Summary of the impact

Two research council grants were awarded to the Brunel Institute of Ageing Studies in order to: identify how health, social care and finance professionals' detect and prevent elder financial abuse and to develop and test, through a randomised controlled trial, a web-based training resource to improve workforce capacity to make decisions in this domain.

The training resource has been shown to be effective and has been advocated for member use by such organisations as the College of Occupational Therapists, the Building Societies Association and Age UK. Impacts have included raised international awareness of elder financial abuse, increased international collaborative work between stakeholders and improved professional decision-making capacity.

Underpinning research

Two senior academics, Dr Priscilla Harries and Professor Mary Gilhooly, jointly led the research (September 2008 - August 2012). They were both employed at the School of Health Sciences and Social Care, Brunel University for the duration of the research and impact period. The case study is being submitted to both the Allied Health Professions UoA (Harries) and the Social Work and Social Policy (SW&SP) UoA (Gilhooly).

The first grant was awarded to Professor Mary Gilhooly as Principal Investigator (2008-2011), a Gerontologist and the Deputy Head of Research at the School of Health Sciences and Social Care (UoA SW&SP). Dr Priscilla Harries, a Reader in Occupational Therapy (AHP UoA) was the Lead Co-Investigator on the first grant due to her expertise in conducting professional decision making studies. Dr Harries supervised the two PhD students attached to the project (Davies and Notley) as well as acted as the day-to-day co-ordinator of the research activities. She worked closely with Dr Cairns (Research Fellow) and liaised with all other project partners (co-authors of papers in section 3). The other project partners participated in advisory board events, conducted Phase III of the research and undertook dissemination activities. A second grant application, an ESRC follow on project, was designed and successfully awarded to Dr Harries (2011-2012): Harries led the research as PI with Gilhooly and Gilhooly as CIs. Davies, managed by Harries, was the postdoctoral research fellow on the second grant, having successfully completed her PhD with Dr Harries as first supervisor.

First Grant awarded: Gilhooly M, Harries P, Gilhooly K J, Henessey C, Stanley D, Gilbert, T & Penhale B. "Detecting and preventing financial abuse of older adults: An examination of decision-making by managers and professionals in health, social care, banking." New Dynamics of Ageing cross-council programme. Grant ref RES-352-25-0026. September 2008-September 2011, £268,527 (FEC £325,878).

In Phase I of the first grant we interviewed professionals from health, social care and finance about actual incidents of suspected abuse to identify how they had detected and prevented abuse. In Phase II we statistically modelled their decision making behaviour across a large set of scenarios and measured consistency and discrimination in order to identify the experts amongst the sample. Phase III was a policy analysis of the relevant documents used by the three professional groups so this could be compared with practice behaviour.

We found that of the many factors, which the professionals thought they used in decision making, only a few appeared to persuade professionals that financial abuse was taking place. Likewise, only a handful of factors influenced decision making in relation to subsequent actions taken. The cues that exerted the greatest influence on health and social care professionals were the mental capacity of the older person and the nature of the financial problem and, in the case of those in finance, who was in charge of the money (See Ref 1, 2, 3, 4, 5). While the cues reported in this study show a family resemblance to those listed in published policy, this study was unique in its focus on real world cases.

Follow on grant awarded: Harries P, Gilhooly M, Gilhooly K. Developing decision training tools to enhance the ability of professionals to detect and prevent financial elder abuse. ESRC follow on grant September 2011 -August 2012. £92,743 (FEC £115,929).

Dr Harries was the PI who designed and led the research funded by the second grant. We had had discovered an overwhelming consensus that a training tool should be developed to assist various professional groups to accurately identify and deal with a case of financial elder abuse. With the second award the findings were used to develop a web based training resource for health, social care and finance professionals, which was tested for efficacy through a randomised controlled trial. This showed a statistically significant positive effect of the training on professional capacity to detect and prevent financial elder abuse. These findings are reported in the final report (Reference 6); the journal article is in review. The training resource was combined with a range of other information resources to provide a web resource to enhance professionals' decision-making capacity in relation to elder financial abuse.

References to the research

(Davies was the PhD student in the first project and the research fellow in the second project).

Details of the impact

Impact 1 & 2

Increased international collaboration between stakeholders and raised international awareness: The research undertaken through the NDA grant has raised the international profile of the need to detect and prevent elder financial abuse by bringing it to the attention of a range of professionals and organisations such as the Metropolitan Police, Elder Law Centres, Care Homes and the professional groups involved in the research. This social impact has been achieved through 10+ publications, 30+ national and international presentations and events for organisations such as, the Building Societies Association, the Care Homes Association, the Social Care sector. The charity, Action on Elder Abuse, have run a number of elder financial abuse seminar series with the research team between 2010 - 2012, to disseminate the findings to members. Presentations at conferences in Dublin and London as part of the World Elder Abuse Awareness Day (June 2011) facilitated networking of academics studying elder financial abuse. The presentation in Dublin was webcast, leading to further networking internationally.

Evidence is demonstrated through the following:

• Operation Sterling from the Metropolitan Police approached the team in 2009 requesting to become involved as a partner in the financial elder abuse project. Following the completion of the training website they have requested further research is undertaken to create an equivalent training tool for the Police training. Sterling's appreciation of our work has led to an invitation to consult with the Scottish Business Crime Centres (Scottish Government) "Protecting Vulnerable Adults from Financial Harm" work stream group and with the trading standards representative of the Dementia Friendly financial services sub group of David Cameron's Dementia Challenge.
• The linking of several international research groups and organisations all of whom visited the team at Brunel University, e.g., the National Centre for the Protection of Older People, University College Dublin; the Elder Law Centre, Pennsylvania State University; and the (Canadian) National Initiative for the Care of the Elderly, Toronto University and Queensland Police, Australia. The researchers also convened the first meeting for the Metropolitan Police and HSBC so strategies could be planned to prevent scam fraud.
• Dr Creedon used the findings in his study commissioned by Wells Fargo Bank in the US.
• Pearson, Director, the Elder Law Centre, Pennsylvania State University used the findings to inform her legal research on abuse and exploitation • Dr Mulroy and Professor O'Neill focused on the research findings in their BMJ editorial on elder abuse (BMJ 2011: 343: d6027)
• Letters of support for a training tool received from stakeholders such as Age UK, Alzheimer's Society, a GP surgery, Action on Elder Abuse.
• Invited appearance on the Jeremy Vine BBC Radio 2 Programme in December 2009 to share research findings on the `topical issue' of financial elder abuse.

Impact 3

Enhanced decision making capacity within the health, social care and finance professions:

The research impacts have also been achieved through the use of the outputs designed and tested during the ESRC funded follow-on project. The resource outputs have been made freely available on-line from August 2012 for health, social care and banking professionals to use (see www.elderfinancialabuse.co.uk). The four components of the professional training tools developed from the project posted on the web include:

1. Online decision training aids - These were used by 151 novice professionals as part of a randomised controlled trial of efficacy. A positive effect on novices' decision-making capacity was demonstrated.
2. Podcasts - Enhanced podcasts have been developed which presented a range of professionals giving their perspectives on elder financial abuse case scenarios, and domain specific advice on effective cross sector working. These have been favourably received in dissemination workshops.
3. Case scenarios of actual cases of financial elder abuse for use in education and training- Developed from Phase I research findings. These are based on real case experiences of elder financial abuse encountered by professionals working in the social care, health and banking sectors.
4. Seminar instruction packs - Providing professionals with targeted advice about how to use the case scenarios in small group education and training exercises.

Evidence is demonstrated through the following:

• Twenty-six independent requests for access to the web training site were made before the website was released including public sector organisations, finance organisations as well as interested individuals.
• The randomised control test that tested the effectiveness of the decision training tool has shown a positive effect on decision making capacity.
• Training resources produced have been endorsed for member use by Age UK, professional bodies such as the College of Occupational Therapists, CIFFAS Fraud detection Agency and Building Society Association.
• The number of individual users of the training website, which was made openly accessible in August 2012, is now 1500+.

The training tools have been used in the health and social care sectors to operationalise policies regarding practitioner development. e.g. Stirling University provided training via the `Professional Practitioner Initiative' and in the Northeast, the social care sector utilized the training tools for CPD as well as being used extensively by international groups e.g. Age Concern, New Zealand.

Sources to corroborate the impact

Increased international collaboration between stakeholders and raised international awareness:

(i) Documents showing value of the findings e.g. BMJ Editorial, http://www.bmj.com/content/343/bmj.d6027; Media - Jeremy Vines radio programme, Co-Op Newsletter, Barchester Care Homes newsletter and Email from the Elder Law Centre, Pennsylvania State University, Wells Fargo Bank.

(ii)Value of findings as evidenced through successful ESRC grant application for a Follow On Knowledge Transfer project e.g. Letters stating need for a training resource from Social Care Safeguarding Team, Building Societies Association, Action on Elder Abuse, Age UK, Alzheimer's Society, College of Occupational Therapists, GP Surgery.

(iii) Over 30 conference/seminar/workshop presentations with Webcasts of keynote address at international conference.

(iv)) NDA and follow on grant Findings brochures (in print and available on the NDA and ESRC web pages) http://www.newdynamics.group.shef.ac.uk/assets/files/NDA%20Findings%207.pdf • Newsletters on the project web page • End of award dissemination conference hosted by Brunel University. Request for similar research and training for the Police Economic and Specialist Crime OCU, Operation Sterling, New Scotland Yard.

(v) Evidence of organisations advocating use of training website: Screen shot of College of Occupational Therapists website, http://www.cot.co.uk/news/cotss-older-people/free-resources-improve-detection-and-prevention-elder-financial-abuse CIFAS Spectrum Newsletter, Age UK Safeguarding Newsletter.

(vi) Evidence of product developed — http://www.elderfinancialabuse.co.uk — screenshot and web link for the training resource website e.g. Podcasts

Enhanced decision making capacity within the health, social care and finance professions:

(vii) Corroborating statement — Letter from Rosemead GP Surgery stating the impact the research has had: "I have experienced improved detection and prevention rates of elder abuse, I have seen improvements in reporting procedures and I have experienced improved interdisciplinary working practices: I believe these improvements are largely as a result of the research undertaken by Brunel." Full statement available.

(viii) Corroborating contact — Senior Trading Standards Officer, Angus Council: Evidence of influencing the Dementia Friendly financial services sub group of David Cameron's Dementia Challenge.

(vi) Corroborating contact — Head of Research and Development, College of Occupational Therapists: Evidence of organisations advocating use of training website.

(x) Corroborating contact — Policy Advisor, Building Societies Association: Evidence of impact on finance professionals.