Search

Older adults are the fastest growing age sub-group in prison. Prison, health and social work staff are required to provide support for complex health and social care issues including Dementia and Mild Cognitive Impairment (MCI). Dementia care for those living in the community is a national priority. There is, however, a lack of empirical evidence regarding service provision for those living in prison. This study was the first national survey of England and Wales to establish current service provision. Questionnaires were distributed to heads of healthcare and governors of all prisons in England and Wales. Our response rate was 85 (78%) for governors and 77 (71%) for healthcare managers. Reported prevalence of dementia/MCI from respondents was well below prevalence estimates from research. Furthermore, only 23 prisons (30%) had routine screening, and the majority reported that they did not have a defined care pathway (53; 69%) for dementia/MCI. Overall, the provision of services for those experiencing symptoms of dementia and MCI in prison is sub-optimal; however, many respondents reported aspirations to enhance services for this group. The forthcoming Ministry of Justice's national strategy for ageing prisons should include recommended care pathways for dementia and MCI to strive towards equivalence of care to community settings. [ABSTRACT FROM AUTHOR]

Introduction: Correctional institutions are challenged by increasing numbers of older prisoners. Existing literature highlights the vulnerability of this group that is reflected by various somatic and mental health issues including cognitive dysfunctions. Although cognitive training studies in various target groups of older people have been conducted, there is lack of data regarding cognitive training in older prisoners. A structured cognitive group training program ("NEUROvitalis Prison") with 12 weekly sessions was offered to male prisoners in Germany. Methods: Post intervention an exploratory qualitative study was conducted. Prisoners (N = 18) and staff (N = 4) perspectives were explored by conducting face-to-face semi-structured interviews. Audiotaped data were fully transcribed and deductive-inductive content analyses applied. Results: Both the prisoners and the staff perceived the cognitive training as very positive and stimulating. Moreover, the importance of the training was pronounced in terms of an increase in self-esteem and understanding of cognition and aging in the prisoners. Discussion: Our data indicate that cognitive training may be a feasible and valuable intervention for older prisoners that will be appreciated by both inmates and staff. The qualitative data provide substantial insight into the experiences with the applied cognitive training program. Moreover, valuable modifications for future conduct can be derived. [ABSTRACT FROM AUTHOR]

This paper considers the pains of life-sentence imprisonment through the novel vantage point of old age understood as a process. Our prison populations are getting older and the use of life sentences is dramatically increasing. Yet, research, campaigning, law and policy have not addressed the long-term consequences of imposing life sentences on prisoners who will age. Whilst far from exhaustive, our study draws on studies in gerontology, health policy and penology. We rely on shared analysis of collected official data from the US and the UK to highlight how the expansion and growth of life sentences on the one hand, and the dramatic aging of the prison population, on the other, are intertwined and need to be considered together. This article emphasizes the urgency of taking a holistic approach to penal severity, one that includes analyses of scale, lived experiences, as well as of law and politics, to uncover the multiple forms of marginalization elderly prisoners are exposed to. Aging is a phenomenon we will all experience, yet, in the context of imprisonment, we argue that old age is a 'prison problem' rather than a 'prisoner problem,', urging research and policy to depart from the conventional and reductive view of the older prisoner as one in need of transformation and treatment or as being inherently criminal. [ABSTRACT FROM AUTHOR]

IntroductionCorrectional institutions are challenged by increasing numbers of older prisoners. Existing literature highlights the vulnerability of this group that is reflected by various somatic and mental health issues including cognitive dysfunctions. Although cognitive training studies in various target groups of older people have been conducted, there is lack of data regarding cognitive training in older prisoners. A structured cognitive group training program (“NEUROvitalis Prison”) with 12 weekly sessions was offered to male prisoners in Germany.MethodsPost intervention an exploratory qualitative study was conducted. Prisoners (N = 18) and staff (N = 4) perspectives were explored by conducting face-to-face semi-structured interviews. Audiotaped data were fully transcribed and deductive-inductive content analyses applied.ResultsBoth the prisoners and the staff perceived the cognitive training as very positive and stimulating. Moreover, the importance of the training was pronounced in terms of an increase in self-esteem and understanding of cognition and aging in the prisoners.DiscussionOur data indicate that cognitive training may be a feasible and valuable intervention for older prisoners that will be appreciated by both inmates and staff. The qualitative data provide substantial insight into the experiences with the applied cognitive training program. Moreover, valuable modifications for future conduct can be derived.

The rising prevalence of dementia in the UK presents a public health and economic challenge. People over the age of 60 are the fastest growing age group in prison and the number of people in prison who experience dementia is rising. There is a lack of research focused on improving management and support for people in prison who may experience dementia, but growing awareness of the need for staff training in prisons to identify and support people showing symptoms of dementia. This paper reports the development of a theory and evidence-based training package for prison staff and peer carers to identify and support people in prison with mild cognitive impairment or dementia. Training content and format was informed by the literature on dementia training in prisons and analysis of qualitative and quantitative data from semi-structured interviews with prison staff and a survey administered to prison governors and healthcare managers, both of which explored current provision of dementia training and training needs. A stakeholder working group reviewed and revised the training during two interactive meetings. Future research to evaluate the effectiveness of the training in practice is required. [ABSTRACT FROM AUTHOR]

Older prisoners are the fasted growing sub group in prisons across developed countries. They have high levels of health and social care needs in relation to their younger counterpart and those of the same age living in the community. There are a lack of interventions to ensure their needs are met. The older prisoner health and social care assessment and plan (OHSCAP) provided a structured process for addressing need and it's effectiveness was evaluated in a randomised controlled trial (RCT). This paper presents findings from the nested qualitative study relating to this RCT. The aim of this study was to explore the facilitators and barriers to delivering the OHSCAP. Semi-structured interviews were conducted with twelve staff members delivering the OHSCAP and 14 service users who had received the intervention. The framework method was used to analyse the data produced. Participants described a 'broken' prison system. They discussed a staffing crisis resulting in individuals' human rights being violated, which led to dangerous conditions in the prison. These conditions further impeding the staffing crisis, as recruitment was difficult and staff sickness was high. This 'broken' prison cycle significantly contributed to a lack of adequate attention being paid to OHSCAP processes. The delivery of health and social care interventions in prison is challenging when basic systems relating to staffing and safety are not adequate. Future research needs to consider how these circumstances can be mitigated. [ABSTRACT FROM AUTHOR]

Background: Serious games have the potential to transform the field of cognitive assessment. The use of serious game-based cognitive assessments in prison environments is particularly exciting. This is because interventions are urgently needed to address the rapid increase in the number of currently incarcerated older adults globally and because of the heightened risks of dementia and cognitive decline present in this population. Game-based assessments are assumed to be fun, engaging, and suitable alternatives to traditional cognitive testing, but these assumptions remain mostly untested in older adults. This is especially true for older adults in prison, whose preferences and needs are seldom heard and may deviate from those previously captured in studies on cognition and serious games. Objective: This study aimed to understand the design preferences of older adults in prison for a game-based cognitive assessment. Methods: This study used reflexive thematic analysis, underpinned by critical realism, and applied the technique of abduction. Overall, 4 focus groups with a total of 20 participants were conducted with older adults (aged >50 years; aged >45 years for Aboriginal and Torres Strait Islander people) across 3 distinct prison environments in Australia. Results: Self-determination theory was used as a theoretical foundation to interpret the results. Overall, 3 themes were generated: Goldilocks--getting gameplay difficulty just right through optimal challenge (the first theme emphasizes the participants' collective desire for an individualized optimal level of difficulty in serious gameplay), Avoiding Childish Graphics--gimmicky gameplay can be condescending (the second theme raises the importance of avoiding immature and childlike gameplay features, as some older end users in prison felt that these can be condescending), and A Balanced Diet--meaningful choice and variety keeps game-based assessments fun (the third theme highlights the strong user preference for meaningful choice and variety in any serious game-based cognitive assessment to maximize in-game autonomy). Conclusions: The collection of these themes provides novel insights into key game design preferences of marginalized older adults. [ABSTRACT FROM AUTHOR]

Imprisoned persons are transported for several purposes including transfers to a different prison, legal-procedural reasons such as court hearings, and to receive medical treatments. The availability and acceptability of transportation may limit access to healthcare if health services cannot be provided within the prison grounds. The aim of this article is to examine the conditions of medical transport for older prisoners in Switzerland and to assess whether or not these practices are in line with international recommendations. Interviews with experts working in the prison context and with older prisoners were conducted. Results show that handcuffing practices and space restrictions during medical transport are not adapted to prisoners' health condition. Older prisoners risk being exposed and humiliated by transport conditions. The reasons for delayed medical transport can be administrative constraints or erroneous medical judgement. Switzerland's cantonal system results in a variety of regulations for transports, so that cantonal differences, administrative constraints and inappropriate conditions can delay access to necessary healthcare and increase suffering. [ABSTRACT FROM AUTHOR]

Over the last two decades, there has been a rapid rise in the proportion of older adults in prisons across the world. While the cause for this trend depends on local demographic, legal and social circumstances, ethnographic attention to this issue remains sparse. This commentary examines the contributions of two recent books on older adults in prisons in order to highlight key questions and findings that might provide a foundation for future research for the anthropology of aging and the life course. Despite focusing on different national contexts, both works reveal the disproportionate harm to older adults as a result of incarceration, as well as the ways individuals cope, even in very restrictive institutional environments. I conclude by stressing the need for more ethnographic attention to the growing overlap between aging and the carceral (in and out of prisons), and the importance of this research for questioning our broader assumptions about aging, care, crime and justice.

Background and Purpose: The number of older people in prisons is increasing across the globe. Many have poor physical and mental health, higher prevalence of head injury, cognitive impairment and dementia than found in community populations. Meeting the complex needs of this vulnerable group has become an increasing concern for prison and prison healthcare services. The aim of this multi method qualitative study was to investigate how men with diagnosed or suspected dementia were identified, assessed, and cared for in Scottish prisons. It also explored the lived experience of individuals being assessed for or diagnosed with dementia within four prisons. The data from twenty nine interviews was thematically analysed and used to collaboratively propose principles for dementia care in prison and present the resultant co-designed care pathway., Results: At the time of data collection almost all the men known to have a dementia diagnosis or suspected dementia had complex health and social care needs, and some were living with advanced dementia. Prison healthcare staff reported taking a 'case by case' approach to their pre- and post-diagnostic care. Meeting these prisoner's needs was complicated by the absence of organisational leads for care of older adults or people with dementia and there was no pathway or model in place to guide staff. Prison healthcare teams often had difficulty accessing specialist community services to support diagnosis. There was a lack of dementia education and knowledge about how to provide pre and post diagnostic dementia care in this setting amongst staff. The findings arising from this research have informed the co-production of two important evidence informed innovations namely a Model of Care and a pre- and post-diagnostic Care Pathway., Conclusion: This research adds insights critical to understanding the adequacy of current approaches to meeting dementia related needs within the prison setting. To our knowledge this paper offers the first co-produced evidence informed pre- and post- diagnostic dementia care pathway and model of care for use in prisons. These could serve as tools for change that could enable prison healthcare staff to deliver the right care, at the right time, by the right people, and provide an opportunity to assess risk and plan care for the future., (© 2024. The Author(s).)

While the overall United States prison population has decreased over the last 10 years, the number of sentenced individuals above the age of 50 nearly doubled during the same period. The focus of this study, the pains of imprisonment experienced by the aging, is an under-researched area in the prison literature. Results from a sample of 134 male participants of True Grit, a structured living program for older prisoners, indicate strong agreement among sexagenarians, among septuagenarians, and between them. Previous studies of the pains of imprisonment found similar evaluations of the most and least difficult aspects of incarceration. While different instruments were used, collectively these studies suggest some commonality in the greatest hardships and least problematic aspects of incarceration. Policy implications derived from the present research are considered. [ABSTRACT FROM AUTHOR]

A growing number of older people remain in custody each year resulting in an increasing number of common mental and physical health concerns. No prior evidenced-based targeted psychological interventions support this group of people, and little is known about their needs, current activities, and health-related problems. We addressed these gaps through a project involving older prisoners, prison staff and a project advisory group in one male and one female prison site in the North of England. Systematic review evidence supports the development of an implementation tool kit addressing strategies to develop and deliver interventions that are sustainable, acceptable, and feasible in the prison environment. Prison strategies need to specifically address the needs of older people in custody. Relatively inexpensive activities, with some thought to delivery and flexibility have the potential to benefit common mental and physical health, increasing quality of life, reducing high economic and social cost, mortality, and reoffending in this age group. [ABSTRACT FROM AUTHOR]

Background and Objectives The care and well-being of an increasing number of older prisoners living with dementia require an adequate care continuum. Longstanding barriers, including limited resources and relevant expertise, necessitate an interdisciplinary approach and incorporation of external organizations in supporting prisoners with dementia. However, little is known about their perspectives and experiences. This study aimed to explore the role of external organizations in providing care for prisoners with dementia in Australia. Research Design and Methods In this qualitative descriptive study, 27 participants from legal, health, and social services rendering services in Australian prisons were recruited. Qualitative data were generated by applying the Nominal Group Technique in research group discussions. Demographic/background data were used to generate descriptive statistics through Qualtrics. Results Inductive thematic analysis of qualitative data revealed challenges and opportunities for future dementia care in Australian prisons. Six research discussion groups represented participants from Victoria, Queensland, New South Wales, Western Australia, and Tasmania. Identified themes included (a) possible models of care for prisoners with dementia, (b) uncovering the invisible issues of dementia care in prisons, and (c) proposed next steps for improved care of prisoners with dementia. Discussion and Implications This study provided recommendations for multiple stakeholders to overcome barriers in providing dementia care to prisoners. Increased collaboration between corrective services and external organizations was recommended, with a clear delineation of custodial and care priorities. External organizations highlighted the wider community's responsibility to care for older prisoners and the need to explore emerging areas of practice in this regard. [ABSTRACT FROM AUTHOR]

Over the last two decades, there has been a rapid rise in the proportion of older adults in prisons across the world. While the cause for this trend depends on local demographic, legal and social circumstances, ethnographic attention to this issue remains sparse. This commentary examines the contributions of two recent books on older adults in prisons in order to highlight key questions and findings that might provide a foundation for future research for the anthropology of aging and the life course. Despite focusing on different national contexts, both works reveal the disproportionate harm to older adults as a result of incarceration, as well as the ways individuals cope, even in very restrictive institutional environments. I conclude by stressing the need for more ethnographic attention to the growing overlap between aging and the carceral (in and out of prisons), and the importance of this research for questioning our broader assumptions about aging, care, crime and justice. [ABSTRACT FROM AUTHOR]

Numbers of older prisoners have been increasing in recent years and there is no national strategy addressing their care. Older prisoners have more physical health needs, complex social care needs and high rates of mental disorder compared with younger prisoners. These needs are often not identified or addressed. We developed the Older prisoner Health and Social Care Assessment and Plan (OHSCAP), a structured approach for identifying and managing the health and social care needs of older prisoners. It consists of an assessment, care plan and review of needs. The current study aims to establish the fidelity of implementation of the OHSCAP as part of a larger RCT. Compliance, context and competence fidelity were audited to assess compliance with training and the manual, adequacy of completion and identification of needs and quality of care planning. Results showed that the OHSCAP was not implemented as intended with needs identified not being consistently translated into care plan actions, little evidence to suggest that prisoner involvement in the care planning process and difficulties in collaborative working. Implications with respect to effectively embedding complex interventions within prisons, along with wider policy-related issues affecting the entire prison estate are discussed. [ABSTRACT FROM AUTHOR]

Our immense prison population is aging and as a result, ex-felons are being released from incarceration later and later in life. Older ex-felons have the lowest recidivism rates in the country, but despite having served their time, their reintegration into society is not an easy road to navigate. In many states, one's felony status can come with permanent exclusion from one of the most fundamental aspects of American society: voting. State felony disenfranchisement laws dictate whether an individual after their release from prison is able to participate in our elections. But an ex-felon's ability to participate in our democracy varies state-to-state. Created during the Reconstruction, felony disenfranchisement laws originated in the South as another vestige of Jim Crow discrimination. But unlike the rest of Jim Crow laws which were struck down, about fifty years ago, the Supreme Court upheld the constitutionality of state felony disenfranchisement laws, allowing each state to determine whether felony status can be a barrier to voting. As a result, in more than half of the fifty states, one's felony status can delay or even permanently prohibit an ex-felon's right to vote. States fall into one of four different buckets based on the severity of their disenfranchisement laws, ranging from no restrictions to voting to a permanent bar from ever again entering the voting booth. Mass incarceration and increases in the length of sentencing have only increased the number of individuals these disenfranchisement laws impact. This impact does not just affect an ex-felon's voting rights, but also, can alter the electorate to the point of potentially affecting the results of elections had this bloc of exfelons been alternatively allowed to vote. Research has previously been conducted to determine the impact of these disenfranchisement laws on race, but not on age. The analysis of this Note, takes a first look at the extent in which age has been impacted by these laws, by selecting states in each of the four buckets to see the number of older exfelons who are having their voting rights negatively impacted. This Note recommends solutions tailored for each of the four categories of states, including modernizing voter registration and education laws, shortening the period an ex-felon must wait post-release from prison to register to vote, and eliminating the payments of court fines and restitution as barriers to voter registration. [ABSTRACT FROM AUTHOR]

As an intersubjective human experience, fear impacts the health and quality of life of older adults. To date, no clear and empirical attempt has been made yet to describe how fear is developed among older inmates toward other inmates, hence this grounded theory study. Twenty-five (25) older prisoners from the National Bilibid Prison in Muntinlupa, Philippines took part in an in-depth, face to face individual interview. Guided by the Corbin and Strauss Method of grounded theory analysis, gathered field texts were subjected to open, axial and selective coding procedures. The emerging themes were then validated via member checking procedure. Interestingly, the study afforded the Ferris wheel model of older prisoners' fear towards other inmates with four underlying phases. These phases provide an elucidation of the individual and collective contributions of environmental stimuli that shape an older inmates' preconceived notion of prison ecology; the experience of and exposure to violent behaviors inside prison; the development of avoidance as a maladaptive coping mechanism; and the role of spirituality and support group. Findings of this study are valuable guideposts for penal institutions to adopt a more inter-disciplinary approach to crafting induction programs and transitioning experiences for new inmates that foster better coping skills through a well-defined system of socialization, communication and interaction between and among inmates. [ABSTRACT FROM AUTHOR]

Abstract Background Suicide is a major problem across the lifespan, yet rates are highest among middle-aged and older adults; a trend which remains relatively stable across varying sociological settings, including prisons. Despite this understanding, there is limited knowledge on the nature of suicidal thoughts and attempts among older prisoners, especially with respect to how they compare to younger counterparts. The present study aimed to increase insight into the relationship between age and suicidal thoughts and attempted suicide among prisoners, with particular focus on factors that may explain age-based variability. Results Cross-sectional data were drawn from a nationally representative sample of 18,185 prisoners housed within 326 prisons across the United States. In general, analyses revealed that: (a) attempted suicide was more commonly reported among younger prisoners, while suicidal ideation was more commonly reported among older prisoners; (b) the relationship between age and probability of reporting suicidal thoughts and behavior is curvilinear; (c) younger and older prisoners exhibit somewhat differing predictive patterns of suicidal thoughts and behavior (e.g., physical illness is directly associated with suicidal history for younger prisoners, whereas the effect of physical illness on suicidal history for older prisoners is mediated by depression). Conclusions There is evidence to suggest that suicidal thoughts and behavior may manifest differently for younger and older prisoners, with differing patterns of risk. More research is needed on age-based variability in suicidal thoughts and attempted suicide among prisoners, as well as those factors that might explain this variability. Importantly, future research must continue to investigate the nature of suicidal thoughts and behavior among older prisoners.

Background: Older people are the fastest-growing demographic group among prisoners in England and Wales and they have complex health and social care needs. Their care is frequently ad hoc and uncoordinated. No previous research has explored how to identify and appropriately address the needs of older adults in prison. We hypothesised that the Older prisoner Health and Social Care Assessment and Plan (OHSCAP) would significantly increase the proportion of met health and social care needs 3 months after prison entry, compared to treatment as usual (TAU).Methods: The study was a parallel randomised controlled trial (RCT) recruiting male prisoners aged 50 and over from 10 prisons in northern England. Participants received the OHSCAP or TAU. A clinical trials unit used minimisation with a random element as the allocation procedure. Data analysis was conducted blind to allocation status. The intervention group had their needs assessed using the OHSCAP tool and care plans were devised; processes that lasted approximately 30 min in total per prisoner. TAU included the standard prison health assessment and care. The intention to treat principle was followed. The trial was registered with the UK Clinical Research Network Portfolio (ISRCTN ID: 11841493) and was closed on 30 November 2016.Results: Data were collected between 28 January 2014 and 06 April 2016. Two hundred and forty nine older prisoners were assigned TAU of which 32 transferred prison; 12 were released; 2 withdrew and 1 was deemed unsafe to interview. Two hundred and fifty three 3 prisoners were assigned the OHSCAP of which 33 transferred prison; 11 were released; 6 withdrew and 1 was deemed unsafe to interview. Consequently, data from 202 participants were analysed in each of the two groups. There were no significant differences in the number of unmet needs as measured by the Camberwell Assessment of Needs - Forensic Short Version (CANFOR-S). The mean number of unmet needs for the OHSCAP group at follow-up was 2.03 (SD = 2.07) and 2.06 (SD = 2.11) for the TAU group (mean difference = 0.088; 95% CI - 0.276 to 0.449, p = 0.621). No adverse events were reported.Conclusion: The OHSCAP was fundamentally not implemented as planned, partly due to the national prison staffing crisis that ensued during the study period. Therefore, those receiving the OHSCAP did not experience improved outcomes compared to those who received TAU.Trial Registration: Current Controlled Trials: ISRCTN11841493 , 25/10/2012. [ABSTRACT FROM AUTHOR]

Abstract Background The number of older prisoners has risen exponentially over the last two decades, especially in high-income countries. Due to the increased and somewhat inadequately met health and social care needs of this group of prisoners, coupled with their vulnerability arising from higher levels of isolation, poverty and exploitation, financial costs have spiralled and human rights concerns have grown. This review aimed to present an overview of programmes that addressed older prisoners’ social care needs, a particularly underdeveloped area, with a view to assessing the extent to which they could inform policy and practice. Methods Following Whittemore and Knafl’s (J Adv Nurs 52:546-553, 2005) integrative review approach, a comprehensive search - including 16 electronic databases and hand searching - was undertaken up to May 2017 using search terms related to context, function and disability. The quality of included papers was assessed, data were extracted using a review-specific form based on the PICO formula, and research questions addressed using a narrative synthesis approach. Additionally, reporting followed PRISMA guidelines. Results A total of 29 papers were selected for inclusion, the majority of which focused on hospice programmes, with the remainder describing personal care-focused services, structured day programmes, and adaptations to prison operations (regime) and accommodation in support of prisoners’ social care needs. Whilst the programmes were reported to have some positive impacts on prisoners and the prison overall, and programmes were perceived to be cost-effective or cost-neutral, outcomes regarding staff were more mixed. Findings were tempered by the methodological shortcomings of the included papers, with many assessed as low quality, with a lack of prisoner participation, and an absence of experimental studies. Conclusions The evidence base for programmes addressing older prisoners’ social care needs appears to be at an embryonic stage. Further robust studies evaluating the effectiveness and cost-effectiveness of programmes addressing older prisoners’ social care needs are imperative in better informing policy and practice in support of this highly vulnerable group.

Summary: In light of longstanding concern about the lack of social care in prisons, the 2014 Care Act made local authorities in England responsible for identifying, assessing and meeting prisoners' social care needs. However, service planning is difficult, for little is known about the level of demand or the extent to which the needs of older and younger prisoners differ. Against this background, face-to-face interviews (including screens for social care needs, substance misuse and mental health problems) were undertaken with a sample of male prisoners in North-West England. Findings: Three hundred and ninety-nine participants were aged 18–49 and 80 aged 50 plus. Overall, more than a 10th of participants had problems maintaining personal hygiene, dressing and/or getting around the prison safely; a significant minority lacked meaningful occupation; and approaching a sixth acknowledged problems forming/maintaining relationships. Older prisoners were significantly more likely than younger prisoners to need help with personal hygiene, dressing and moving around safely and to identify problems with their physical health and memory. Applications: The findings highlight the substantial number of older prisoners who could potentially benefit from some form of social care and support if they are to maintain their safety and dignity and make best use of their time in prison. They also underline the need to develop suitable screening and assessment tools for older prisoners, and for further research on the best service models for prisoners requiring intimate personal care. [ABSTRACT FROM AUTHOR]

Despite a recent decline in the U.S. prison population, the older prisoner population is growing rapidly. U.S. prisons are constitutionally required to provide health care to prisoners. As the population ages, healthcare costs rise, states are forced to cut spending, and many correctional agencies struggle to meet this legal standard of care. Failure to meet the healthcare needs of older prisoners, who now account for nearly 10% of the prison population, can cause avoidable suffering in a medically vulnerable population and violation of the constitutional mandate for timely access to an appropriate level of care while incarcerated. Older prisoners who cannot access adequate health care in prison also affect community healthcare systems because more than 95% of prisoners are eventually released, many to urban communities where healthcare disparities are common and acute healthcare resources are overused. A lack of uniform quality and cost data has significantly hampered innovations in policy and practice to improve value in correctional health care (achieving desired health outcomes at sustainable costs). With their unique knowledge of complex chronic disease management, experts in geriatrics are positioned to help address the aging crisis in correctional health care. This article delineates the basic health, cost, and outcomes data that geriatricians and gerontologists need to respond to this crisis, identifies gaps in the available data, and anticipates barriers to data collection that, if addressed, could enable clinicians and policy-makers to evaluate and improve the value of geriatric prison health care.

The risk of coronavirus (COVID-19) spreading in prisons is especially acute. This has resulted in an unprecedented number of prisoners being released across the world-including many prisoners in the United States. From the health, social, and political perspectives, this is a sound approach. This is especially the situation in relation to older prisoners and those who have not been imprisoned for serious sexual and violent offenses. Despite the large number of prisoners that are being released, the United States will still have the largest prison population on earth-and by a large margin. However, the coronavirus pandemic and the response to it has considerably wider implications for the broader criminal justice system. In particular, it brings into focus a large number of other unintended adverse consequences experienced by prisoners. These include being deprived of the right to procreate; materially increasing the risk that they will be assaulted or raped in prison, and suffering a considerable reduction in their lifetime earnings. The familial relationships of most prisoners are also normally materially impaired. The adverse, incidental harms associated with prison and the impact that this should have on sentencing law is an under-researched area of law. This Article fills that gap in the literature: we argue that sentences for most ofenders should be reduced to accommodate the incidental hardships experienced by prisoners. The result would be a large reduction in the United States prison and jail population, without an increase in the crime rate. [ABSTRACT FROM AUTHOR]

This article presents a sequence of reflexive observations based on my experiences as a lone researcher, conducting sensitive qualitative research with vulnerable adult male prisoners who were convicted of sexual offences. The data collection process was imbued with intrapersonal and inter-subjective challenges, including rapport building with participants, negotiating with gatekeepers, care for vulnerable participants and dealing with the emotional dissonance emanating from the management of unsolicited disclosures. The closed nature of the institution, security processes, hierarchical relations and aspects of the prisoner culture increased the complexity of the research process. It is argued that researching vulnerable groups in sensitive locations is replete with ethical and interpersonal tensions. Given that other researchers conducting sensitive research with hard to reach populations may encounter similar issues, this paper aims to capture in detail some of the difficulties and presents the main points of learning from the experience. [ABSTRACT FROM AUTHOR]

Background: People aged ≥ 50 years constitute the fastest-growing group in the prison population of England and Wales. This population has complex health and social care needs. There is currently no national strategy to guide the development of the many-faceted services required for this vulnerable population; therefore, prisons are responding to the issue with a range of local initiatives that are untested and often susceptible to failure if they are not fully embedded in and securely funded as part of commissioned services. Objectives: The objectives were to establish the prevalence of dementia and mild cognitive impairment in prisoners in England and Wales and their health and social care needs; validate the six-item cognitive impairment test for routine use in prisons to aid early and consistent identification of older prisoners with possible dementia or mild cognitive impairment; identify gaps in current service provision; understand the first-hand experiences of prisoners living with dementia and mild cognitive impairment; develop a care pathway for prisoners with dementia and mild cognitive impairment; develop dementia and mild cognitive impairment training packages for staff and prisoners; and produce health economic costings for the care pathway and training packages. Design: This was a mixed-methods study. Setting: The study setting was prisons in England and Wales. Participants: Prisoners aged ≥ 50 years and multiagency staff working in prison discipline and health and social care services took part. Results: Quantitative research estimated that the prevalence rate of suspected dementia and mild cognitive impairment in the prison population of England and Wales is 8%. This equates to 1090 individuals. Only two people (3%) in our sample had a relevant diagnosis in their health-care notes, suggesting current under-recognition of these conditions. The prevalence rate in prisons was approximately two times higher among individuals aged 60–69 years and four times higher among those aged ≥ 70 years than among those in the same age groups living in the community. The Montreal Cognitive Assessment screening test was found to be more effective than the six-item cognitive impairment test assessment in the older prisoner population. Qualitative research determined that staff and prisoners lacked training in knowledge and awareness of dementia and mild cognitive impairment, and this leads to problematic behaviour being viewed as a disciplinary issue rather than a health issue. Local initiatives to improve the lives of prisoners with dementia and mild cognitive impairment are often disadvantaged by not being part of commissioned services, making them difficult to sustain. Multidisciplinary working is hampered by agencies continuing to work in silos, with inadequate communication across professional boundaries. A step-by-step care pathway for prisoners with dementia and mild cognitive impairment was developed, and two tiers of training materials were produced for staff and prisoners. Limitations: Our prevalence rate was based on the results of a standardised assessment tool, rather than on clinical diagnosis by a mental health professional, and therefore it may represent an overestimation. Furthermore, we were unable to distinguish subcategories of dementia. We were also unable to distinguish between a likely diagnosis of dementia and other conditions presenting with mild cognitive impairment, including learning disability, severe depression and hearing impairment. Questionnaires regarding current service provision were collected over an extended period of time, so they do not reflect a ‘snapshot’ of service provision at a particular point. Conclusions: We hypothesise that implementing the step-by-step care pathway and the training resources developed in this study will improve the care of older prisoners with dementia and mild cognitive impairment. Future work: The care pathway and training materials should be evaluated in situ. Alternatives to prison for those with dementia or mild cognitive impairment should be developed and evaluated. Funding: This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 27. See the NIHR Journals Library website for further project information.

Older adults comprise an increasing proportion of the prison and homeless populations. While older age is associated with adverse post-release health events and incarceration is a risk factor for homelessness, the health status and homelessness risk of older pre-release prisoners are unknown. Moreover, most post-release services are geared towards veterans; it is unknown whether the needs of non-veterans differ from those of veterans.To assess health status and risk of homelessness of older pre-release prisoners, and to compare veterans with non-veterans.Cross-sectional study of 360 prisoners (≥55 years of age) within 2 years of release from prison using data from the 2004 Survey of Inmates in State and Federal Correctional Facilities.Veteran status, health status (based on self-report), and risk of homelessness (homelessness before arrest).Mean age was 61 years; 93.8% were men and 56.5% were white. Nearly 40% were veterans, of whom 77.2% reported likely VA service eligibility. Veterans were more likely to be white and to have obtained a high school diploma or GED. Overall, 79.1% reported a medical condition and 13.6% reported a serious mental illness. There was little difference in health status between veterans and non-veterans. Although 1 in 12 prisoners reported a risk factor for homelessness, the risk factors did not differ according to veteran status.Older pre-release prisoners had a high burden of medical and mental illness and were at risk for post-release homelessness regardless of veteran status. Reentry programs linking pre-release older prisoners to medical and psychiatric services and to homelessness prevention programs are needed for both veterans and non-veterans.

Copyright of Journal of Society & Social Work is the property of Journal of Society and Social Work and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

There has been a significant increase in the older prison population over the past several decades, bringing a need to better understand how to effectively prevent and address misconduct among this age group. Research examining the factors that influence elderly inmates' engagement in misconduct remains scant. The present research sought to examine the correlates of misconduct among younger, middle-age, and elderly inmates, as well as investigate any differences in the factors associated with misconduct for elderly inmates as compared to younger inmates, and elderly inmates compared to middle-age inmates. The findings revealed several variables that significantly affected an inmate's likelihood of engaging in disciplinary infractions. Important differences were further revealed when the relationship between age and prison misconduct was examined. [ABSTRACT FROM AUTHOR]

Background: Suicide is a major problem across the lifespan, yet rates are highest among middle-aged and older adults; a trend which remains relatively stable across varying sociological settings, including prisons. Despite this understanding, there is limited knowledge on the nature of suicidal thoughts and attempts among older prisoners, especially with respect to how they compare to younger counterparts. The present study aimed to increase insight into the relationship between age and suicidal thoughts and attempted suicide among prisoners, with particular focus on factors that may explain age-based variability. Results: Cross-sectional data were drawn from a nationally representative sample of 18,185 prisoners housed within 326 prisons across the United States. In general, analyses revealed that: (a) attempted suicide was more commonly reported among younger prisoners, while suicidal ideation was more commonly reported among older prisoners; (b) the relationship between age and probability of reporting suicidal thoughts and behavior is curvilinear; (c) younger and older prisoners exhibit somewhat differing predictive patterns of suicidal thoughts and behavior (e.g., physical illness is directly associated with suicidal history for younger prisoners, whereas the effect of physical illness on suicidal history for older prisoners is mediated by depression). Conclusions: There is evidence to suggest that suicidal thoughts and behavior may manifest differently for younger and older prisoners, with differing patterns of risk. More research is needed on age-based variability in suicidal thoughts and attempted suicide among prisoners, as well as those factors that might explain this variability. Importantly, future research must continue to investigate the nature of suicidal thoughts and behavior among older prisoners. [ABSTRACT FROM AUTHOR]

The 2013–2017 Australian Royal Commission into Institutional Responses to Child Sexual Abuse found that children were abused in over 4000 Australian institutions between 1980 and 2015. The Commission referred at least 309 matters relating to abuse in Catholic institutions to the police. It is predicted that, in the coming years, older males will comprise an increasingly large part of the prison population in Australia. High increases are already being noted in one Australian jurisdiction, the Australian Capital Territory (the ACT). This paper provides a discussion on the current experiences of older prisoners in Australia and how agencies, such as corrective services, can best address the needs of this population in the coming years. [ABSTRACT FROM AUTHOR]

The article discusses the significance of the principles behind the U.S. juvenile justice reform to criminal sentencing reform for elderly prisoners. Topics discussed include the decline in numbers of juvenile committed to correctional facilities due to the juvenile justice reform, the loss of dignity associated with a criminal conviction, and the cost of incarcerating elderly prisoners.

The unremitting growth of older inmates in prison populations is one of the most pressing concerns in federal corrections today; however, empirical research on the topic says little about the causes of these changes. This article addresses this gap by applying an established methodology to analyze and quantify the contributions of key factors driving the growth of aging federal prison populations. Specifically, we use data from the Federal Justice Statistics Program (FJSP) to determine how changes to prisoner age at entry, rate of entry, and rate of exit have shaped the prison population over recent decades. Overall, we find that from 1994 to 2004, rapid increases in the rate of prisoner admission explain the majority of growth in the elderly population, but that since 2004, age at admission has been much more important, with longer time served and rate of admission also playing a role. These influences appear to be quite different from those shaping state prison populations. Our results suggest optimal policy responses to aging populations will need to be tailored to their jurisdiction. [ABSTRACT FROM AUTHOR]

Numbers of older prisoners have been increasing in recent years and there is no national strategy addressing their care. Older prisoners have more physical health needs, complex social care needs and high rates of mental disorder compared with younger prisoners. These needs are often not identified or addressed. We developed the Older prisoner Health and Social Care Assessment and Plan (OHSCAP), a structured approach for identifying and managing the health and social care needs of older prisoners. It consists of an assessment, care plan and review of needs. The current study aims to establish the fidelity of implementation of the OHSCAP as part of a larger RCT. Compliance with training and the manual, identification of needs and quality of care planning were all audited. Results showed that the OHSCAP was not implemented as intended. Identified needs were not consistently translated into care plan actions. There was little evidence to suggest prisoner involvement in the care planning process. Clear difficulties in collaborative working were also idenfified. Implications with respect to effectively embedding complex interventions within prisons, along with wider policy related issues affecting the entire prison estate are discussed. [ABSTRACT FROM AUTHOR]

This article explores the capacity for Australian prison libraries to support the 'whole person'. Based on a phenomenological study of the experiences of using prison libraries by Australian adult prisoners, the article identifies three ways that prison libraries can reduce stress, and support positive mental health, and thereby serve the 'whole person' within their user groups. The study finds that prison libraries can support prisoner wellbeing by providing opportunities for autonomy, by acting as therapeutic spaces, and by supporting positive behaviour management. As a phenomenological study, the experiences of the prisoners regarding their libraries serving them as 'whole people' are described in their own words. We can hear the prisoners' voices as they describe how their libraries contribute to their wellbeing. Through a study of prisoners' lived experiences and how these experiences are reflected, or not reflected in the extant literature, it is possible to demonstrate that prison libraries do have the capacity to serve the 'whole person' and thereby support prisoner wellbeing. [ABSTRACT FROM AUTHOR]