More and more older people are comfortable with technology such as smartphones. But as some develop dementia, families must decide whether to step in and protect them from temptations online. Journalist Judith Graham, writing for Kaiser Health News (KHN), describes problems that can crop up, along with some possible solutions. KHN posted her article on September 26, 2019. Funding from the Silver Century Foundation helps KHN develop articles (like this one) on longevity and related health and social issues.
At first, Robert Zorowitz, MD, 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.
Increasingly, families will encounter similar concerns as older adults become reliant on computers, cell phones 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 [is] senior medical director for Optum, 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,” [he said.]
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 percent of adults 65 and older used the Internet in 2019, up from 43 percent in 2010. And 42 percent of older adults owned smartphones in 2017, the latest year for which data is available, up from 18 percent in 2013.
Already, some physicians are adapting to this new digital reality. At Johns Hopkins Medicine, Halima Amjad, MD, 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.”
Safety can become an issue for an older person with dementia who gets emails from scammers.
At Rush University’s Alzheimer’s Disease Center in Chicago, neurologist Neelum Aggarwal, MD, 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.’”
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 cell phones 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 cell phone apps for patients in these circumstances.
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, CO. Ideally, consent should be granted in writing.
Older adults with Alzheimer’s commonly turn away from digital devices as they forget how to use them.
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.
Eventually, Selma Zorowitz lost interest in her computer as she slipped further into dementia and spent the end of her life in a nursing home. She died in 2014 at age 87.
Older adults with Alzheimer’s disease commonly turn away from digital devices as they forget how to use them, said Lon Schneider, MD, 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 cell phone 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.
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 cell phone, 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. There’s also a parental-control setting on the TV to prevent access to “adult” channels.
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 cell phone—his primary form of communication. (He has stopped using the computer.) 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.”
Judith Graham writes a column on aging and health for KFF Health News, where she’s a contributing columnist. She also freelances for other publications. Earlier in her career, Judith contributed more than 80 pieces to the New York Times blog, The New Old Age. She was nominated for a Pulitzer Prize for a series on defective pacemakers and was part of a Chicago Tribune team that won a Pulitzer in 2001.
