Cognitive Functioning Improves After Cochlear Implant

 Cognitive functioning improved 12 months after cochlear implantation for older adults with severe hearing loss and poor cognition, data from a single-center study showed.

Among 21 cochlear implant candidates whose preoperative scores indicated mild cognitive impairment, overall cognitive scores improved 12 months after cochlear implant activation from a median percentile of 5 to 12 (difference of 7, 95% CI 2-12), reported Ellen Andries, MSc, of Antwerp University Hospital in Belgium, and colleagues.

Eight participants' scores improved enough to move them out of the mild cognitive impairment category (16th percentile), Andries and co-authors reported in JAMA Otolaryngology-Head & Neck Surgery

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Speech recognition in noise improved, which was tied to a rise in cognitive abilities.

The study is one of the first to examine cochlear implants among older adults with preoperative poor cognitive functioning, the researchers noted.

"Several large studies have previously demonstrated an improvement of cognitive functioning in severely hearing-impaired older adults after cochlear implantation, but few of these studies specifically analyzed participants achieving poor cognitive outcomes preoperatively," Andries told MedPage Today.

The findings suggest cochlear implantation is not contraindicated in candidates with cognitive decline and should be considered after a multidisciplinary evaluation, she noted.

"The management of modifiable risk factors for dementia, such as hearing loss, is important as there is currently no cure for dementia and its incidence is rising rapidly," Andries added. The top modifiable risk factoropens in a new tab or window for dementia prevention is hearing loss, which accounts for 8.2% of the global dementia burden, according to a recent Lancet Commission report.

The analysis included cochlear implant candidates 55 and older with poor baseline cognitive scores among participants in Antwerp University Hospital's larger prospective cohort study from April 2015 to September 2021. Median age was 72, and 62% were men. Speech processors were activated approximately 4 weeks after cochlear implantation surgery.

All participants had a preoperative total score on the Repeatable Battery for the Assessment of Neuropsychological Status for hearing-impaired patients (RBANS-H) that indicated mild cognitive impairment -- a score at least 1 standard deviation below the mean compared with age-appropriate normative data (16th percentile or lower).

The RBANS-H evaluates five cognitive subdomains: immediate memory, attention, language, visuospatial/constructional, and delayed memory. The test battery has alternate forms A and B; both were used to assess patients 1 month preoperatively and 12 months after speech processor activation.

Speech recognition in noise was measured with the Leuven Intelligibility Sentences Test (LISTopens in a new tab or window). Anxiety and depression symptoms were identified using the Hospital Anxiety and Depression Scale (HADS) preoperatively and 12 months after activation.

Most participants (16 of 21) showed improvement in the RBANS-H total percentile 12 months after cochlear implant activation. The RBANS-H percentile remained stable in one participant and decreased in four.

Speech recognition in noise improved after activation (mean score 17.16 vs 5.67 on a scale where lower is better, for a difference of −11.49, 95% CI −14.26 to −8.72). Better speech recognition in noise was associated with significantly better cognitive functioning (r_s −0.48).

Other variables, including years of education, sex, RBANS-H version, and depression and anxiety symptoms, were not related to changes in RBANS-H scores.

The findings support the information degradation hypothesisopens in a new tab or window as a potential explanation for the link between hearing loss and cognition, Andries and colleagues observed. "This hypothesis states that older adults with hearing loss need to rely more on cognitive resources to compensate for impaired auditory input, resulting in more mental fatigue and a higher cognitive load, which leads to a reduction of cognitive resources available for other cognitive tasks," they noted.

The study lacked a control group for ethical reasons, the researchers pointed out, and unknown factors like infection, medications, or pain could have influenced cognitive performance.

The small sample size was also a limitation, they acknowledged. "Further longitudinal research including a larger sample of cochlear implant candidates with cognitive decline is therefore recommended," they wrote.

Disclosures

Antwerp University Hospital received a research grant from MED-EL in Innsbruck, Austria.

Andries reported no disclosures. Co-authors reported relationships with Janssen Pharmaceuticals, ADx Neurosciences, icometrix, Biogen, Roche, Pfizer/Eisai, Novartis, Cochlear, and MED-EL.

Primary Source

JAMA Otolaryngology -- Head & Neck Surgery

Source Reference: opens in a new tab or windowAndries E, et al "Evaluation of cognitive functioning before and after cochlear implantation in adults aged 55 years and older at risk for mild cognitive impairment" JAMA Otolaryngol Head Neck Surg 2023; DOI: 10.1001/jamaoto.2022.5046.

https://www.medpagetoday.com/neurology/dementia/103141

Can the Biases Built Into ChatGPT Be Fixed?

 Leo Anthony Celi, MD, MPH, principal research scientist at the MIT Laboratory for Computational Physiology (LCP) and an intensive care unit physician at Beth Israel Deaconess Medical Center in Boston, discusses the biases that large language models like ChatGPT

opens in a new tab or window are built upon and outlines some solutions to make its use in medicine more equitable.

The following is a transcript of his remarks:

Recently there has been commotion when some investigators demonstrated that they were able to train ChatGPT to pass licensing exams. The first one was the U.S. Medical Licensing Exam

opens in a new tab or window. Since then it has passed almost every standardized test that is currently being used to evaluate students.

What we are concerned with is the fact that the data that is being used to train large language models is biased. The internet is dominated by content coming from well-funded institutions from rich countries, and that is particularly true for medical content. We are afraid that the output of large language models would reflect the bias, and that if you ask a question and you're coming from Brazil or Uganda, the answer that you will get from large language models such as ChatGPT may not be applicable to you.

We are not discounting the power of these technologies. These technologies will for sure be a part of how we teach and how we learn, but I think we need to focus on improving the data input that we are training these large language models on. We have to make sure that there's representation, especially from countries that are disproportionately burdened by disease.

Can we improve the data input of not just large language models, but also artificial intelligence in general?

One of the concrete recommendations that we have discussed in previous papers is diversifying the people who are sitting at the table, and that means we need more investigators coming from parts of the world that are disproportionately burdened by disease. We need more scientists from low- and middle-income countries because they understand health and disease better than the investigators who are from ivory tower institutions.

We are also recommending bringing in and recruiting more social scientists and working with the machine learning community. The social scientists are experts in understanding the disparities and the biases that exist and they may be able to help us address and guarantee that the algorithms we are developing will not perpetuate or even magnify the inequities that we're seeing now.

I think those are two very explicit recommendations that we are giving to the community, but they are easier said than done. This would mean that we would have to overhaul the systems that create and validate knowledge, and there will be a lot of pushback about that.

We have to improve how we teach medicine or even other disciplines, because knowledge is being taught as something that is static, when in fact there is no such thing as permanent ground truth. The learners have to be aware that ground truth is continuously shifting. They also need to be aware of how the knowledge system has been put together. They have to be aware of the gaps and the uncertainties in the knowledge system and the impact of those gaps and uncertainties when applying the knowledge itself.

Unfortunately, that is not happening anywhere in any discipline. We are being fed to ingest and digest a body of knowledge, and we do not really understand how that body of knowledge came about. What are the limitations? What are the biases in that body of knowledge?

To us, there is a need to democratize the creation and the validation of knowledge. This should not be in the sole control of a few academics who may not be able to fully understand the context of health and disease from different lenses.

We think that this has been one of the contributors of why we're seeing a lot of suboptimal outcomes, because there are very few people sitting on the table. By diversifying those people, by bringing in people who understand health and disease better, I think that we are finally going to move the needle.

I've had some pushback. People ask, how can you tell us that this will work? Because it'll require a lot of energy and even cost to revamp the system. What are the guarantees that it's going to work? Well, I don't have any guarantees, but I also know that continuing the way we do things, continuing the current system, is not miraculously going to produce a different result. We keep saying that every system produces the results that it gets. And unless we change that system, we're going to come up with the same problems that we've seen over the last century.

https://www.medpagetoday.com/publichealthpolicy/equity-in-medicine/103164

Variability Among Breast Cancer Risk Classification Models

 

Jeremy S. Paige MD, PhD, 

Christoph I. Lee MD, MS, MBA, 

Pin-Chieh Wang PhD, 

William Hsu PhD, 

Adam R. Brentnall PhD, 

Anne C. Hoyt MD, 

Arash Naeim MD, PhD & 

Joann G. Elmore MD, MPH 

Abstract

Background

Breast cancer risk models guide screening and chemoprevention decisions, but the extent and effect of variability among models, particularly at the individual level, is uncertain.

Objective

To quantify the accuracy and disagreement between commonly used risk models in categorizing individual women as average vs. high risk for developing invasive breast cancer.

Design

Comparison of three risk prediction models: Breast Cancer Risk Assessment Tool (BCRAT), Breast Cancer Surveillance Consortium (BCSC) model, and International Breast Intervention Study (IBIS) model.

Subjects

Women 40 to 74 years of age presenting for screening mammography at a multisite health system between 2011 and 2015, with 5-year follow-up for cancer outcome.

Main Measures

Comparison of model discrimination and calibration at the population level and inter-model agreement for 5-year breast cancer risk at the individual level using two cutoffs (≥ 1.67% and ≥ 3.0%).

Key Results

A total of 31,115 women were included. When using the ≥ 1.67% threshold, more than 21% of women were classified as high risk for developing breast cancer in the next 5 years by one model, but average risk by another model. When using the ≥ 3.0% threshold, more than 5% of women had disagreements in risk severity between models. Almost half of the women (46.6%) were classified as high risk by at least one of the three models (e.g., if all three models were applied) for the threshold of ≥ 1.67%, and 11.1% were classified as high risk for ≥ 3.0%. All three models had similar accuracy at the population level.

Conclusions

Breast cancer risk estimates for individual women vary substantially, depending on which risk assessment model is used. The choice of cutoff used to define high risk can lead to adverse effects for screening, preventive care, and quality of life for misidentified individuals. Clinicians need to be aware of the high false-positive and false-negative rates and variation between models when talking with patients.

https://link.springer.com/article/10.1007/s11606-023-08043-4

What You Need to Know About Cardiovascular Disease and Cancer

  American Cancer Society (ACS) research estimates there are more than 18 million adult survivors of cancer in the United States, and that number is expected to climb to more than 22 million by 2030. Although that’s encouraging news, it also puts increasing numbers of survivors at risk for cardiovascular disease or CVD. A recent study found adult survivors of cancer had a 42% greater risk of CVD than people without cancer. The authors found that survivors of cancer had a particularly higher risk of developing heart failure (52% higher risk), followed by stroke (22% higher risk). The incidence of CVD was highest in survivors who had breast, lung, and hematological/lymphatic cancers. With February designated as American Heart Month, it’s a good reminder for people with cancer to monitor their cardiovascular health. 

 
“Treatments for cancer, like radiation and chemotherapy, can help people live longer. However, certain treatments have potential side effects, including new or worsening heart disease,” says Dr. Arif Kamal, chief patient officer at the American Cancer Society. “The type of damage to your heart and the risk of causing a problem can vary depending on the therapy, but it’s a real health risk that is oftentimes neglected.” 
 
Heart conditions that can develop or worsen after cancer treatment are: 

• Congestive heart failure 
• Coronary artery disease 
• Cardiomyopathy 
• Damage to heart valves 
• Myocarditis (Inflammation of the heart muscle)
• High blood pressure 

CVD affecting people with cancer has led to the increase of cardio-oncology as a subspecialty of medicine. Cardio-oncology focuses on identifying, monitoring, and treating cardiovascular diseases caused by cancer treatment. The goal is to reduce the side effects cancer treatment can have on a person’s cardiovascular system. Cardio-oncologists collaborate with other healthcare providers to tailor treatment and care to your needs. 

“Cancer survivors are a high-risk population and should be prioritized for interventions that lower the chance of heart disease later in life,” said Kamal. “Health care providers need to actively reinforce the importance of prevention against CVD.” 

Sometimes cancer-related side effects and symptoms don’t show up until long after treatment ends. Whether you're still in treatment, recently completed it, or long since finished, be sure you’re getting follow-up care and doing everything you can to safeguard your health. The ACS has information to help you take steps to protect your health, including: 
 

• Avoiding tobacco products
• Getting to and staying at a healthy weight  
• Getting regular exercise 
• Eating a healthy diet  
• Avoiding or minimizing alcohol use 
• Getting recommended cancer screenings 
• Creating a survivorship care plan 
• Keeping your follow-up appointments 
• Taking care of your emotional health 

Kamal also recommends working with your cancer care team to find out whether your treatment can cause any heart-related problems. If so, there are often ways to help lower the risk. 

https://pressroom.cancer.org/releases?item=1187

Monoclonal Antibodies Linked to Reduced RSV Burden in Young Kids

 Prophylactic use of three monoclonal antibodies was associated with substantial reductions in respiratory syncytial virus (RSV)-related infections and hospitalizations in children under 5, a systematic review and meta-analysis showed.

Across 14 randomized controlled trials involving over 18,000 high-risk children, moderate- to high-certainty evidence showed that nirsevimab, palivizumab, and motavizumab were associated with significant reductions in RSV-related infections and hospitalizations per 1,000 participants compared with placebo, reported Long Ge, PhD, of Lanzhou University in Lanzhou City, China, and colleagues:

• Nirsevimab: -123 (95% CI -138 to -100) and -54 (95% CI -64 to -38)
• Palivizumab: -108 (95% CI -127 to -82) and -39 (95% CI -48 to -28)
• Motavizumab: -136 (95% CI -146 to -125) and -48 (95% CI -58 to -33)

Moderate-certainty evidence showed that intensive care unit admissions per 1,000 participants were significantly lower with motavizumab (-8, 95% CI -9 to -4) and palivizumab (-5, 95% CI -7 to 0), as was supplemental oxygen use per 1,000 participants (-59 [95% CI -63 to -54] and -55 [95% CI -61 to -41], respectively), while nirsevimab was associated with significantly reduced supplemental oxygen use per 1,000 participants (-59, 95% CI -65 to -40), they noted in JAMA Network Open

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No significant differences were found in all-cause mortality or drug-related adverse events.

While four monoclonal antibodies were included in the meta-analysis, suptavumab showed no significant benefits.

"The World Health Organization published documents in 2021opens in a new tab or window that already encouraged the development of preventive interventions for RSV," Ge and team wrote. "Palivizumab is currently the most widely used prophylaxis for preventing RSV disease in infants."

"Although the efficacy of palivizumab has been proved, it is not available in some countries, such as China," they noted. "Meanwhile, the high price of palivizumab imposes a substantial economic burden on low- and middle-income families. Therefore, new monoclonal antibodies (mAbs) have been developed, such as nirsevimab, which could protect infants from RSV-related infection and hospitalization during an entire RSV season with a single dose."

"However, the relative efficacy and safety of different mAbs have not been compared comprehensively," they added, which led them to conduct their study.

Amesh Adalja, MD, of Johns Hopkins Bloomberg School of Public Health in Baltimore, told MedPage Today that "the findings are not surprising. We've seen data on the efficacy of monoclonal antibodies in the prevention of RSV and high-risk individuals for some time. We have an approved product here in the United States, as well as a new approved product in the European Union, which will likely soon be approved in the United States."

"The new monoclonal antibody coupled with new vaccines will hopefully have a major impact on RSV in future seasons, making it much more manageable and decreasing its burden," he said.

For this review and meta-analysis, Ge and colleagues searched PubMed, Embase, CENTRAL, and ClinicalTrials.gov for relevant trials from database inception to March 2022. They included 14 randomized controlled trials involving 18,042 children under 5 years of age. Median age at study entry was 3.9 months, the median proportion of boys was 52.4%, and most were white. About 67% were born prematurely, 8.1% had chronic lung disease, and 14% had congenital heart disease.

Ge and team noted that some comparison groups lacked direct evidence and could only be assessed through indirect comparisons.

In addition, some comparisons were rated as low certainty of evidence, mainly due to risk of bias and imprecision because of lacking evidence or a wide credible interval, they said, and future studies are needed to address these issues.

Disclosures

The study authors reported no conflicts of interest.

Adalja reported relationships with GSK, Sanofi, and Pfizer.

Primary Source

JAMA Network Open

Source Reference: opens in a new tab or windowSun M, et al "Monoclonal antibody for the prevention of respiratory syncytial virus in infants and children: a systematic review and network meta-analysis" JAMA Netw Open 2023; DOI: 10.1001/jamanetworkopen.2023.0023.

https://www.medpagetoday.com/infectiousdisease/uritheflu/103173

Senate Committee Puts PBMs Under the Microscope

 Pharmacy benefit managers (PBMs) -- middlemen between pharmacies, health insurers, and drug companies -- are responsible for driving up prescription drug prices and shuttering independent pharmacies, witnesses said during a hearing held by the Senate Commerce, Science, & Transportation Committee

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Three of the four witnesses -- an economist, a physician, and a pharmacist -- called on Congress to require greater transparency and accountability from PBMs.

"Since 2014, prescription drug prices have increased 35%, outpacing increases in wages, gas, internet service, and food," committee chair Maria Cantwell (D-Wash.) said at Thursday's hearing. And "the evidence suggests that PBMs are part of the high drug cost increase."

When PBMs first entered the healthcare space, they were independent from health plans and helped bring down prices by encouraging more use of generic drugs and by increasing mail-order services, explained Erin Trish, PhD, an economist and co-director of the USC Schaeffer Center at the University of Southern California School of Pharmacy. "However, a wave of consolidation and other activities in the last few years have distorted behavior," Trish said.

Three PBMs currently control 80% of the market, Cantwell noted, with pharmacy chains and health insurers buying up the biggest PBMs. This leaves independent pharmacies, care providers, and patients with no other options when PBMs raise their prices, she said. Congress is determined to rein in these "mysterious middlemen," Cantwell said, and won't be deterred by things like the complexity of the drug-pricing system.

PBMs' Impact on Patients

Debra Patt, MD, PhD, a breast cancer specialist for Texas Oncology in Austin and vice president of the Community Oncology Alliance, said PBMs can threaten patients' access to care.

Cancer patients need timely access to treatment, and PBMs, by steering prescription fills to specialty and mail-order pharmacies, have denied and delayed that care, she said. "The delays and detours are difficult to anticipate and limit a doctor's ability to effectively control the cancer," which can result in "poor disease control, morbidity, and mortality for the patients we serve."

Tania, a 40-year-old woman with metastatic breast cancer who is one of Patt's patients, was blocked by a PBM from accessing abemaciclib (Verzenio), which Patt believed to be one of the most effective treatment options for Tania's particular case. As she watched Tania's cancer grow, Patt knew she could not wait for the PBM and insurer to approve her appeal for abemaciclib, and so she turned to "less effective and more toxic chemotherapy," she said. As of last week, Tania has two new brain metastases for which she'll need radiation.

While she can't say definitively that Tania would be in better health had she received abemaciclib, the literature suggests Tania might have doubled her chances of living without her cancer progressing, in comparison to chemotherapy. And because it would have caused less toxicity, Tania likely would have been able to continue working and live a "more normal life," Patt said.

Another problem with PBMs is that they create "extremely expensive waste," she said. Physicians, particularly oncologists, often modify treatments to optimize them and mitigate toxicities, sometimes as quickly as 1 or 2 weeks after starting a medication, However, PBMs sometimes require scripts that must be filled for a 90-day supply, which means patients often end up with a month or even 2 months' supply of a drug they can't use, Patt said.

PBMs' Power over Independent Pharmacies

For independent pharmacies, PBMs create a whole other set of challenges.

In his opening statement

opens in a new tab or window, Ryan Oftebro, PharmD, owner of Kelley-Ross Pharmacy Group in Seattle and an associate professor at the University of Washington School of Pharmacy, shared examples of PBM abuses.

In 2021, a PBM moved a generic cholesterol drug, rosuvastatin (Crestor) from tier 1 to tier 3 of the formulary and raised copays from $15 to $141 for the same 90-day supply. (A 90-day supply of rosuvastatin cost $10 to buy from a drug wholesaler, while the "highly inflated and completely arbitrary," as Oftebro put it, average wholesale price (AWP) was $805.40 for 90 tablets.)

The result of the formulary change was "an unnecessary out-of-pocket spend" for the patient and a "windfall" for the PBM, which then collected money that it characterized as "overpayments" to pharmacies under the new pricing structure, even though the pharmacy itself had not received the extra money, according to Oftebro's written testimony. This happened over 150 times in 2021, with rosuvastatin and with "several other medications," he noted.

Independent pharmacies are also forced into "totally unbearable" contracts with PBMs where they have "zero negotiating power," Oftebro told the committee. Because of one such contract and the unmanageable retroactive fees it was subjected to -- which rose from $81,000 in 2018 to over $538,000 in 2021 -- one Kelley-Ross pharmacy in the East Lake neighborhood of Seattle, and the only one in that community, was forced to close, he told the committee.

In Defense of PBMs

Casey Mulligan, PhD, professor of economics and program director of the Initiative on Enabling Choice and Competition in Healthcare at the University of Chicago, was the only witness to argue in favor of PBMs.

He likened the PBM model to that of a buyer's club, for example Costco or Sam's Club. If Costco negotiated with skateboard manufacturers individually they could hike their prices, so instead, Mulligan said, "Costco limits who can sell to their members to those pricing the lowest." The "best response" for a seller in that scenario is to steeply discount their products and make up the loss through volume. "Much like Costco excludes [expensive] skateboard manufacturers, PBMs can place manufacturers' products to incentivize discounts for consumers," he said, referring to placement on formulary tiers.

Cantwell said that while she loved the Costco model, the comparison didn't hold water. "If you buy in bulk, yes, you should get a discount. The question here is who is getting the discount? Is the consumer getting the discount or are the very manufacturers who own the PBMs getting the discount and pocketing it?"

Ranking Member Ted Cruz (R-Texas), however, defended PBMs and argued that the PBM Transparency Actopens in a new tab or window, a bill introduced by Cantwell and Sen. Chuck Grassley (R-Iowa) would do more harm than good. The bill prohibits PBMs from charging a health plan a different amount than the PBM reimburses the pharmacy and would also prohibit the practice of "unfairly or deceptively ... clawing back reimbursement payments."

Cruz said it's important to consider the tradeoffs with any bill and that "government regulation can create substantial compliance costs and also create barriers to entry for competitors." He asked whether the bill would lead to more or less consolidation, and Mulligan suggested it would "disproportionately hurt small businesses" and increase consolidation.

When asked about the bill's impact on drug prices, Mulligan said the increased regulation would drive prices up. "You're going to undermine the one tool [PBMs] had to try to create some competition in that space by burdening the very companies whose job it is and who have successfully gotten lower prices for the consumer," Mulligan said.

However, most senators on the committee, from both sides of the aisle, questioned that logic. "I've yet to find a patient who says that PBMs have saved them money," said Sen. Marsha Blackburn (R-Tenn.).

Cantwell and Grassley's bill passed out of the committee during the last session of Congress by a vote of 19-9. On Friday, Cantwell said she hopes to see it advance out of the Senate soon and be considered by the House.

https://www.medpagetoday.com/practicemanagement/practicemanagement/103180

You want to help adult kids in tough times, but that can give you financial woes too

 The problems with supporting your adult kids, and how to set boundaries

Kimberly King, a single mom to three adult children, enjoyed a rewarding career as a kindergarten teacher for over a decade. Then, her 23-year-old son was diagnosed with schizophrenia and hospitalized for a year before later having to move into her home in Stratford, Connecticut.

Unfortunately, because King's son had only held a series of small jobs, he did not qualify for disability benefits, so he became financially dependent on King. Adding to the financial stress of her situation, King had to quit her teaching job to be a stay-at-home caregiver.

King is part of the nearly one-third of parents with adult children who provide them with financial support, according to a Credit Karma survey of 1,008 adults in October 2022.

For many of these parents, helping their child has taken a toll. Of all the respondents who said they were financially supporting their adult children, 69% said doing so caused them personal financial stress.

One of the biggest reasons people turn to their parents for financial support is suddenly losing their job. Unfortunately, in the current marketplace, job security is anything but guaranteed.

Stanford Graduate School of Business professor Jeffrey Pfeffer estimates that in 2022 alone, the biggest tech companies dismissed more than 120,000 people.

Announcements of layoffs continued in 2023. In January, Microsoft (MSFT) said it would lay off 10,000 workers and Amazon (AMZN) has announced it will cut 18,000 jobs, the largest layoff in the company's history.

While recent years were a boon for hiring managers -- the economy added 6.7 million jobs in 2021 and 4.5 million last year, according to the Bureau of Labor Statistics--the labor market doesn't look so rosy in 2023.

The pressures of unemployment come at a time when the cost of everyday items like groceries and gas have been rising faster than they have for a generation. When you compound the burdens of inflation and unemployment, it's no surprise that nearly a quarter of parents who help their children financially do so on a regular basis, according to the Credit Karma survey.

Retirees are most vulnerable

Still, while inflation can hurt people of all ages, it's especially burdensome on those older than 65. That is because older adults often rely on one income or retirement savings, so they often must stretch their assets further to cover their day-to-day living costs, not to mention those of a family member.

Add up all these money pressures and you've got a recipe for financial stress. An AARP report released in November 2022 found that the increase in the share of adults who found themselves financially worse off was most stark in those aged 65+.

If you're an older parent who wants to support a child financially, you need to assess your own finances and determine how much you can afford to give so you don't put yourself in a situation where you cannot realistically cover your own expenses.

Tips for you and your adult child

Here are a few practices and considerations to keep in mind if you're an older parent who unexpectedly finds yourself footing the bill for your adult child.

Have an honest talk and set limits

Your relationship with your child may be close and you feel that you can trust them, but you still need to establish clear boundaries and expectations for financial support.

"Have an open and honest conversation with your adult child about your financial situation and their need for support," said Trinity Owen, chief financial officer at The Pay at Home Parent, a financial advice website. "This way, you can both understand how much you can provide and what types of support are appropriate. Make sure to discuss any expectations for repayment."

Create a budget that considers both your and your child's needs

Once you and your child are on the same page about your expectations and financial needs, it's time to create a budget that will cover essentials for both of you while being realistic. One of the most significant advantages of setting a budget is that it will help you and your child stick to a set amount of money and avoid overspending.

"If you can, set up a separate account for your adult child's expenses so you can easily track what's coming in and going out," Owen said. "Make sure to establish clear boundaries when providing financial support. Giving in to every request can be tempting but being firm and consistent with your boundaries is essential. This will help your adult child take responsibility for their finances and not become too reliant on you."

Be mindful about taking from your savings

King used her savings and inheritance to pay for her son's medical expenses, therapy and legal fees. While she's no longer bringing home income from her teaching job, King has been able to cover the costs with royalties from a book she wrote. However, because those funds cover day-to-day living costs and her child's medical expenses, she's no longer putting money away for savings or an IRA.

As a parent, it is crucial to be aware of the risks involved in providing financial support to your adult child, especially if you are struggling financially.

While it may be tempting to dip into your savings, be cautious about depleting too much, especially if you're saving for retirement. If you've already set a goal about how old you want to be when you retire, you may need to adjust that date. Be aware that you'll need more savings the earlier you plan to retire.

Set a cut-off date for your support

As a parent, the last thing you want is for your adult child to become financially dependent on you indefinitely.

"You might even consider setting an expiration date to give your adult children a timeline for when they need to be back on their feet," said Courtney Alev, Credit Karma's consumer financial advocate.

Financial support should be temporary, as you ultimately want to help your child to support themselves again. If they're unemployed, help them look for jobs. If they are paying down student loans, suggest ways to manage the debt.

Brace yourself for emotional fallout

Consider both the short and long-term impact that giving money to your adult child will have on your relationship with them.

Chances are your adult child isn't over the moon that they have to depend on their parents for financial support in adulthood. Needing this kind of help is humbling and there is a slight chance your adult child could come to resent you, especially if they feel like they are being treated like a young child.

No one wants to see their child struggle financially. Still, if you plan to give your child a considerable amount of your own money, it's best to plan wisely and ensure that your assistance is sustainable and realistic.

https://www.morningstar.com/news/marketwatch/20230217527/you-want-to-help-your-adult-kids-in-tough-times-but-that-can-give-you-financial-woes-of-your-own