A Tale of Two Experiences: Navigating End of Life Care with a History of Incarceration.

Abstract

The adverse health effects of incarceration are well-documented, impacting individuals throughout their life course. However, the influence of a history of incarceration on end-of-life (EOL) experiences remains unexplored. This study aims to examine how prior incarceration affects individuals' experiences and care needs as they approach the end of life. Leveraging the Health and Retirement Study, we conducted secondary analyses on 1,710 individuals who participated between 2012-2018. Through retrospective cohort analysis, we explored the association between incarceration history and EOL care, focusing on pain and symptom burden. Analyses showed that individuals with a history of incarceration experienced significantly higher levels of pain (65% reported "moderate" or "severe" pain) compared to non-incarcerated individuals (50%; AOR = 1.45, 95% CI: 1.22-1.71, p < 0.001). Additionally, the symptom burden index revealed formerly incarcerated individuals had a higher average symptom score (2.8 vs. 2.1; β = 0.7, 95% CI: 0.5-0.9, p < 0.001), indicating a greater range of symptoms in their final year of life. These disparities persisted after adjusting for demographic, health, and socioeconomic variables. This study reveals that a history of incarceration significantly impacts EOL experiences, with formerly incarcerated individuals facing higher levels of pain and a greater symptom burden compared to non-incarcerated individuals. This underscores the need for tailored palliative care to address the unique needs of this vulnerable population. This research highlights a critical area for intervention and calls for healthcare systems to adapt their practices to better serve those with incarceration histories.