarterly review meeting, Mary initially seemed confused. I was able to reassure her about the stability of her finances, and she seemed clearer by the time we finished. Three weeks later, I received a handwritten letter from her: “You have my finances in a mess. I can’t get to my money. You are fired.”

I was stunned. Yet ethically I was required to comply with her wishes by moving her holdings to another broker.

Several subsequent conversations demonstrated that Mary was suffering from periodic memory loss and delusion. Had she been disabled by a sudden accident or a stroke, I could have stepped in. Yet, because her decision to fire me was made at a time when she was arguably still competent, my hands were tied.

In theory, I could have gone to court with my power of attorney or in my position as trustee and petitioned to have Mary declared incompetent. But that posed a problem: Essentially, I would have been telling a judge, “Mary fired me as her adviser. I’d like to have her declared incompetent so I can re-hire myself as her adviser.” There was no way I was going to ask a judge to do that. I had a clear conflict of interest.

Since this experience, I have confirmed the wisdom, given the potential for conflict of interest, of never serving as a trustee or power of attorney for a client. With the help of suggestions from several other planners, I’ve also learned some strategies to help protect clients from themselves.

One tool is to ask clients to sign a statement authorizing a planner concerned about possible irrational behavior to contact someone, such as a family member or physician, designated by the client. While this would not prevent a client from firing an adviser, it would provide a method of discussing the issue and also involve another person in the decision.

Another possibility is to put clients’ assets into either an irrevocable living trust or a Domestic Asset Protection Trust (in states that allow them) and naming someone other than the client or the planner as trustee. While the client, as the beneficiary, would have the power to fire the trustee, concern about a trustee being fired irrationally could be mitigated to some degree by having a corporate trustee. In addition, with a DAPT, the beneficiary client would not have the power to amend the trust without the agreement of the trustee. This would give some protection against self-destructive choices by a client who was gradually losing competency. One disadvantage of this approach is cost, so it isn’t an option for everyone.

Perhaps the most important strategy is to work with clients to create a contingency plan in the event of mental decline. It could include arrangements to consult with family members or other professionals such as physicians, social workers, and counselors. For clients without close family members, the plan might authorize the financial adviser to call for an evaluation, by professionals chosen in advance by the client, if the client’s behavior appeared irrational. This team approach might alleviate clients’ fears about being judged incompetent by the person managing their assets.

The possibility of mental decline is something no one wants to consider. Yet it’s as essential a financial planning concern as making a will. Helping clients build financial resources for old age includes helping them create safety nets to protect those resources from themselves.

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Rick Kahler is president of Kahler Financial Group, a fee-only financial planning firm. His work and research regarding the integration of financial planning and psychology has been featured or cited in scores of broadcast media, periodicals and books. He is a co-author of four books on financial planning and therapy. He is a faculty member at Golden Gate University and the president of the Financial Therapy Association.

TIME Heart Disease

Americans Are Having Fewer and Fewer Strokes

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In the last two decades the stroke rate among Americans has dropped, and those that do have strokes have a lower risk of dying from then than they did in the past.

In a new study, researchers followed 14,357 Americans who were stroke-free in 1987 until 2011. They found a 24% overall drop in first-time strokes in each of the last two decades and an overall 20% decline per decade in deaths after stroke. The authors note that progress in stroke rates was primarily seen in the over-65 age group and stressed the continued need to lower the number of strokes in younger people.

The study, published in the Journal of the American Medical Association (JAMA), reports that the declines can be credited to better control over risk factors like blood pressure, getting people to quit smoking, and the fact that so many Americans are on cholesterol-controlling statins.

There’s still concern, however, over the high number of Americans suffering from obesity and type 2 diabetes, since both can increase the risk for stroke. About a third of American adults are obese, and if trends continue, one in three Americans will have a form of diabetes by 2050, according to CDC data. Considering already about 80,000 people in the U.S. have a stroke each year, the number still needs to drop, and addressing all risk factors is one way to get Americans’ overall health in check and continue to lower the stroke rate.

TIME Stroke

This Microwave Helmet Can Sense Strokes

Scientists have invented a helmet that can detect the occurrence and type of a stroke by bouncing microwaves off the brain

+ READ ARTICLE

Scientists in Sweden have invented a helmet that can identify whether a person has experienced a stroke, the BBC reports.

The headwear can further determine what kind of a stroke has occurred, allowing doctors to quickly diagnose and treat patients.

The helmet works by bouncing microwaves off a person’s brain and identifying whether there’s a bleed or a clot within it. Initial tests, involving 45 patients, proved successful. The helmet’s inventors now plan to roll the device out to ambulance teams and eventually put the technology in pillows as well.

At present, doctors treating stroke victims need to determine whether a clot or a leaking blood vessel caused the stroke. A CT scan is able to show this, but CT scanners aren’t available in every hospital and a scan can take time to set up. Delays in stroke treatment can be serious — brain tissue can begin to die if more than four hours passes between a stroke and treatment. The microwave helmet could reduce such delays, though researchers say more testing is required.

Some doctors have suggested that the helmet won’t completely replace other forms of diagnosis.

Dr. Shamim Quadir from the UK’s Stroke Association said that “while this research is at an early stage, microwave-based systems may become a portable, affordable, technology that could help rapidly identify the type of stroke a patient has had, and get them treated faster.”

[BBC]

 

TIME medicine

FDA Clears the Way for New Blood-Clot Medication

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A microscopic view of blood clotting inside an artery. Getty Images

Zontivity, a new drug from Merck, can be used to reduce the risk of stroke or cardiovascular death and treat patients who have suffered a heart attack

The FDA gave the go-ahead to a new drug on Thursday that can be used to inhibit blood clots.

The new medication, which reduces the risk of heart attacks and strokes, is produced by American pharmaceutical manufacturer Merck & Co. and will be sold under the name Zontivity.

“In patients who have had a heart attack or who have peripheral arterial disease, this drug will lower the risk of heart attack, stroke and cardiovascular death,” said Ellis Unger, director of the FDA’s Office of Drug Evaluation I.

However, like other blood-clot inhibitors, Zontivity increases the risk of bleeding by hindering platelets in the blood from clustering together. For these reasons, the FDA advises patients who have suffered from a stroke or traumatic head injury to avoid the medication.

The approval of the drug was reportedly delayed over safety concerns due to fatal bleeding in patients who were given the medication during clinical trials, according to Reuters.

TIME

States That are Cheating Death

Where you live can help determine how long you'll live.

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The only sure things in life are death and taxes, and now your home state might control both of them. A report in the Center for Disease Control’s Morbidity and Mortality Weekly Report this week analyzed premature deaths from the five leading causes – heart disease, cancer, lower respiratory illnesses, stroke and unintentional injuries – by state and found that 40% of them were preventable.

The fact that we can do better in avoiding early death isn’t news, given that we’re fond of some unhealthy habits, including smoking, eating lots of fat, sugar and salt and not exercising enough, but what’s surprising is that where you live plays such a large role in determining how likely you are to die early from a preventable cause. Living in states in the southeast, for example, can increase your chances of dying prematurely from each of the five leading causes than living in certain western states. Different regional lifestyles certainly play a part, but the availability of health-related programs such as screening for cancer and blood pressure, and safe places to exercise, can also help to bring preventable death rates down. Living healthy is half the battle in avoiding an early death, and living in the right state can be the other.

TIME

Researchers Are Going to Dose 18,000 Volunteers With Little Chocolate Pills

Chocolate bars heap
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Rest of the world dies of envy

Researchers will feed intense concentrations of chocolate to thousands of volunteers to see if it improves their heart health.

No, this isn’t a chocoholic’s fever dream, this is a three year study just launched by the National Heart, Lung and Blood Institute and chocolate-maker Mars Inc.

According to AP, the study expands on previous research of cocoa flavanols, the essential nutrients in dark chocolate, which have been shown to lower the risk of strokes and heart attacks.

Lest anyone think about self-medicating in the name of science, researchers caution that the pills also strip out sugar and fat. They also contain concentrations of chocolate nutrients that no one could get from regular candy bars without bursting.
[AP]

TIME Pregnancy

Increased Risk of Blood Clots Lasts 12 Weeks After Pregnancy, Not Just Six

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New research shows that women are at risk of stroke or heart attack after giving birth for longer than doctors originally thought

Women have a heightened risk of blood clots for 12 weeks following birth, twice as long as doctors originally believed, according to new research. Blood clots can cause problems such as stroke or heart attack.

The head of the study, Dr. Hooman Kamel, presented the new research, published online in the New England Journal of Medicine, on Thursday at the American Heart Association stroke conference. Women are more prone to blood clots after giving birth because blood components increase during labor to prevent too much bleeding. As a result, blood from the legs has more trouble traveling to the heart. If clots in the legs travel to the lungs, they can be fatal. Strokes are rare after pregnancy, but result in death about 10% of the time.

Doctors sometimes prescribe blood thinners to women at high risk of blood clots for six weeks after pregnancy, but the new study suggests that isn’t long enough. The study followed 1.7 million California women who gave birth to their first child. Over the next year and a half, 1,015 of them developed clots — 248 of whom had strokes and 47 of whom had heart attacks. The risk of blood clot was 11 times greater in the first six weeks and more than two times greater for the six weeks following that.

TIME Heart Disease

As Temperatures Dip, Risk of Stroke Rises

Young woman about to cross the street in snow
Jose Luis Pelaez—Getty Images

Colder weather linked to more deaths, but more research needed to understand connection

Changes in temperature may impact stroke risk, hospitalization, and even death from stroke, new research says.

Major changes in temperature and humidity could be linked to more hospitalizations from stroke, researchers say. In their study, which was presented at the American Stroke Association’s International Stroke Conference in San Diego, the researchers also found that colder temperatures were linked to more hospital stroke deaths. With every 1°F increase in temperature, there was a 0.86% decrease in likelihood of being admitted to a hospital for a stroke, and a 1.1% decrease in dying from a stroke.

To come up with these findings, the researchers look at more than 134,500 people sent to hospitals between 2009 and 2010 for a stroke. They then compared the stroke cases and outcomes to temperature data for that time period.

The mechanics behind the trend are not fully understood, but in an interview with the Associated Press, researchers said that our blood vessels constrict in cold weather and this can raise blood pressure and add stress to the body, which makes blood more likely to clot. High humidity can also cause dehydration, which leads to an increased risk for clotting and stress.

More research is needed to confirm the findings, but the researchers say that the people at risk for stroke may want to protect themselves from exposure to massive changes in temperature and humidity.

TIME Women's Health

First Stroke Guidelines for Women Created

Strokes are the third leading cause of death for women in the U.S.
Strokes are the third leading cause of death for women in the U.S. Jaime Monfort—Getty Images

Hormonal changes caused by pregnancy or birth control are factors in the third leading cause of death for females, the American Heart Association reports

The American Heart Association outlined Thursday its first ever guidelines for primary care provider sand OBGYNs developed specifically to prevent women’s strokes, the third leading cause of death for U.S. women, and the fifth leading cause for men.

Stroke risk factors for both men and women include high blood pressure, high cholesterol, and smoking, but certain hormonal changes can reportedly increase a woman’s risk.

“If you are a woman…your risk is also influenced by hormones, reproductive health, pregnancy, childbirth and other sex-related factors,” said Cheryl Bushnell, M.D., M.H.S., author of the new scientific statement published in the American Heart Association journal Stroke.

According to the guidelines, women with a history of high blood pressure before pregnancy are at risk for preeclampsia, a blood pressure disorder that occurs during pregnancy. Preeclampsia doubles the risk for stroke and increases the risk for high blood pressure four-fold, according to the guidelines.

The combination of high blood pressure and birth control use can also raise a woman’s risk for stroke. Migraines with aura, diabetes, depression, and emotional stress, which occur more frequently among women, are also contributing factors.

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