Cognitive Impairment in Donors: Identifying Issues and Applying Best Practices

We are on the precipice of one of the largest wealth transfers in human history, with an estimated $35,000,000,000,000 in assets accumulated by the Baby Boomer generation that will be distributed to individuals and organizations over the coming years. As fundraisers, this is one of the most significant opportunities to match donors’ philanthropic passions with the mission and possibilities of your organization, but it also presents one of the greatest challenges, as well. Cognitive impairment is a growing issue among our elderly population, which refers to a set of signs and symptoms that impact a person’s attention, memory, problem-solving skills, and judgment as we age. Cognitive impairment is permanent and increases in severity over time, ultimately often resulting in a medical diagnosis of Alzheimer’s Disease or one of the many forms of dementia. As we engage with our elderly donors, it is critically important that we identify issues and apply best practices when it is suspected or confirmed that there are cognitive impairment issues present.

At Cognitive Empowerment Consulting Group, one of the first steps we take in teaching fundraising professionals and advancement staff is how to identify when an elderly donor may be experiencing cognitive impairment. The Alzheimer’s Association and Centers for Disease Control and Prevention (CDC) compiled a list of the top ten signs of cognitive impairment that includes the following:

1. Memory loss
2. Difficulty problem-solving
3. Difficulty completing familiar tasks
4. Confusion with time or place
5. Trouble understanding visuals
6. Problems with words
7. Misplacing items
8. Decreased judgment
9. Withdrawal from social activities
10. Changes in mood or personality
    

From the perspective of a fundraiser or advancement staff, these signs can take many forms when speaking with a donor over the phone, seeing them in person at a visit, or at an event. Consider whether you have had a donor over the age of 65 years old do or say any of the following:

• Forgotten a meeting or forgotten past conversations with you more than once,
• Has difficulty doing basic math when asked to make a pledge,
• Has difficulty providing basic information such as an address, spouse or children’s name, or phone number,
• Gets confused about where you are or what time it is,
• Accuses family members, friends, or caretakers of stealing items that could be easily misplaced (ex: wristwatch or keys),
• Promising or making substantial gifts or recurring gifts at a higher frequency without explaining why, 
• Sudden withdrawal from your organization’s events (Zoom calls, galas, board meetings, pledge drives, volunteer activities, etc.) without explanation, and 
• Significant changes in mood or personality – in particular changes involving confusion, agitation, or fear.

All of these could be signs that an elderly donor is experiencing cognitive impairment and should be followed up on by your organization. It must be noted that there could be other reasons for some of these changes – perhaps a donor is giving substantially more because they have reprioritized your organization in their philanthropic causes, but at a certain age it could also be because they forgot that they already made their annual gift or are getting confused about the communications received by your organization and think that a cause they care about is in desperate need of help. It is incumbent on the organization to be proactive in their outreach when these signs are recognized to avoid ethical, and potentially legal, issues. 

To put the issue of cognitive impairment into perspective, according to the Blackbaud Institute the average age of a donor in the United States is 65 years old. This makes sense because older donors have had a longer time to accumulate wealth, pay off their debts, and are in a place to start giving their wealth away to causes that are meaningful to them. In 2019, there were an estimated 54.9 million people in the United States ages 65 years old and older, and that population is expected to grow exponentially over the coming decades. There will be an estimated 80 million people in this age group by 2040 and over 95.5 million people aged 65 years old and older by 2060. Sixty-five years old is also the average age when the first signs and symptoms of cognitive impairment begin to present themselves. According to the CDC, around 1 in 9 people aged 65 years and older are currently showing signs of cognitive impairment, and that number increases to 1 in 7 people ages 72 years and older. In the 85 years and older subset, an estimated 85 percent of people are showing some signs and symptoms of cognitive decline. This is an issue that impacts fundraisers at all levels, and it is practically an inevitability that at some point you will encounter a donor experiencing cognitive impairment if you have not already. 

So, what should you do if you suspect or confirm that a donor has cognitive impairment? The first step is to take a pause in the giving conversation to assess the situation. It is important to remember that you should never make decisions regarding this situation in a vacuum, which means that the next steps involve informing internal partners and identifying any potential external partners who could help determine the proper next steps to navigate the scenario. Properly documenting what transpired is critical, and creating a plan to transition the donor to stewardship in a manner that respects the relationship they have developed with your organization while also recognizing that their current cognitive state may mean that alterations need to be made to your normal stewardship touches. 

The Cognitive Empowerment Consulting Group is here to help your organization navigate the delicate and growing issue of donor cognitive impairment with your advancement team. Our membership subscription includes a suite of online courses, resource library, private consultation time, and an in-person or virtual educational workshop tailored to address individual donor issues and organizational implementation of best practices. Our subscription services are tiered to meet the needs of organizations of all sizes, and we encourage anyone interested in learning more about this critically important topic to reach out to us through our website – where you can take a free sample of one of our online courses – or by emailing us at info@cognitiveempowerment.com.