Aging Prison Research Articles

The Perceived Benefits of an Arts Project for Health and Wellbeing of Older Offenders.

The increasing ageing prison population is becoming a pressing issue throughout the criminal justice system. Alongside the rising population, are a host of health and wellbeing issues that contribute to older offenders needs whilst in prison. It has been recommended that meaningful activities can have positive effects on this population and therefore this paper uniquely reviews older offenders accounts of taking part in an arts based project, Good Vibrations, whilst imprisoned. The Good Vibrations project engages individuals in Gamelan music making with an end of project performance. This study used independent in-depth interviews to capture the voices of older offenders who took part in an art based prison project. The interview data was analysed using thematic analysis, which highlighted themes that were consistent with other populations who have taken part in a Good Vibrations project, along with specific age relating issues of mobility, motivation, identity and wellbeing.

Exploring the Association between Race and Health among Older Adults Who Are Incarcerated

One of the little known ironies in the field of prison health is the notion that prison may actually have health-stabilizing effects for some groups. This study contributes to this line of inquiry by examining a variety of physical and mental health indicators among an older cohort of prisoners. Furthermore, this study's focus on race addresses a notable gap in the growing literature on older prisoner health. A cross-section of 625 males who were incarcerated residing in a northeastern state prison system was surveyed and data on self-reported health status and stress and individual demographics characteristics were collected. Univariate and multivariate logistic regressions were used to quantify racial differences with respect to self-reported stress after adjusting for potential confounders. Results suggest that Black men who are older and incarcerated appear to be more resilient than White men who are older. An association was found between race and self-reported stress though not statistically significant. Health status is a significant predictor of self-reported stress in univariate and multivariate analyses. Having ever committed a violent offense and having received mental health services (in and out patient) are statistically associated with self-reported stress. Black men who were older in this study appear to cope better with stress related to incarceration than White men who were older, which may in turn affect other physical and mental health outcomes. Future research is needed to address factors that stabilize health and reduce stress among a racially diverse, aging prison population.

Aging Prisoners' Views on Healthcare Services in Swiss Prisons.

Due to the higher morbidity prevalent in the increasing older population, prisons are facing new challenges on a structural, ethical, and financial level. This study's goal was to explore older prisoners' views and experiences regarding the quality of medical services. In this qualitative study, 35 semi-structured interviews were conducted with older inmates aged 50 years and above in 12 different prisons in the German-speaking (23 interviews) and the French-speaking parts (12 interviews) of Switzerland. The majority of older prisoners in this sample expressed concerns about quality of treatment throughout incarceration. Topics addressed reached from quality of the entrance to routine examinations, quality of the treatment received, and delays in care and services provided. This study's findings suggest that healthcare in prison is often perceived as insufficient and inadequate by older inmates.

Health Self-management Among Older Prisoners: Current Understandings and Directions for Policy, Practice, and Research

ABSTRACTThe population of aging prisoners has increased significantly over the past several decades, resulting in concerns about the criminal justice system’s ability to address the needs of prisoners and parolees with chronic health conditions. This is troubling, given the health disparities among incarcerated populations. Health self-management has become a strategy within the community-based health care industry to improve health services and outcomes while reducing health care costs for nonincarcerated individuals with chronic conditions. However, to date little research has focused on the practice or promotion of health self-management among current and former incarcerated populations. This article highlights current understandings about chronic health self-management among older prisoners and parolees, with an emphasis on the potential benefits and current challenges in promoting their health self-management practices. Finally, specific recommendations are made for promoting health self-management for these populations through social work practice, policy advocacy, and research to achieve goals in improving health outcomes and reducing healthcare costs.

The collision of care and punishment: Ageing prisoners’ view on compassionate release

Most prisoners wish to spend their last days outside prison. Early release of seriously ill and ageing prisoners, commonly termed compassionate release, can be granted based on legal regulations but is rarely successful. The aim of this paper is to present the views of ageing prisoners on compassionate release using qualitative interviews. Participants argued for compassionate release on the grounds of illness and old age, citing respect for human dignity. Their hopes of an early release however often contradicted their actual experiences. Framing these results within Garland’s depiction of the criminology of the self and the criminology of the other, it is evident that in reality, the punitive strategy prevails. This strategy explains the rare use of compassionate release and how it negatively impacts prisoners’ access to end-of-life care. A possible solution is the welfarist criminology, strongly supported by a human rights approach. Awareness of the dominance of the punitive strategy is crucial for medical personnel as they are best placed to ensure access to end-of-life care for prisoners through compassionate release.

Doing Harder Time? The Experiences of an Ageing Male Prison Population in England and Wales

In his seminal text Society of Captives, Gresham Sykes discusses the general pains of imprisonment to which all prisoners are subjected: the deprivation of liberty, the deprivation of heterosexual relationships, and the deprivation of autonomy. Sykes recognised that different prisoners experience these pains differently, and as a result, are affected to a greater or lesser degree by their time inside. In this groundbreaking book, Natalie Mann investigates the idea that apart from the general pains of imprisonment discussed by Sykes, certain characteristics which certain prisoners hold makes them more likely to suffer from what she terms term 'added pains', i.e. the extra difficulties, deprivations and frustrations which exist within certain subsections of the prison population. The ageing prison population is a key example of a group who experience added pains of imprisonment. Their weaker appearance, their old-fashioned views and their less able bodies are all factors which result in them experiencing extra problems within prison. It is these added pains and the ageing men's experiences of them, which this book addresses. Framed within the theoretical perspective of structuration theory, but also drawing on aspects of Goffman's interactionism and Bourdieu's concept of habitus, this book offers a unique interpretation of research carried out with ageing prisoners and their prison officers and shows the reality of prison for those who are reaching the end of their life course.

Aging Prisoners in Switzerland: An analysis of Their Health Care Utilization.

This study assessed health care utilization of aging prisoners and compared it with that of younger prisoners. Health care utilization comprised visits to general practitioners (GPs), nurses, and mental health professionals (MHPs) for a period of 6 months. Using retrospective study design, data were extracted from medical records of 190 older prisoners (50 years and older) and 190 younger inmates (18-49 years). Age group was a dichotomous predictor variable with type of sentencing and time spent in prison as covariates. Descriptive statistics and generalized linear mixed models (GLMMs) were performed. For each of the three outcome variables, two GLMMs were constructed. The first model only included age group as the predictor variable (3 × Unadjusted models). The second included the two covariates in addition to the predictor variable (3 × Adjusted model). Results from the adjusted model indicate that visits to GPs significantly differed between the two age groups (p = .022). Older prisoners visited GPs 1.43 times more often than younger prisoners over the 6-month period (adjusted risk ratio [RR] = 1.43, 95% confidence interval [CI] = [1.05, 1.94]). The finding for visits to nurses was not statistically significant (p = .080). However, older prisoners visited nurses 1.36 times more frequently (adjusted RR = 1.36, 95% CI = [0.96, 1.91]). Finally, older prisoners visited MHPs 1.24 times more often than younger prisoners (adjusted RR = 1.24, 95% CI = [.95, 1.61]) and this finding was also not statistically significant (p = .11). Study findings underline that older prisoners utilized health care more often than younger prisoners although in most models the finding did not reach statistical significance. The prison system must develop solutions to address the needs of an aging population, particularly those with physical and mental health problems.

The association of adverse childhood experiences with mid-life depressive symptoms and quality of life among incarcerated males: exploring multiple mediation

Objectives: To explore the association of experiencing death, trauma, and abuse during childhood with depressive symptoms and quality of life at mid-life among incarcerated men and to understand how current social support and coping strategies mediate the impact of childhood trauma histories on mental health.Methods: Study participants were 192 male inmates in a maximum security prison. Participants completed measures of adverse childhood experiences related to death, trauma, and abuse, and depressive symptoms and quality of life. Data were analyzed using multiple mediation modeling.Results: Men who reported having experienced adverse childhood experiences reported more depressive symptoms and lower quality of life than their counterparts. The results showed that in models both unadjusted and adjusted for age, race, education, number of years served, and whether the inmate had a life sentence, the association between adverse childhood experiences and quality of life were partially explained by the total of the indirect effects (point estimate = −.5052; CI.95 = −1.0364, −.0429 and point estimate = −.7792; CI.95 = −1.6369, −.0381), primarily via social support. However, the associations between adverse childhood experiences and depressive symptoms were not explained by social support and coping.Conclusion: Adverse childhood experiences are associated with deleterious mental health effects in later life. Social support and coping partially mediate the association between adverse childhood experiences and quality of life. The high prevalence of childhood trauma among aging prison inmates warrants attention to increasing social support mechanisms to improve mental health.

Randomized Trial of Group Music Therapy With Chinese Prisoners

This study investigated the effects of group music therapy on improving anxiety, depression, and self-esteem in Chinese prisoners. Two-hundred male prisoners were randomly assigned to music therapy (n = 100) or standard care (n = 100). The music therapy had 20 sessions of group therapy compared with standard care. Anxiety (State and Trait Anxiety Inventory [STAI]), depression (Beck Depression Inventory [BDI]), and self-esteem (Texas Social Behavior Inventory [TSBI], Rosenberg Self-Esteem Inventory [RSI]) were measured by standardized scales at baseline, mid-program, and post-program. Data were analyzed based on the intention to treat principle. Compared with standard care, anxiety and depression in the music therapy condition decreased significantly at mid-test and post-test; self-esteem improved significantly at mid-test (TSBI) and at post-test (TSBI, RSI). Improvements were greater in younger participants (STAI-Trait, RSI) and/or in those with a lower level of education (STAI-State, STAI-Trait). Group music therapy seems to be effective in improving anxiety, depression, and self-esteem and was shown to be most beneficial for prisoners of younger age or with lower education level.

Malign neglect: assessing older women's health care experiences in prison.

The problem of providing mandated medical care has become commonplace as correctional systems in the United States struggle to manage unprecedented increases in its aging prison population. This study explores older incarcerated women's perceptions of prison health care policies and their day-to-day survival experiences. Aggregate data obtained from a sample of 327 older women (mean age = 56) residing in prison facilities in five Southern states were used to identify a baseline of health conditions and needs for this vulnerable group. With an average of 4.2 chronic health conditions, frequently histories of victimization, and high rates of mental health issues, the women's experiences of negotiating health care was particularly challenging. By incorporating the voices of older women, we expose the contradictions, dilemmas, and obstacles they experience in their attempts to obtain health care. It is clear from the personal accounts shared that, despite court mandates, penal harm practices such as delaying or denying medical treatment as well as occasional staff indifferences are common in women's prisons. With older women having the greatest need for health care, an age- and gender-sensitive approach is recommended.

Ageing Prisoners’ Views on Death and Dying: Contemplating End-of-Life in Prison

Rising numbers of ageing prisoners and goals on implementing equivalent health care in prison raise issues surrounding end-of-life care for prisoners. The paucity of research on this topic in Europe means that the needs of older prisoners contemplating death in prison have not been established. To investigate elderly prisoners' attitudes towards death and dying, 35 qualitative interviews with inmates aged 51 to 71 years were conducted in 12 Swiss prisons. About half of the prisoners reported having thought about dying in prison, with some mentioning it in relation with suicidal thoughts and others to disease and old age. Themes identified during data analysis included general thoughts about death and dying, accounts of other prisoners' deaths, availability of end-of-life services, contact with social relations, and wishes to die outside of prison. Study findings are discussed using Allmark's concept of "death without indignities," bringing forth two ethical issues: fostering autonomy and removing barriers. Attributing the identified themes to these two ethical actions clarifies the current needs of ageing prisoners in Switzerland and could be a first step towards the implementation of end-of-life services in correctional systems.

Expert perspectives on Western European prison health services: do ageing prisoners receive equivalent care?

Health care in prison and particularly the health care of older prisoners are increasingly important topics due to the growth of the ageing prisoner population. The aim of this paper is to gain insight into the approaches used in the provision of equivalent health care to ageing prisoners and to confront the intuitive definition of equivalent care and the practical and ethical challenges that have been experienced by individuals working in this field. Forty interviews took place with experts working in the prison setting from three Western European countries to discover their views on prison health care. Experts indicated that the provision of equivalent care in prison is difficult mostly due to four factors: variability of care in different prisons, gatekeeper systems, lack of personnel, and delays in providing access. This lack of equivalence can be fixed by allocating adequate budgets and developing standards for health care in prison.

An examination of prison misconduct among older inmates

One of the consistent research findings is the relationship between age and inmate misconduct. Previous research indicates that as inmates age, they are generally involved in less-deviant behavior and less-violent behavior, thus showing an inverse relationship between age and inmate deviant behavior. However, most of the previous studies examining age focused attention on comparing young offenders with middle-age offenders. The unique challenges faced by older inmates may complicate adjustment as these offenders struggle to fit into facilities that were not designed to house older offenders. Using data from the Survey of Inmates in State Correctional Facilities, we examine the types of violations committed by older versus younger inmates. The findings suggest that there are important differences in the factors associated with misconduct for older inmates as compared to younger prisoners and point to the need to further explore how to best manage the aging prisoner population.

Bridging community and prison for older adults: invoking human rights and elder and intergenerational family justice.

Older adults in prison present a significant health and human rights challenge for the criminal justice system. To date, there is no known study that provides a comprehensive examination or portrait of older persons in prison. The purpose of this paper is to understand individual, family, system, and community vulnerabilities that can complicate successful community reintegration for these individuals. This study provides a cross-sectional, descriptive analysis of biopsychosocial, spiritual, and prison use characteristics associated with a sample of 677 older prisoners, aged 50+, in a state-wide prison system. Results indicate the extent of diversity within this population based on demographic, clinical, social, legal profiles, prison service use patterns, and professional and personal contacts. Due to the diversity within this population, an interdisciplinary approach is needed to address the complex social and health care needs of an aging prison population and to plan for their reentry. Practical implications - These findings suggest the need for holistic prevention, assessment, and interventions to interrupt the social-structural disparities that foster and support pathways to incarceration and recidivism. The human rights implications for the current treatment of older adults in prison include providing in-prison treatment that promotes safety, well-being, reconciliation, and seamless bridges between prison and community for older adults and their families. The True Grit Program is presented as an example of a humanistic and holistic approach of such an approach.

Inside grey walls: unprepared for an aging inmate population

Inadequate infrastructure and health care to support aging prisoners is an emerging problem in federal penitentiaries, says the Office of the Correctional Investigator of Canada. An Investigation of the Correctional Service of Canada’s Mortality Review Process recently issued by Howard Sapers

Health Literacy

Recent research literature indicates that African Americans (AA) generally execute advance directives to a much lower degree than do non-Hispanic Euro-American adults. The purpose of this research study was to investigate the degree to which social and demographic variables are associated with knowledge of advance directives among AA aging prisoners. A combined sample (N=100) of AA Aging Prisoners generated from three randomly selected sub-samples were collected from three of five state correctional facilities in a Mid-Atlantic Region in the United States. Each prisoner completed the Jordan Advance Directive Measurement Scale©. Three categorical groups emerged from the combined sample. Those groups were based on the Health Status question regarding knowledge of advance directives Null hypotheses were tested and data were analyzed using Pearson’s Chi-Square Test of Independence. There was no significant degree of independence between any of the three pairs of sub-groups. The researchers informally discovered the prisoners’ lack of basic knowledge of advance directives.

Aging Prisoners: A Brief Report of Key Legal and Policy Dilemmas

Background: The social phenomenon of the aging of the prison population has raised various legal and policy challenges. Objective: The goal of this brief report is to describe the current key legal-policy dilemmas in this field. Methods: A computerized search for legal documents, articles and studies using relevant key words was conducted in computerized databases. Results: Five key dilemmas were found: (1) Early and compassionate release of older prisoners; (2) Segregation or integration of older prisoners; (3) Heaven or hell? The meaning of imprisonment in old age; (4) Fixed v. tailored sentences to older offenders; and (5) Is prison the right place to send older offenders? Conclusion: Evidence regarding the unique socio-medical needs of older prisoners does not provide easy or simple answers to the legal-policy dilemmas in this field. Hence, as of today, the scholarly discussions in this field seem to be more normative (what "should" be the solution) rather than empirical (what "is" the evidence-based solution). Therefore, more empirical evidence is needed in order to design old-age based legal-policies towards older prisoners.

Sentencing outcomes of the older prison population: an exploration of the age leniency argument

Using data compiled by the United States Sentencing Commission, we examine whether defendants sentenced in US federal courts are shown leniency based on their age, paying particular attention to the outcomes of older defendants (age 50 and over). One way in which this research is unique is that it focuses exclusively on a sample of older offenders and makes more precise distinctions by separately examining three categories of ‘elderly’ offenders – the ‘young-old,’ the ‘middle-old,’ and the ‘oldest-old.’ Consistent with prior research, our findings indicate an age leniency effect where younger defendants (the ‘young-old’) had the highest odds and older defendants (the ‘oldest-old’) had the lowest odds of incarceration. However, contrary to expectations, this finding does not hold for the sentence length decision. Legal factors (criminal history, number of counts, going to trial) also played a large role in increasing the likelihood and length of their sentence outcomes. In addition, variations were found across different types of offense categories. The findings in this study point to the importance of making clearer distinctions between the ‘elderly’ offender populations and suggest that findings may be masked if differences between the ‘young-old’ and the ‘old-old’ are not considered. Our results indicate the need for continued exploration of issues dealing specifically with the aging prison population, as well as the examination of policies and practices that impact offenders of all ages.

The Case for Human Agency, Well-Being, and Community Reintegration for People Aging in Prison

This study profiled 2,913 adults aged 50 and older sentenced to a statewide correctional system and their parole eligibility status with implications for community reintegration, resettlement, and recovery needs. The research team developed the Correctional Tracking Data Extraction Tool to gather official data and personal and legal characteristics from a state department of corrections website. The majority of older prisoners were men from racial/ethnic minorities between the ages of 50 and 59 with a range of minor to serious offenses. Time served in prison ranged from 1 month to 45 years; more than 40% were eligible for parole within 5 years. These findings underscore the need for an intervention that can address the differing typologies and individual-level and systemic issues that gave rise to the aging prisoner population. Promising practices that address elements of a conceptual model in prison and community reintegration and recovery for older adult prisoners are reviewed.

Ageing Prisoners' Health Care: Analysing the Legal Settings in Europe and the United States

Background: Relatively little is known about the current health care situation and the legal rights of ageing prisoners worldwide. To date, only a few studies have investigated their rights to health care. However, elderly prisoners need special attention. Objective: The aim of this article is to critically review the health care situation of older prisoners by analysing the relevant national and international legal frameworks with a particular focus on Switzerland, England and Wales, and the United States (US). Methods: Publications on legal frameworks were searched using Web of Science, PubMed, MEDLINE, HeinOnline, and the National Criminal Justice Reference Service. Searches utilizing combinations of keywords relating to ageing prisoners were performed. Relevant reports and policy documents were obtained in order to understand the legal settings in Switzerland, England and Wales, and the US. All articles, reports, and policy documents published in English and German between 1774 to June 2012 were included for analysis. Using a comparative approach, an outline was completed to distinguish positive policies in this area. Regulatory approaches were investigated through evaluations of soft laws applicable in Europe and US Supreme Court judgements. Results: Even though several documents could be interpreted as guaranteeing adequate health care for ageing prisoners, there is no specific regulation that addresses this issue completely. The Vienna International Plan of Action on Ageing contributes the most by providing an in-depth analysis of the health care needs of older persons. Still, critical analysis of retrieved documents reveals the lack of specific legislation regarding the health care for ageing prisoners. Conclusion: No consistent regulation delineates the provision of health care for ageing prisoners. Neither national nor international institutions have enforceable laws that secure the precarious situation of older adults in prisons. To initiate a change, this work presents critical issues that must be addressed to protect the right to health care and well-being of ageing prisoners. Additionally, it is important to design legal structures and guidelines which acknowledge and accommodate the needs of ageing prisoners.