Estimating the Prevalence of Dementia in a sample of Australian Prisoners: The Cohort Study Design, Results and Implications for Public Health and Prison Sectors

Abstract

AbstractBackgroundThe number of older prisoners within our prison system is increasing. The health challenges faced by prisoners in general contribute to prisoners being considered ‘old’ within the prison system once they reach the age of 50. The prison lifestyle, combined with the risk factor profiles of those incarcerated (higher rates of low educational attainment, smoking, substance use, head injury, psychiatric illness, unmet chronic health needs) suggests that older prisoners are likely to be at significantly higher risk of developing dementia than those of similar ages in the general population.Surprisingly, however, we know very little about the prevalence of dementia within prison systems both internationally and locally, with no Australian data being available. This study aimed to estimate the prevalence of dementia among older prisoners within prisons in Victoria, Australia. Cognitive screening was conducted on a large sample of older prisoners housed within 3 correctional facilities in Victoria, such that the overall prevalence of dementia within this vulnerable group could be ascertained, as a first step towards appropriate service planning.MethodDementia assessments of over 100 prisoners aged over 50 years, were conducted across three prison sites in Victoria, Australia. Each assessment included a demographic interview to capture the presence of risk factors and an Addenbrooke’s Cognitive Examination 3rd edition. All assessment data were reviewed by a psychogeriatrician for quality and to identify false positive dementia screens.ResultThe total sample of prisoners 114 reported higher rates of risk factors than those seen in the general population. Conservative dementia prevalence rates based on psychogeriatrician review of self‐reported medical history and patterns of responding on the ACE‐III suggest that dementia is more prevalent in prison populations than in the Australian general population. The overall sample of 95 included assessments suggested prisoners were up to eight times more likely to have dementia than population estimates of 1.1%.ConclusionDementia is likely to be more prevalent in prison systems due to increased risk factors profiles. This poses a significant challenge for corrective services as the ageing prisoner population continues to increase. This study provides rationale for review of planning and service provision to older prisoners.