Conceptualisation of financial capability in adults with acquired cognitive impairment: A qualitative evidence synthesis.
Sarah Swan, Freyr Patterson, Terra M Bredy and 1 others
PMID 40501270WHAT IT FOUND
Financial capability in adults with acquired cognitive impairment was described across models as multidimensional: task skills, real-world performance, context, supports, exploitation risk and legal capacity.
Definitions varied, and independent task performance alone did not capture capability.
Key findings
01The synthesis identified financial capability as a multidimensional construct spanning financial tasks, knowledge and skills, real-world performance, and individual contextual factors.
02Financial competence in a controlled setting did not necessarily mean real-world financial performance; supports could enable capability despite poor test performance.
03Legal-capacity models focused on understanding, appreciation, reasoning and expressing choice, alongside exploitation risk factors such as undue influence and prior exploitation.
STILL TO COME
How it was doneWhat they foundWhat it means for OTs
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What it does not show
The review synthesised conceptual models and qualitative findings, not patient outcomes or intervention trials, so it does not show that using any model improves financial capability or safety. Only papers with an original comprehensive definition, theoretical model or conceptual framework specific to financial capability were included, so broader cognitive, functional or brain rehabilitation models and some assessment tools were left out. The neuropathological theme was based on only three papers, all in mild cognitive impairment or Alzheimer's disease, and was downgraded to moderate confidence because it may not apply to the wider acquired cognitive impairment population. Eight included papers were rated moderate quality, often because the theoretical perspective or the relationships between concepts were not clearly described. Lower quality papers were not excluded because the literature pool was limited. The original plan to treat definitions and conceptualisations separately was abandoned because they were intertwined, so the synthesis reports them together.
Declared interests
The authors declared no potential conflicts of interest. The work was supported by an Australian Government Research and Training Program Scholarship awarded to Sarah Swan, a PhD candidate.
The easy way to misread this
Do not treat these themes as proof that a financial capability model works. The review synthesised conceptual models and qualitative studies, and it did not include intervention studies.