Screening practices for financial abuse of older people at a large metropolitan hospital: a qualitative study of health professionals

Financial abuse of older people (FAOP) refers to material exploitation resulting in harm to older individuals that incorporates a breach of trust. Current practice does not involve routine screening, varies among healthcare professionals (HPs) and relies on individual experience. Given rising FAOP prevalence in Australia, practices need to be reviewed to improve safety of vulnerable older individuals. This study aimed (i) to explore the state of current HPs’ practices regarding the identification of FAOP and ideas regarding improvement, (ii) to identify risk factors and signs of abuse that could be used for FAOP monitoring and prevention. Qualitative study with five focus group interviews including 37 HPs from a range of professions at Nepean Hospital, Sydney, Australia. Interviews were audiotaped, transcribed and thematically analysed using the Framework approach. Nearly 1/3 of participants were social workers, about a quarter each were occupational therapists or nurses, 41% worked in hospital-based aged care. Two higher-order themes were identified, with three main themes mapped on each: Identification and monitoring: (i) Risk factors for older adults (e.g., decline in cognitive capacity, low financial literacy, isolation, lower physical capacity, cultural norms) (ii) Risk factors for abusers (e.g., self-appointed financial decision-making, financial strain, addiction); (iii) Observed signs (e.g., urgency to change financial decision-making, coercive control, opportunistic management of finances, inconsistencies in care, reluctance to engage with HP); and Implementation strategies: (iv) Barriers (e.g., insufficient funding, lack of time, older person’s reluctance to provide consent to reporting, lack of evidence); (v) Facilitators (e.g., education, routine monitoring, use of an evidence-based tool, improved referral and follow up processes); (vi) Motivation (e.g., attitude to routine screening, perceived seriousness of the problem). This study identified FAOP vulnerabilities that can be used for identification and monitoring at-risk patients in healthcare settings, which can be used in development of new screening practices. Findings also revealed a number of implementation strategies that can guide practice change.