Detained and Distressed: Persistent Distressing Symptoms in a Population of Older Jail Inmates (TH360B)

Abstract

•Describe the prevalence of symptomatic distress in a population of older jail inmates, including physical, psychological, existential, and social suffering.•Identify sociodemographic and health factors associated with physically distressing symptoms in this population.•Understand the high prevalence of overlap among physical distress and other forms of distress (psychological, social, and existential) in older jail inmates and its implications for jail-based treatment paradigms. Among older adults, distressing symptoms are associated with decreased function, acute care use, and mortality. However, little is known about distressing symptomatology in the rapidly growing population of older jail inmates. This study describes the prevalence of and factors associated with distressing symptoms in older jail inmates, and examines the overlap between different forms of symptom distress. This descriptive cross-sectional study of 125 jail inmates age 55 or older in the San Francisco County jail examined the following forms of symptom distress: physical (Memorial Symptom Assessment Scale, defined as severe, frequent, and distressing), psychological (anxiety [GAD-2] or depression [PHQ-2]), existential (Patient Dignity Inventory), and social (Three Item Loneliness Scale). Participant sociodemographics, health conditions, functional ability, and behavioral health risk factors were collected using self-report and chart review. We identified factors associated with physical distress using Chi-squared tests, and determined overlap between forms of distress using set theory analysis. Participants had a mean age of 60 (range 55-87 yrs.) and were predominantly black (63%) and of low-income (86% <$15,000/yr). Overall, 100 (80%) participants reported one or more distressing symptoms, including physical (44%), psychological (56%), existential (71%), and social (45%). Factors associated with physical distress included low income, multimorbidity, serious mental illness (SMI), and functional impairment. Many participants experienced multiple forms of distress; of the 100 participants with any distressing symptom, 51% reported 3 or more forms of distress. Nearly all participants with physical distress also reported existential distress (93%). Among older inmates, physical distress was associated with poor health (multimorbidity, functional impairment, SMI) and low income. Overlap between forms of distress was common, particularly physical and existential distress.