Early Behavioral Markers of Loss of Financial Capacity.

Importance: Many conditions, including neurodegenerative diseases and psychiatric disorders, can impair financial decision-making in older age. Although banking data offer rich insights, they have not yet been leveraged to understand how the loss of financial capacity is associated with financial behaviors. Objective: To describe the behavioral indicators of financial capacity loss and the association of financial capacity loss with financial vulnerability. Design, Setting, and Participants: In this case-control study, banking data recorded by a major UK bank between January 1, 2009, and April 21, 2023, were used to compare the financial outcomes of a group of 16 742 donors of power of attorney (PoA) registrations with a "loss of financial capacity" marker and a control group of 50 226 individuals with no reported financial capacity loss that matched the demographic and socioeconomic characteristics of the donor group 10 years prior to their PoA registration. Group differences in financial outcomes were examined in the 10-year period leading up to the PoA registration. Analysis took place between December 2023 and December 2024. Exposures: Bank registrations of PoAs recorded between 2019 and 2023 for which the attorney reported that the donor lost financial capacity. Main Outcome Measures: A broad range of 344 financial measures capturing day-to-day transactional activity (eg, spending on travel and hobbies) and other financial behaviors (eg, online banking logins). Results: The group of donors of PoA registrations with a "loss of financial capacity" marker comprised 16 742 individuals (mean [SD] age, 72.8 [8.5] years; 10 285 women [61.4%]), and the control group comprised 50 226 individuals (mean [SD] age, 72.7 [8.2] years; 30 657 women [61.0%]). During the 5 years prior to PoA registration, compared with the control group, donors were increasingly less likely to spend on everyday activities (clothing [difference, -9.1 percentage points (pp); 95% CI, -10.0 to -8.3 pp], travel [eg, hotels; difference, -9.6 pp; 95% CI, -10.5 to -8.8 pp], hobbies [eg, gardening; difference, -7.9 pp; 95% CI, -8.8 to -7.1 pp]) and more likely to spend on items associated with increased time at home (eg, household gas and electricity bills [difference, 5.1 pp; 95% CI, 4.6-5.7 pp]). Signs of heightened financial vulnerability in the donor group compared with the control group included an increase in the frequencies of PIN (personal identification number) reset requests (difference, 0.002 [95% CI, 0.002-0.003]), fraud cases (eg, animal charity difference, 0.0003 [95% CI, 0.0002-0.0003]), and lost or stolen credit or debit cards reported (difference, 0.005 [95% CI, 0.004-0.006]) and increased spending on charity (difference, 1.1 pp [95% CI, 0.5-1.7 pp]). In addition, the donor group exhibited reduced attention to finances compared with the control group via decreased online banking activity (difference in number of monthly online banking logins, -1.0 [95% CI, -1.1 to -0.8]). Conclusions and Relevance: This study highlighted the financial behaviors and vulnerabilities associated with declining financial capacity, such as a decrease in activity across multiple domains of daily life. These findings illustrate how banking data can reveal early behavioral signs and financial harms associated with financial capacity loss.