Conceptualisation of financial capability in adults with acquired cognitive impairment: A qualitative evidence synthesis

TL;DR

This paper reviews how financial capability is defined and understood for adults with cognitive impairments, highlighting inconsistencies and the need for better conceptual models.

Contribution

The study provides a qualitative synthesis of existing models and frameworks for financial capability in adults with cognitive impairments.

Findings

21 papers were analyzed, revealing 15 distinct models of financial capability.

There is inconsistency in terminology and definitions across the literature.

Models increasingly use economic terms and focus on real-world performance in context.

Abstract

To explore definitions, theoretical models and conceptual frameworks related to financial capability in adults with acquired cognitive impairment from acquired brain injury or other neurological disease, including dementia.

A systematic search of PubMed (inclusive of Medline), CINAHL, EMBASE, PsycINFO, ABI-inform, SCOPUS and the Cochrane database for papers published until May 2025.

A qualitative evidence synthesis approach was utilised in conjunction with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Eligible papers articulated an original comprehensive definition and/or theoretical model or conceptual framework focused on financial capability in the target population. Papers were screened by two researchers, with methodological quality of included papers critically appraised. Data were extracted for tabulation and thematic synthesis, which was completed via coding and categorisation into descriptive and analytical themes.

The final analysis included 21 papers from the initial screening of 6516 papers. Fifteen discrete models were identified, with results indicating inconsistency in terminology use and meanings. Models that consider real-world performance within an individual's contextual environment are increasingly utilising economics related terminology such as financial capability. The majority of papers related to people with dementia and were multidisciplinary in authorship, or from the psychology literature. Themes found in the literature include the multi-dimensionality of financial capability, financial decision-making ability and exploitation risk for legal capacity, and the neuropathological cause of declining financial capability.

Further research with the inclusion of the consumer lived experience is recommended to inform models of care for this complex area of practice.

Figures