The Long Goodbye

Richard Connor

RETIREMENT COMES with many risks, but the scariest I’ve witnessed is dementia. It’s estimated that more than six million Americans are living with Alzheimer’s, and they account for just 60% to 80% of all dementia cases.

Other types include vascular dementia, frontotemporal dementia, Parkinson’s disease dementia and Lewy body dementia. Drug side effects, brain injury, depression and alcoholism can create dementia symptoms, too. The symptoms may get better when those conditions are treated.

Whatever the cause, dementia can lead to memory loss and serious difficulties handling everyday activities of daily living. Seniors with cognitive issues are at significantly higher risk of making poor financial decisions, and are more susceptible to fraud and abuse, according to a report by researchers from the Federal Reserve and the University of Michigan. They also tend to withdraw from financial responsibilities.

That last symptom—financial withdrawal—I saw firsthand with my mother-in-law and my wife’s widowed aunt. Both women had been quite capable money managers in their prime. As their cognitive issues progressed, however, they lost interest in their finances and were happy to allow family members like me to take over.

Often, there are subtle signs before significant symptoms of cognitive decline become apparent. My close friend John said the first sign of his wife Mary’s terrible illness was getting a late notice on a bill—something that she would never have allowed before.

Mary developed symptoms of frontotemporal degeneration (FTD), which is the most common form of dementia for those under age 60. FTD is not well known, is widely misunderstood and is often misdiagnosed. Symptoms include “progressive changes to personality, language, decision making, behavior, and movement.”

John and Mary aggressively pursued a diagnosis through one of the major hospital systems in the Philadelphia area. They tried various treatment options and even participated in some trial studies. Unfortunately, none of this prevented Mary’s symptoms from worsening.

She soon required constant care. Her decline coincided with the COVID-19 pandemic, which made finding help that much harder. Her family pitched in to take care of her. Eventually, though, it got to the point where the required care was too great. John had been researching facilities and was able to place Mary in one near her family and friends. She passed away earlier this year at the far-too-young age of 67.

Caring for a senior with dementia can be exhausting and expensive. The Alzheimer’s Association outlines several care options, including in-home care, adult daycare, long-term care and hospice. It suggests using Genworth insurance company’s tool to find the median cost of many of these services in your city and state.

As you might expect, there’s a wide variation in cost. In my state of New Jersey, the median cost for a private room in a nursing home was $145,818 a year in 2021. In Arkansas, the same room cost $80,300. A home health aide working 44 hours a week in New Jersey would be paid an average $68,526 a year. In Arkansas, that aide would get $50,336.

What can we do to reduce the risk of this illness? Keep working. An article from HealthDay suggests that delaying retirement may reduce the risk of early onset dementia. It cites a French study of 429,000 self-employed workers, which found a 3% reduction in dementia risk for each extra year worked.

The data seems to be in line with the “use it or lose it” hypothesis of brain health. The study showed an association between higher retirement age and lower dementia risk, but not a cause-and-effect relationship. One Alzheimer’s expert said she wasn’t surprised by the findings.

“There seems to be growing evidence that staying cognitively active is really important to reducing a person’s risk, and perhaps professional activity may be one of those cognitive activities,” said Heather Snyder, director of medical and scientific operations for the Alzheimer’s Association, as quoted in the HealthDay article. “Things that promote lifelong learning seem to be beneficial. But that may mean different things for different people… and exactly what that is, we can’t define at this point.”

The lesson for each of us is to prepare as best we can. Stay as healthy and active as possible. Get your finances organized and simplified. Talk to family and have legal papers drawn up specifying how you want your affairs handled if you lose capacity. Get all your estate documents prepared and make sure family members know where to find them.

Richard Connor is a semi-retired aerospace engineer with a keen interest in finance. He enjoys a wide variety of other interests, including chasing grandkids, space, sports, travel, winemaking and reading. Follow Rick on Twitter @RConnor609 and check out his earlier articles.

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