With
cognitive impairment, these devices become difficult to use and, in some cases,
problematic.
At first, Dr. Robert
Zorowitz thought his 83-year-old mother was confused. She couldn’t remember
passwords to accounts on her computer. She would call and say programs had
stopped working.
But over time,
Zorowitz realized his mother — a highly intelligent woman who was comfortable
with technology ― was showing early signs of dementia.
With cognitive
impairment, these devices become difficult to use and, in some cases,
problematic.
Increasingly,
families will encounter similar concerns as older adults become reliant on
computers, cellphones and tablets: With cognitive impairment, these devices
become difficult to use and, in some cases, problematic.
Computer skills may
deteriorate even “before [older adults] misplace keys, forget names or display
other more classic signs of early dementia,” Zorowitz wrote recently on a group
email list for geriatricians. He’s based in New York City and senior medical
director for Optum Inc., a health services company.
“Deciding whether to
block their access to their bank accounts, stocks and other online resources
may present the same ethical dilemmas as taking away their car keys.”
Left to their own
devices
The emergence of this
issue tracks the growing popularity of devices that let older adults
communicate with friends and family via email, join interest groups on
Facebook, visit virtually via Skype or FaceTime, and bank, shop, take courses
or read publications online.
According to
the Pew Research
Center, 73% of adults 65 and older used the Internet in 2019, up
from 43% in 2010. And 42% of older adults owned smartphones in 2017, the latest
year for which data is
available, up from 18% in 2013.
Already, some
physicians are adapting to this new digital reality. At Johns Hopkins Medicine,
Dr. Halima Amjad, an assistant professor of medicine, now asks older patients
if they use a computer or smartphone and are having trouble such as forgetting
passwords or getting locked out of accounts.
“If there’s a notable
change in how someone is using technology,” she said, “we would proceed with a
more in-depth cognitive evaluation.”
At Rush University’s
Alzheimer’s Disease Center in Chicago, neurologist Dr. Neelum Aggarwal finds
that older adults are bringing up problems with technology as a
“non-threatening way to talk about trouble with thinking.”
“Instead of saying,
‘I have issues with my memory,’ people will say, ‘I just can’t figure out my
smartphone’ or ‘I was trying to start that computer program and it took forever
to get that done.’”
Older adults are
bringing up problems with technology as a “non-threatening way to talk about
trouble with thinking.”
If the person
previously used digital devices without difficulty, Aggarwal will try to
identify the underlying problem. Does the older adult have problems with vision
or coordination? Is she having trouble understanding language? Is memory
becoming compromised? Is it hard for her to follow the steps needed to complete
a transaction?
If using technology
has become frustrating, Aggarwal recommends deleting apps on cellphones and
programs on computers.
“The anxiety
associated with ‘Oh, my God, I have to use this and I don’t know how’ totally
sets people back and undoes any gains that technology might offer,” she said.
“It’s similar to what I do with medications: I’ll help someone get rid of
what’s not needed and keep only what’s really essential.”
Typically, she said,
she recommends no more than five to 10 cellphone apps for patients in these
circumstances.
Safe mode
When safety becomes
an issue — say, for an older adult with dementia who’s being approached by
scammers on email ― family members should first try counseling the person
against giving out their Social Security or credit card information, said
Cynthia Clyburn, a social worker in the neurology division at Penn Medicine in
Philadelphia.
If that doesn’t work,
try to spend time together at the computer so you can monitor what’s going on.
“Make it a group activity,” Clyburn said. If possible, create shared passwords
so you have shared access.
But beware of
appropriating someone’s passwords and using them to check email or online bank
or brokerage accounts. “Without consent, it’s a federal crime to use an
individual’s password to access their accounts,” said Catherine Seal, an
elder-law attorney at Kirtland & Seal in Colorado Springs, Colo. Ideally,
consent should be granted in writing.
With his mother’s
permission, one of Zorowitz’s brothers ― a physician in Baltimore — installed
GoToMyPC, an application that allowed him to remotely manage her computer. He
used it to reset passwords and manage items on her desktop and sometimes to order
groceries online from Peapod.
Recently, Arthur went
on Amazon and ordered four pocket translators, several watches and a large
quantity of maple sugar candies for $1,000.
Older adults with
Alzheimer’s disease commonly turn away from digital devices as they forget how
to use them, said Dr. Lon Schneider, a professor of psychiatry and neurology at
the University of Southern California.
More difficult,
often, are situations faced by people with frontotemporal dementia (FTD), which
affects a person’s judgment, self-awareness and ability to assess risk.
Sally Balch Hurme’s
75-year-old husband, Arthur, has FTD, diagnosed in 2015. Every day, this
elder-law attorney and author struggles to keep him safe in a digital world
full of threats.
Hundreds of emails
pour onto Arthur’s cellphone from telemarketers with hard-to-resist offers. His
Facebook account is peopled with “friends” from foreign countries, all
strangers. “He has no idea who they are. Some of them are wearing bandoliers of
ammunition, holding their guns,” Hurme said. “It is horrific.”
Then, there’s Amazon,
a never-ending source of shopping temptation. Recently, Arthur ordered four
pocket translators, several watches and a large quantity of maple sugar candies
for $1,000. Though returns are possible, Hurme doesn’t always know where Arthur
has stored items he’s bought.
“Parental control”
What steps has she
taken to manage the situation? With Arthur’s permission, she unsubscribes him
from accounts that send him emails and removes friends from his Facebook account.
On his cellphone, she has installed a “parental control” app that blocks him
from using it between midnight and 6 a.m. ― hours when he was most likely to
engage in online activities.
Instead of an
open-ended credit card, Hurme gives Arthur a “stored value” card with a limited
amount of money. She manages household finances, and he doesn’t have access to
the couple’s online banking account. Credit bureaus have been told not to open
any account in Arthur’s name.
If Hurme had her way,
she said, she’d get rid of Arthur’s cellphone — his primary form of
communication. But “I’m very sensitive to respecting his dignity and letting
him be as independent and autonomous as possible,” she said. For all the
dangers it presents, “his phone is his connection with the outside world, and I
can’t take that away from him.”
Kaiser Health News is a nonprofit
news service covering health issues. It is an editorially independent program
of the Kaiser Family Foundation, which is not affiliated with Kaiser
Permanente.
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