Abstract
BackgroundThe 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.MethodsFollowing 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.ResultsA 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.ConclusionsThe 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.
Highlights
The number of older prisoners has risen exponentially over the last two decades, especially in highincome countries
Given the scarcity of research in this area, a brief pilot search was conducted upon which it was decided to employ a systematic integrative review methodology. This method offered the flexibility needed to incorporate a wide variety of study methodologies and provided a systematic approach to conducting the literature review, enabling us to meet the aims of the research. This particular integrative review primarily used an adapted version of Whittemore and Knafl’s (2005) approach, with reporting informed by PRISMA systematic review guidelines and checklist (Moher et al, 2009) - see Additional file 1 for the completed PRISMA 2009 checklist for this review
Twenty-nine papers were considered to meet the criteria for inclusion in this review, and Fig. 1 depicts the stages of the screening process undertaken to reach this selection in PRISMA format: Table 2 gives an overview of the included papers, categorised according to programme type: prison hospices, structured programmes, personal care-focused programmes, and regime and accommodation adaptations
Summary
The number of older prisoners has risen exponentially over the last two decades, especially in highincome countries. Concerns have been expressed about the spiralling costs of imprisoning large numbers of older people These are estimated to be three times that of younger prisoners largely due to increased health and social care needs (Bedard, Metzger, & Williams, 2016; Senior et al, 2013), reportedly affecting around 85–90% of prisoners over the age of 50 (Di Lorito, Völlm & Dening, 2018; Hayes, Burns, Turnbull, & Shaw, 2012; Senior et al, 2013). The provision of prison social care has been described in even more parlous terms, with infrequent to non-existent social care contact for prisoners, exacerbated by unclear lines of responsibility (Justice Committee, 2013; Pettus-Davis, 2012; Scheyett, Pettus-Davis, McCarter, & Brigham, 2012; Scottish Prison Service, 2017)
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