Relationship Between Neurocognitive Impairment and Financial Competence in Elderly Ugandans Receiving Social Assistance Grants

<p><b><span>Background:</span></b><span> Social protection programs, such as Uganda’s Senior Citizens Grant (SCG), are designed to provide financial support to improve the welfare of older adults. Neurocognitive impairment affects financial competence and may impair beneficiaries’ ability to manage financial resources effectively. However, evidence from low-income settings remains limited. This study therefore examined the association between neurocognitive impairment and financial competence in elderly Ugandans receiving social assistance grants. </span></p> <p><a rel="nofollow"></a><b><span>Methods:</span></b><span> A cross-sectional study was conducted among 588 elderly SCG beneficiaries sampled from ten Ugandan districts<b>. </b>Data were collected between 4^th October and 19^th November 2024 during the scheduled SCG disbursement period. Neurocognitive impairment was assessed using the Mini-Mental State Examination. Financial competence was assessed across six domains: involvement in financial decision-making, saving, borrowing, investment knowledge, insurance knowledge, and retirement planning. Each domain was treated as a separate binary outcome. Binary Logistic regression was used to estimate adjusted odds ratios (aORs) for each outcome while controlling for sociodemographic, health, and functional variables.</span></p> <p><b><span>Results:</span></b><span> The prevalence of neurocognitive impairment was 60.0% (95% CI: 56.0–63.9%). Engagement across different financial domains was generally low. Only about 27.0% were involved in financial decisions or reported saving (24.8%). Only 10.2% had taken a loan, 8.9% had investment knowledge, 4.1% had insurance knowledge, and 13.2% reported having any retirement plans. After adjustment, neurocognitive impairment was strongly associated with reduced odds of involvement in financial decisions in several domains, including financial decision-making (aOR 0.49, p&lt;0.001), saving (aOR 0.62, p=0.022), investment knowledge (aOR 0.30, p&lt;0.001), and insurance knowledge (aOR 0.13, p=0.002). </span></p> <p><b><span>Conclusions:</span></b><span> Neurocognitive impairment is widespread among elderly Ugandans receiving SCG. The impairment is associated with multiple domains of financial competence, which may undermine individuals' ability to fully benefit from social protection interventions. Routine screening for neurocognitive impairment and tailored financial management support may enhance program effectiveness and safeguard older persons’ welfare.</span></p>