One important first step in our research project has been to understand existing academic knowledge about how different types of cognitive impairment and exploitation intersect.  We are currently finalising the results of our ‘scoping review’ which attempts to map literature across many different disciplines and fields.  It has been an interesting process with some fascinating findings emerging. 

Our first challenge was to come up with an information search strategy that encompassed the wide range of cognitive impairments, differences and mental health conditions we wanted to consider in our study, as well as the various types of exploitation.  We were conscious of the contested definitions of ‘cognitive impairment’ and ‘exploitation’, but sought to retain as broad a definition as possible, and shared this in our search protocol.  Following a pilot study on the topic in Nottingham, it seemed important to include those with so-called ‘moderate’ impairments, and be open to less well-known types of exploitation, such as spiritual exploitation.  We were also keen to focus this study on the way that cognitive impairments could increase risk exploitation, rather than result from exploitation, and this was an important basis for refining the articles we considered.  

A further issue with the search strategy was that not all types of exploitation are recognised as exploitation – for example, survivors of criminal exploitation maybe viewed as members of criminal networks.  We therefore had to use a wide range of terms to capture studies exploring this aspect of the problem.  Ultimately, our ‘search string’ – a set of key words for searching electronic databases – included over 50 terms.  Fortunately, we had the help of the University of Nottingham’s fantastic senior research librarian Alison Ashmore, who helped us with our search, as well as a myriad of technical issues we experienced with databases.

We ran these searches at the end of January, and then spent much of the next couple of months screening the search results for relevance.  Our searches elicited around 6000 results, and we reviewed these by title, abstract and full text, which eventually resulted in 100 articles for inclusion in the final analysis.  We then utilised survey software to record the key points about each article, guided by our protocol, to capture data especially useful to our study.  While we are still writing up the findings and results, some interesting themes have already emerged.  First, is the importance of considering mental health conditions and trauma, often stemming from adverse childhood experiences (ACEs).  While we were looking at a very broad range of potential cognitive vulnerabilities, this has emerged as by far the most common issue discussed in the literature.  Secondly, the most common form of exploitation discussed has been sexual exploitation, with many of these studies especially focusing on minors.  There was also a cluster of papers discussing financial exploitation of those experiencing cognitive decline.  Interestingly, despite the presence of cognitive decline, psychological health was also additionally discussed as a potential vulnerability in these studies, emphasising the importance of attention to mental health.

While we are still finalising the results and writing them up in the form of an academic paper for peer review, this scoping review has been very helpful to our study.  The findings are guiding the questions for our survey for professionals and local authorities, and will inform the next phase of the project which focuses on qualitative interviews with front-line workers and those with lived experience. 

The review has also emphasised the knowledge gap in our area of research, as the scoping review demonstrates that links between cognitive impairment and forms of exploitation such as forced labour, criminal exploitation and ‘mate crime’ are rarely studied.  Vulnerabilities less-frequently discussed in the literature include learning disabilities and differences, such as ADHD, and Autism Spectrum Disorder.  This is despite prominent cases of labour exploitation of people with learning disabilities, which inspired our project. 

For further information contact:

Dr. Imogen Lambert, Research Fellow in Cognitive Impairment and Exploitation
Imogen.lambert@nottingham.ac.uk