Older Prisoners Research Articles

A systematic integrative review of programmes addressing the social care needs of older prisoners

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.

An Examination of Mental Health and Psychiatric Care among Older Prisoners in the United States

ABSTRACTDespite that prisons in the United States (and other high-income countries) have witnessed an increase in the proportion of older inmates, and that prison populations exhibit high rates of psychiatric illness, there is limited knowledge on the nature of older inmates’ psychological health and use/provision of psychiatric care. The present study addresses these gaps, analyzing a nationally representative sample of 1,907 male and female older inmates (age range = 50–84 years; M = 56) housed in U.S. state and federal prisons. The results highlight: (a) the prevalence of psychological issues among older prisoners; (b) factors associated with certain mental disorders and symptoms of mental health issues; (c) the prevalence of psychiatric treatment before and during imprisonment for those with (and without) reported psychological health issues; (d) similarities and differences between male and female older inmates in relation to psychological health, factors associated with psychological issues, and the use/provision of psychiatric care. Discussion points toward recommendations for managing inmate mental health, as well as direction for further research on older inmate mental health and psychiatric care.

The Quality of Life Perception Gap in Prison Health Care Settings: Rater Disparities among Incarcerated Patients and Peer Caregivers

Peer caregivers are specially-trained incarcerated persons who support the needs of patients in correctional health care settings. Their role is of particular importance in light of the growing population of older adult prisoners with complex health problems in U.S. prisons. The purpose of the current study was to examine the disparity between patient and peer caregiver ratings of patient quality of life (QoL) in a sample of correctional health dyads (n = 52) in a state prison system. The current study also aimed to identify which patient and caregiver characteristics were most closely associated with emerging disparities. The sample and measures were described using frequencies and descriptive statistics. Patient QoL was measured using the McGill Quality of Life Scale-Cardiff Short Form and rater disparity was calculated at the individual- and group-level. Potential correlates were identified using bivariate statistics. Main results indicate group-level disparities were smallest among psychological and physical QoL (d = .06), and largest regarding existential QoL (d = .22). Few bivariate relationships were meaningful in effect, though patient characteristics accounted for 79% of emerging associations (viz. primary diagnosis). Though disparities emerged, peer caregivers in correctional health settings have unique strengths regarding assessment of patient QoL. Implications related to reducing dyadic disparities and targeting caregiver training regarding the importance of patient existential QoL are discussed.

Health-care needs of older women prisoners: Perspectives of the health-care workers who care for them

ABSTRACTThe proportion of older incarcerated women is growing, yet little is known regarding their health-care needs. Using focus group methodology, this study sought to elucidate the unique health-care needs of older women prisoners through the perspectives of correctional health-care providers. Three organizing themes emerged regarding the health of older women prisoners: (a) the meaning of being “older” in the prison setting; (b) challenges impacting correctional health-care workers’ care delivery; and (c) unmet health-care-related needs. Correctional health-care workers’ insights can provide guidance regarding how to optimize the health of the increasing population of older women prisoners.

Older adults’ lived experience of incarceration

This qualitative analysis explores older adults’ lived experiences of incarceration. As part of a larger mixed-methods longitudinal study, 23 older adults were interviewed about their prison and reentry experiences. Findings describe experiences of loss, lack of medical attention, abuse by staff and other inmates, and the uncertainties and danger of prison life. After release, participants reported experiencing anxiety and stress related to their prison experiences. While participants reported that the ability to manage prison life deteriorated with age, some benefits of their senior status were also described. Maturity may allow older prisoners to remove themselves from volatile situations. Participants described experiences of rest and recovery, reflecting coping mechanism and resilience that could improve psychosocial outcomes during and after prison. This descriptive analysis centers the voices of older prisoners and informs interventions to support this vulnerable community.

GERIATRIC DEPRESSION AND COPING STRATEGIES OF PENALIZED OLDER ADULTS

The older adult prisoners are the most vulnerable to the pressures and the harsh conditions in the prison environment which may be deteriorating and compromising both to their physical and mental health conditions. We have turned our attention towards this research to learn about both physical and psychological status of the older adult prisoners. Using a descriptive design, we gathered data through face-to-face interview using the questionnaires: Geriatric Depression Scale Short Form and Coping Strategies Inventory. The researchers also assessed the physical condition through review of systems. Results revealed that there are physical issues experienced by the older prisoners which are common in old age. There is mild to severe depression among 80% of the participants. Despite the remarkable physical and mental situations, they are in, there are several positive coping strategies used by the older prisoners in dealing with their everyday challenges inside prison. Nursing as a profession are non-selective and non-discriminatory in caring even to these neglected yet vulnerable group. The results of the study may be utilized in understanding the current situation of this sector to provide appropriate interventions and strategies catering to their needs in health and well-being

Suicide in Older Prisoners in Germany.

As in many countries, the numbers of older prisoners are rising in Germany, but scientific information on this group is scarce. For the current study, a survey was used that included all prison suicides in Germany between the years of 2000 and 2013. Suicide rates of the elderly prisoners exceeded the suicide rates of the general population and the same age group. We observed a continuous decrease in the suicide rate of elderly prisoners. When compared to the younger suicide victims in prison, significantly more elderly suicide victims were: female, of German nationality, remand prisoners, or serving a life sentence. In Germany, elderly prisoners are a vulnerable subpopulation of the prison population. Higher suicide rates than in the same age group in the general population indicate unmet needs regarding mental disorders and their specific treatment.

Polypharmacy and drug-drug interactions among older and younger male prisoners in Switzerland.

The purpose of this paper is to determine the prevalence of polypharmacy and drug-drug interactions (DDIs) in older and younger prisoners, and compared if age group is associated with risks of polypharmacy and DDIs. For 380 prisoners from Switzerland (190 were 49 years and younger; 190 were 50 years and older), data concerning their medication use were gathered. MediQ identified if interactions of two or more substances could lead to potentially adverse DDI. Data were analysed using descriptive statistics and generalised linear mixed models. On average, older prisoners took 3.8 medications, while younger prisoners took 2.1 medications. Number of medications taken on one reference day was higher by a factor of 2.4 for older prisoners when compared to younger prisoners (p = 0.002). The odds of polypharmacy was significantly higher for older than for younger prisoners (>=5 medications: odds ratio = 5.52, p = 0.035). Age group analysis indicated that for potentially adverse DDI there was no significant difference (odds ratio = 0.94; p = 0.879). However, when controlling for the number of medication, the risk of adverse DDI was higher in younger than older prisoners, but the result was not significant. Older prisoners are at a higher risk of polypharmacy but their risk for potentially adverse DDI is not significantly different from that of younger prisoners. Special clinical attention must be given to older prisoners who are at risk for polypharmacy. Careful medication management is also important for younger prisoners who are at risk of very complex drug therapies.

Changes in subjective wellbeing of prisoners on remand.

Low levels of subjective wellbeing in prisoners may relate to mental health problems and difficulties in reintegration after imprisonment. The development of subjective wellbeing during imprisonment is mostly unclear. The purpose of this paper is to explore this development in a longitudinal study in association with mental disorders and socioeconomic factors. Subjective wellbeing was assessed via a visual analogue scale and retrieved at admission to remand prison and then again after four and eight weeks. Changes in subjective wellbeing between time-points were analyzed taking into account mental disorders and socioeconomic factors, which were assessed by use of the Mini International Neuropsychiatric Interview - Plus and the Camberwell Assessment of Need - Forensic Version, respectively. On average, subjective wellbeing declined directly after remand prison admission, but differences between individuals were found. At remand prison admission, subjective wellbeing significantly improved rather than declined in prisoners with alcohol and substance use disorders, housing problems, unemployment prior to incarceration and in relatively older prisoners. Other related factors did not add significance to this model. In contrast, during remand imprisonment subjective wellbeing displayed an overall increase. For this increase, no predicting factors were found. However, prisoners with an antisocial personality disorder are more at risk of experiencing a decrease in wellbeing during remand imprisonment. In general, the Dutch prison system appears not to result in a decrease in subjective wellbeing in prisoners suffering from a mental disorder during remand imprisonment.

L’effet de l’âge et de la durée d’incarcération sur la santé mentale des détenus âgés

Inmate aging is considered to start at the age of 50, which is early in relation to aging in the general population. The aging of the criminal population in France poses a real public health problem. There is very little research on the mental health (mental and cognitive disorders) of older inmates. ObjectivesThe objective of this study was to evaluate the effect of age and time spent in prison on mental disorders and cognitive performance of elderly prison inmates. We put forward the hypothesis that age and amount of time spent in prison are associated with the deterioration of older inmates’ mental health, that is, an increase in the prevalence of psychiatric disorders and a decrease in cognitive performance. MethodsWe recruited 138 men aged 50 and over in seven French prisons. The research protocol included a semi-directive interview, the Mini International Neuropsychiatric Interview (MINI DSM-IV) for the assessment of mental disorders, as well as the Rapid Battery for Frontal Efficiency (BREF) and the Mini Mental State Examination (MMSE) for the evaluation of cognitive performance. ResultsThe average age of the inmates (N=138) was 59.7 years (range 50–84, SD=8.02). The average sentence was approximately 13.5 years (SD=7) and the average time spent in prison was 6.9 years (SD=5.9). The results showed a very high prevalence of mental disorders, notably depression and anxiety, and cognitive disorders. However, the probability of occurrence of certain psychiatric diagnoses decreases with age (major depressive episode, agoraphobia, post-traumatic stress disorder and generalized anxiety). In addition, logistic regression estimates showed no significant relationship between time spent in prison and mental disorders. However, there is a significant link between time spent in prison and cognitive impairment. ConclusionOur hypothesis is partially validated. Indeed, age is not associated with mental or cognitive disorders. However, the amount of time spent in prison has an effect on the deterioration of certain cognitive functions. It appears that after the age of 50, it is not chronological age but environmental factors that mainly explain cognitive decline. Our study shows that the longer the detention period, the greater the inmate's cognitive decline. These results highlight the very high vulnerability of elderly prisoners in terms of mental health and emphasize the importance of implementing appropriate detection and care measures to address the needs of this segment of the criminal population. Routine screening for cognitive impairment in all older prisoners should be carried out by caregivers in penitentiary institutions. Furthermore, better follow-up and cognitive assessment of prisoners aged 50 or more and whose length of incarceration exceeds five years could make it possible to detect subjects at risk and to propose appropriate activities to reduce and/or delay the effects of aging in detention.

Mental health, positive affectivity and wellbeing in prison: a comparative study between young and older prisoners

To explore sociodemographic, psychological and psychopathological characteristics, as well as to evaluate the behaviour in an inmate sample. There is a total sample of 182 young and elderly inmates of the Madrid III Prison. The investigation has been carried out with a battery of self-report psychological questionnaires and objective measurements obtained through the prison files. Comparisons of means were made to see if there are significant differences between the two groups (young and elderly inmates) in the variables analysed. The analysis shows that there are no significant differences in wellbeing between young and elderly inmates. However, young people have higher levels of psychological distress, more presence of negative emotions and have a more maladjusted behaviour in prison (they consume more cannabis and have more disciplinary records). Older people better regulate their emotions, adopt better the perspectives of others, showing themselves to be friendlier. The elderly inmates in prison, compared with the youngest, have a better psychological adjustment, more internal resources and a better adaptation to the prison environment despite of no differences in related variables such as time in prison.

Substance use and other mental health disorders among older prisoners

The goal of this study is to explore the status quo of mental health and substance use problems among older prisoners. Our review presents the prevalence as well as co-occurrence of substance use and other mental health disorders in older prisoners. We conducted a systematic review of literature following the PRISMA statement. The search was carried out in four databases and supplemented with manual screenings of bibliographies from all retrieved articles. Publications were included if they met specific inclusion criteria. A total of 17 articles were included and in half of them, older offenders were the main study population. Older inmates have higher prevalence of mental health disorders than younger prisoners and are more likely to use alcohol. Several studies mentioned an association between substance use and other mental health disorders. Access to treatment was a concern with several studies providing recommendations to improve this. Most studies were done on older male prisoners, confirming that older female prisoners constitute a subgroup of a subgroup which is even more vulnerable and under-researched. It is important to carry out more research on both older male and female prisoners to ensure optimal delivery of appropriate mental health care for older prisoners and to prepare for a currently younger population that will age with different and distinct mental health problems and substance use patterns.

The impact of dementia in the prison setting: A systematic review.

Older prisoners are the fastest growing group in the prison population, with an accelerated aging process they are at a high risk of developing dementia. However, no systematic review has explored the impact of dementia in the prison setting. The objectives of this review were to identify the prevalence of dementia in the prison setting and how prison, health and social care providers assess, diagnose, treat, support and care for prisoners with dementia. A systematic search of the literature from the following databases was undertaken: CINHAL, PubMed, BNI, PsychINFO, and MEDLINE. Search strategies were tailored for each database and included recognised Medical Subject Headings. Hand searching of prominent journals in correctional services and dementia, as well as reference lists of included papers was completed. Open Grey website was searched to identify relevant government, local council and charity publications regarding dementia in the prison setting. The appropriate Critical Appraisal Skills Programmes Checklist for all included studies was completed. Following the application of inclusion and exclusion criteria, 10 studies were included in the review. Due to the nature of the data extracted, a meta-synthesis was not possible; therefore, a thematic synthesis was completed. Three themes emerged: prevalence of dementia in the prison population, identification of older prisoner's needs, and knowledge of correctional officers and legal professionals. The prevalence and incidence of dementia in prison populations remain largely unknown. There is a need for national policies and local strategies that support a multi-disciplinary approach to early detection, screening and diagnosis of cognitive impairment and dementia across prison settings. Alongside the development of structured prison environments, non-pharmacological interventions, continued assessment of prisoners with a dynamic care plan, and training for health, social and prison staff and prisoners.

Improving the Health of Older Prisoners: Nutrition and Exercise in Correctional Institutions.

This qualitative article presents and compares the views of older prisoners and expert stakeholders on the topic of nutrition and exercise. The study highlights measures for improving the health of older prisoners. Older prisoners report the need to improve quality of meals provided in prison. They note that prison food is of poor quality and not adapted to their needs. With regard to exercise, they point out the lack of proper opportunities to engage in exercise and sports, and describe several factors that make physical activities either unsuitable or unfeasible. Expert stakeholders see prison as an opportunity to improve the health of those convicted of crimes. In light of the increasing number of older prisoners, age-appropriate nutritional and exercise interventions should take priority in prisons.

AVOIDING THE RUNAROUND: THE LINK BETWEEN CULTURAL HEALTH CAPITAL AND HEALTH MANAGEMENT AMONG OLDER PRISONERS*

AbstractThe link between incarceration and health is of emerging empirical interest to criminological scholars. Yet, we still know little about the needs of the rising population of older prisoners and the health issues they face. By drawing on qualitative data gathered from 193 interviews with older men incarcerated across three U.S. prisons, I examine the specific health promotion strategies available to, and used by, these men through a cultural health capital framework. Findings show that older prisoners make deliberate choices to protect their health from the constraints and deprivations inherent in their carceral lives. In the hopes of better managing chronic and acute disease, the strategies prisoners reference include acquiring medical information, making food and diet modifications, and health advocacy. Notably, the mobilization of cultural health capital is situated within a context of privilege, leaving important implications for both incarcerated individuals and correctional administrators.

Ageing and dying in the contemporary neoliberal prison system: Exploring the ‘double burden’ for older prisoners

Prison populations across the world are increasing. In the United Kingdom, numbers have doubled in the last two decades, and older prisoners now constitute the fastest growing section of the prison population. One key reason for this shifting prisoner demographic is the growing numbers of men convicted of ‘historic’ sexual offences, many of whom are imprisoned for the first time in old age, and housed in prisons not suited to their needs. These demographic changes have profound consequences, including increased demand for health and social care in prison, and rising numbers of anticipated deaths in custody.Using the findings from a recently completed study of palliative care in prison, this paper proposes that older prisoners face a ‘double burden’ when incarcerated. This double burden means that as well as being deprived of their liberty, older people experience additional suffering by not having their health and wellbeing needs met. For some, this double burden includes a ‘de facto life sentence’, whereby because of their advanced age and the likelihood that they will die in prison, they effectively receive a life sentence for a crime that would not normally carry a life sentence. There has been little popular or academic debate concerning the ethical and justice questions that this double burden raises.Drawing on the work of Wacquant and others, the paper proposes that these changes are best understood as unplanned but reasonably foreseeable consequences of neoliberal penal policies. Although the paper focuses on the UK (which by comparison with other European countries has high rates of imprisonment), many of the challenges discussed are emerging in other countries across the world. This paper illustrates starkly how neoliberal policies and discourses have shaped the expansion and composition of the prison population with its consequent implications for health and justice.

A grounded theory of successful aging among select incarcerated older Filipino women

BackgroundAcross the literature, impairment and disability among the older people have been associated with a decline in meeting their special needs. Failure in meeting such needs may cause deterioration of function and threaten successful aging. Accordingly, successful aging studies were carried out among males, in health care institutions, and in communities. In spite of these, the process by which successful aging is experienced by incarcerated older women remains to be a blank spot in research. AimThis study purports to describe the process by which incarcerated older Filipino women experience successful aging. MethodsStrauss and Corbin's grounded theory design was employed. Semistructured interviews were conducted among 15 purposively selected incarcerated older Filipino from a Philippine penal institution exclusive for women. Further, data gathered was reduced to field text and was analyzed through open, axial and selective coding. Finally, truthfulness and trustworthiness of the findings were established through member checking. FindingsThe study generated “The Road to Success Model”. Interestingly, five phases relative to successful aging emerged, namely: Struggling, Remotivating, Reforming, Reintegrating and Sustaining. These phases describe how select incarcerated older Filipino women undergo transformation towards successful aging. Similar to a road, each phase is considered a station where one must pass through in order to get to the destination. ConclusionFindings of the study serve as an impetus for structural and procedural changes in prison, with a view to providing an environment conducive to successful aging and appropriate recognition to the older prisoner's efforts to achieve successful aging.

Cardiovascular Disease Risk Factors among Older Prisoners in the Ashanti Region of Ghana

Cardiovascular Disease Risk Factors among Older Prisoners in the Ashanti Region of Ghana

Systematic review of aged care interventions for older prisoners.

The care of older prisoners is a growing problem. This review examined aged care interventions in prisons. A systematic review was conducted following preferred reporting items for systematic reviews and meta-analyses guidelines. A total of 1186 abstracts were screened for inclusion. Quantitative and qualitative studies were included. Two quantitative studies and five qualitative studies examined aged care interventions (n = 7). An intervention involving physical health activities was not effective in reducing distress compared to a control, and an intervention of psychosocial, physical and spiritual health activities for veterans was not effective when compared to a comparison group. Qualitative analysis generated themes that apply to best practices: addressing older prisoners' needs, identifying barriers for older prisoners and staff, considering the prison culture, program delivery and cultivating older prisoners and staff attitudes. This review found no significant interventions in prisons. However, the qualitative findings showed evidence of best practice.

The effectiveness of the Older prisoner Health and Social Care Assessment and Plan (OHSCAP): a randomised controlled trial

Background Older people are the fastest-growing group in prisons in England and Wales and have complex health and social care needs that often remain unmet. Objectives (1) Evaluate the efficacy of the Older prisoner Health and Social Care Assessment and Plan (OHSCAP) in improving (i) the ability to meet older male prisoners’ health and social care needs, (ii) health-related quality of life (HRQoL), (iii) depressive symptoms and (iv) functional health and well-being and activities of daily living; (2) assess the quality of care plans produced; (3) explore the experiences of older prisoners receiving, and staff conducting, the OHSCAP; and (4) evaluate the cost-effectiveness of the OHSCAP compared with treatment as usual (TAU). Design Multicentre, parallel-group randomised controlled trial (RCT) with follow-up at 3 months, with a nested qualitative study and quality audit of care plans (n = 150, 68%). Setting Ten English prisons. Participants Four hundred and ninety-seven newly arrived male prisoners aged ≥ 50 years with a discharge date at least 3 months from recruitment. A total of 14 prisoners and 11 staff participated in qualitative interviews. Intervention Randomisation to OHSCAP or TAU. The OHSCAP group had health and social needs assessed by a trained health-care worker or prison officer. Care plans were devised and subsequent actions included professional support and appropriate referrals. Main outcome measures Primary outcome measure – mean number of unmet health and social care needs as measured by the Camberwell Assessment of Need – Short Forensic Version. Secondary outcome measures – measures of functional health and well-being, depressive symptoms and HRQoL. A health economic evaluation was undertaken using service contact between baseline and follow-up and appropriate unit cost information. Results A total of 497 prisoners were recruited (248 to OHSCAP and 249 to TAU). The 404 completed follow-ups were split evenly between the trial arms. No significant differences were observed between the intervention and TAU groups in relation to the primary outcome measure. The OHSCAP did not demonstrate convincing benefits in HRQoL over TAU, and there were no significant differences in relation to costs. Audit and qualitative data suggest that the intervention was not implemented as planned. Limitations As a result of the limited follow-up period, potential long-term gains of the intervention were not measured. Some of the standardised tools had limited applicability in prison settings. Cost-effectiveness data were limited by unavailability of relevant unit cost data. Conclusions The OHSCAP failed in its primary objective but, fundamentally, was not implemented as planned. This appears to have been attributable, in some part, to wider difficulties currently affecting the prison landscape, including reduced levels of staffing, the loss of specialist support roles for such initiatives and increased prevalence of regime disruption. Future work Partnership working and information sharing across disciplines within prison settings require improvement. Research should explore the potential involvement of other prisoners and third-sector organisations in identifying and addressing older prisoners’ health and social care needs to better match community provision. Further examination should be undertaken of how the prison regime and system affects the well-being of older prisoners. Future prison-based RCTs should carefully balance the fidelity of initiatives being evaluated and testing in a ‘real-life’ setting. Trial registration Current Controlled Trials ISRCTN11841493. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 5, No. 31. See the NIHR Journals Library website for further project information.