Identifying and enhancing risk thresholds in the detection of elder financial abuse: a signal detection analysis of professionals’ decision making

Priscilla Harries · Huiqin Yang · Miranda S. Davies · Mary Gilhooly · Kenneth J. Gilhooly · Carl A. Thompson

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Elder Abuse and Neglect Decision-Making and Behavioral Economics Clinical Reasoning and Diagnostic Skills

Abstract

BACKGROUND: Financial abuse of elders is an under acknowledged problem and professionals' judgements contribute to both the prevalence of abuse and the ability to prevent and intervene. In the absence of a definitive "gold standard" for the judgement, it is desirable to try and bring novice professionals' judgemental risk thresholds to the level of competent professionals as quickly and effectively as possible. This study aimed to test if a training intervention was able to bring novices' risk thresholds for financial abuse in line with expert opinion. METHODS: A signal detection analysis, within a randomised controlled trial of an educational intervention, was undertaken to examine the effect on the ability of novices to efficiently detect financial abuse. Novices (n = 154) and experts (n = 33) judged "certainty of risk" across 43 scenarios; whether a scenario constituted a case of financial abuse or not was a function of expert opinion. Novices (n = 154) were randomised to receive either an on-line educational intervention to improve financial abuse detection (n = 78) or a control group (no on-line educational intervention, n = 76). Both groups examined 28 scenarios of abuse (11 "signal" scenarios of risk and 17 "noise" scenarios of no risk). After the intervention group had received the on-line training, both groups then examined 15 further scenarios (5 "signal" and 10 "noise" scenarios). RESULTS: Experts were more certain than the novices, pre (Mean 70.61 vs. 58.04) and post intervention (Mean 70.84 vs. 63.04); and more consistent. The intervention group (mean 64.64) were more certain of abuse post-intervention than the control group (mean 61.41, p = 0.02). Signal detection analysis of sensitivity (A´) and bias (C) revealed that this was due to the intervention shifting the novices' tendency towards saying "at risk" (C post intervention -.34) and away from their pre intervention levels of bias (C-.12). Receiver operating curves revealed more efficient judgments in the intervention group. CONCLUSION: An educational intervention can improve judgements of financial abuse amongst novice professionals.

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References

2011Thinking, Fast and Slow 1999Simple Heuristics That Make Us Smart 2009Prevalence and Correlates of Emotional, Physical, Sexual, and Financial Abuse and Potential Neglect in the United States: The National Elder Mistreatment Study 1997Coping with Uncertainty: A Naturalistic Decision-Making Analysis 1996Human Judgment and Social Policy 2008Gut feelings: the intelligence of the unconscious 1997Human judgment and social policy: irreducible uncertainty, inevitable error, unavoidable injustice 2008No Secrets: Guidance on developing and implementing multi-agency policies and procedures to protect vulnerable adults from abuse

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2019Financial-patrimonial elder abuse: an integrative review

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