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

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.

     

Appendicitis as the presenting manifestation of Kawasaki disease

In cases of Kawasaki’s disease (KD) presenting as acute surgical abdomen, rarely has the presence of acute appendicitis been found. We report two cases of histologically confirmed acute appendicitis in the presence of KD and a review of the literature as it pertains to acute abdomen and atypical presentations of KD.