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Imagine for a moment that you organization’s leaders asked you to reach out to a nonagenarian woman about making a philanthropic gift. You manage to connect with this potential donor by phone. During the course of a short, 10-minute phone call the woman asked who you were and why you were calling multiple times. She cannot follow along with the conversation and cannot confirm basic contact details such as her address.
You get a feeling in your gut that this is not someone you should be asking for a charitable gift. What do you do?
This was a very real scenario faced by co-presenters Tara Adams and Anthony Pomonis who shared “Cognitive Impairment In Donors: What You Need to Know,” a session during the AFP ICON 2025 conference in Seattle.
It was this very situation that started Adams down the path of researching the issues involved in fundraising with elderly donors who are showing signs of cognitive impairment. She connected with Pomonis, who had his own harrowing experience with an elderly donor in cognitive decline. Both presenters discovered within their own journeys the dearth of resources available to frontline fundraisers and other advancement staff who wish to learn more about how to handle the ethical and legal concerns when faced with this experience.
Ultimately, it led to the creation of the session and a set of applicable best practices that all fundraisers and advancement staff can use at their organizations and institutions.
Cognitive impairment is a general term that refers to a collection of signs or symptoms that impact a person’s memory, attention span, judgment, and problem-solving skills. When these symptoms reach a critical threshold, they often result in a medical diagnosis of Alzheimer’s Disease or one of the many forms of dementia.
The Alzheimer’s Association created a top 10 list of signs of cognitive decline, which include the following:
- Memory loss that disrupts daily life
- Challenges in planning or solving problems
- Difficulty completing familiar tasks
- Confusion with time or place
- Trouble understanding visual images and spatial relationships
- New problems with speaking or writing
- Misplacing items and losing the ability to retrace steps
- Decreased or poor judgment
- Withdrawal from work or social activities
- Changes in mood or personality
From a fundraising and advancement perspective, these top 10 signs can take many forms. For fundraisers, you might notice issues of memory loss, such as forgetting about a scheduling fundraising visit or telling the same story multiple times in the same sitting. Donors might have difficulty understanding how much money they are committing to in a multi-year pledge or commit to a larger gift than they can afford because they do not comprehend the impact of that gift on their overall finances.
For event or alumni relations staff, you might notice an older donor getting confused or agitated at a large event, or that an older donor who used to attend every meeting and event suddenly stops showing up with no explanation.
Two recent stories in the cultural zeitgeist involving these signs and symptoms involve celebrities Bruce Willis and Wendy Willams. Bruce Willis began having issues with speaking and was diagnosed by his medical team with aphasia; however, within the course of a year his diagnosis was elevated to full frontotemporal dementia. Wendy Williams was similarly diagnosed with frontotemporal dementia following a medical diagnosis of primary progressive aphasia after fans of her television talk show noticed problems with her speech and other behavioral issues during the taping of her show.
Both of these diagnoses happened relatively young — Bruce Willis was in his mid-60’s and Wendy in her late-50s — but it is not entirely uncommon to begin to see the start of signs and symptoms of cognitive decline in this age group of donors. According to the Blackbaud Institute, the average age of a major gift donor in the United States is 65, which is also the average age that the first signs of cognitive impairment might begin to appear. The age group of 65+ years old is growing in size in the United States, with the Baby Boomer generation entering this phase in their lives.
Organizations’ portfolios are likely comprised in large part of prospects and donors in this age range, and that number will only increase in coming years. This means that the chances of encountering older donors with cognitive impairment issues will increase over time. The Centers for Disease Control and Prevention (CDC) estimates one in nine people age 65 and older are currently showing outward signs of cognitive impairment, and that number increases to one in seven for people ages 72 and older. Think about the number of people in your portfolio today who fit into these age ranges. It is likely that you have at least a couple of donors showing signs of cognitive decline whether you realize it or not, and if you have not already encountered this scenario it is increasingly likely that you will at some point in your career.
With these tools in your toolkit, what can you do if you start to notice the signs and symptoms of cognitive impairment in one of your older donors? The first step is to recognize that this is not a situation where you need to make decisions in a vacuum. Seek input from others, both internally and externally, on the best way to approach the issue. Second, do not try to diagnose a prospect or donor with cognitive impairment if you have not been told directly. Third, determine what touchpoints are appropriate between your organization and the donor moving forward, and establish a plan to review these touchpoints on a regular basis.
Cognitive impairment only increases in severity over time, which means that what might have been appropriate one year ago, or even six months ago, might no longer work for the donor.
