Older adults incarcerated in state prison: health and quality of life disparities between age cohorts

Population ageing, incarceration and the growing digital divide: Understanding the effects of digital literacy inequity experienced by older people leaving prison

BACKGROUND

Digital inequity refers to the inequality and exclusion experienced by those who lack the same opportunities or circumstances to support the development of digital skills as the rest of modern society. One rapidly growing and highly vulnerable group to digital inequity is older people attempting to reintegrate into society after release from prison, where technology access is limited. Inadequate support for digital skills in this population entails widespread consequences for public health, human rights, social welfare and recidivism. This qualitative study is the first to: examine digital inequity experienced by older people who have been incarcerated, understand the effects of this on reintegration to society, and begin informing appropriate solutions.

METHOD

Semi-structured interviews were conducted with N = 15 older people (mean age = 57) who had been released from an Australian prison in the last two years, regarding their experiences of digital literacy since leaving prison. Reflexive thematic analysis was conducted under a critical realist lens.

RESULTS

The analysis resulted in six themes that illustrated the extent of digital inequity experienced by this population, and key challenges for improving digital literacy: 'surviving in a digital world', 'stranger in a foreign world', 'questioning the digital divide', 'overcoming your "old" self', 'don't like what you don't know', and 'seeking versus finding help'.

CONCLUSIONS

The digital inequity that older people experience during and after incarceration creates additional challenges for a growing group who are already medically and socially marginalised. Prioritisation of this group for digital literacy initiatives both during incarceration and in the community will have benefits for their health, social and financial reintegration. Their unique life experiences should be considered in designing and delivering these programs. Simultaneously, prisons should be cognizant of the potential detrimental effects of technology restriction on reintegration and criminogenic outcomes.

Depression among incarcerated persons following the death of a loved one: Does social support mitigate grief?

The death of a loved one generates adverse and potentially damaging consequences for surviving family members and friends. The challenges of bereavement can be especially severe when experienced by incarcerated persons who must cope with and grieve the death while incarcerated. Yet, limited research evaluates bereavement among incarcerated persons and whether factors such as social support buffer against health-related consequences. Using data from the LoneStar Project-a study of 802 incarcerated men in Texas-we examine depressive symptoms among currently incarcerated persons with differential exposure to a loved one's death (i.e., immediate family, friends, extended family). Importantly, a high rate of death exists among incarcerated persons' loved ones, with 41% in the sample losing someone on the outside during their final year of incarceration. However, we find that external social support from family and friends and in-prison social cohesion from peers, significantly mitigate the harms of bereavement on depressive symptoms.

Challenging Health Inequities in Incarceration: a Call for Equitable Care for Kidney Disease and Hypertension

PURPOSE OF REVIEW

To review the current literature on care of hypertension and chronic kidney disease for people who are currently and formerly incarcerated, and to make recommendations for improving outcomes.

RECENT FINDINGS

There is a growing body of literature describing care for kidney disease and hypertension for incarcerated and formerly incarcerated individuals that documents the provision of care itself, notably that many jails contract with private companies; the system is not designed to provide sustained, chronic disease care; and the transition from incarceration to community is fraught with gaps in care. However, deficiencies in data collection and regulation still limit our understanding of the quality of care provided in jails and prisons. Furthermore, more data is needed to understand the impact of structural racism in the criminal legal system on overall disparities in care for hypertension and kidney disease. Insurance coverage rates for people who were formerly incarcerated continue to be lower than the general population despite Medicaid expansion in many states. There is little recent data regarding kidney replacement therapy for this population despite known variation in dialysis modalities and transplant programs by state. Transitions clinics, which connect people who were formerly incarcerated with care in the community upon release, are growing and are important avenues by which to deliver care. People who are incarcerated are disproportionately affected by hypertension and kidney disease, yet data regarding the extent of these inequities and availability of quality care is lacking. More work is needed to understand the care of individuals with kidney disease and hypertension in prisons and to improve outcomes for these common chronic conditions. Both providing effective treatment of kidney disease and hypertension in prisons and jails and providing coordinated, quality transition to community care upon release represents an important opportunity for reform in care for a marginalized population.

Devaluing Incarcerated Populations: Deprioritizing Incarcerated Populations for COVID-19 Vaccination

The COVID-19 pandemic has highlighted the need for increased attention to measures in place to protect the health of incarcerated populations. Correctional facilities saw massive COVID-19 outbreaks and correctional nurses have been at the forefront of efforts to control COVID-19 in correctional facilities. Before vaccines were widely available, the National Academies of Science, Engineering, and Medicine developed a framework to guide equitable COVID-19 vaccine allocation. This study assessed the use of the framework by reviewing 15 state COVID-19 vaccination plans to identify how incarcerated populations were prioritized. Thirteen initial plans could be located. Ten of these plans placed incarcerated persons in Phases 1 and 2, while 1 state placed them in Phase 3. However, subsequent versions of the plans revealed that 8 states had deprioritized incarcerated populations by no longer considering them as a unique population. The framework was developed to promote equity, however, incarcerated persons were often dis-included as a high-risk population for vaccine prioritization, prolonging their risk of COVID-19. Engaging in the opportunity to influence both policy and practice, and promote the ethical consideration of incarcerated populations may help to address both the structural (prison) challenges and larger political structures that impacted vaccine availability and ability to provide the best care possible to this high-risk population.

Inequities in the care of older adults: Identifying education gaps in geriatric medicine fellowship

The past year amplified inequities in the care of older adults. Milestones focused on social determinants of health (SDOH) are lacking within Geriatric fellowship training. A virtual learning collaborative GERIAtrics Fellows Learning Online And Together (GERI-A-FLOAT) was developed to connect trainees nationwide. To address gaps in education around SDOH, a needs assessment was conducted to inform a curricular thread. A voluntary, anonymous survey was distributed to fellows through a broad network. We sought to understand prior curricula trainees had that were specifically focused on SDOH and older adults. Respondents prioritized topic areas for the curriculum. Seventy-five respondents completed the survey. More than 50% of participants indicated no training on homelessness, immigration, racism, or LGBTQ+ health at any level of medical training, with more than 70% having no training in sexism or care of formerly incarcerated older adults. The most commonly taught concepts were ableism, ageism, and poverty. Respondents prioritized the topic of racism, ageism, and ableism. There is a lack of consistent SDOH curricula pertaining to older adults across all levels of training. This needs assessment is guiding a curricular thread for GERI-A-FLOAT and ideally larger milestones for fellowships. The time is now to prepare future geriatricians to serve as change agents.

Perceived health status and satisfaction with healthcare services of detained male individuals: a survey in Italy

OBJECTIVES

This study investigated the perceived health status and satisfaction with prison healthcare services of detained male individuals in Italy.

STUDY DESIGN

A cross-sectional study was performed between March and June 2021.

METHODS

Of 800 male detained individuals who were invited to participate in the study, 632 returned the self-administered questionnaire, resulting in a response rate of 79%.

RESULTS

Overall, 72.8% of participants reported that they were moderately or completely satisfied with their health status, and 27.2% stated that they were not at all satisfied. Moreover, 66.2% of participants reported that they had at least one health problem or disease, compared with 34% at the time of incarceration, with 35% reporting multiple health problems/diseases. In total, 10.1% of participants requested healthcare when a health problem occurred, and 12.4% were always satisfied with the healthcare that they received. Significant determinants of dissatisfaction with health status were older age, reported health problems/diseases, suicide attempts, emotional problems and no working activity in prison. Significant determinants of dissatisfaction with healthcare services were younger age, health problems at incarceration, suicide attempts and multiple experiences of incarceration.

CONCLUSIONS

This study shows that detained male individuals have multiple and frequently unmet health needs. Some of the reported health problems or diseases were present at the time of incarceration, but these often worsened and/or increased during detention. This study highlights the need to promote evidence-based intervention to strengthen the role of healthcare services provided in prisons.

The functional health needs of older persons in custody: A rapid review

INTRODUCTION

The number of older persons in custody is increasing and older incarcerated individuals have higher functional healthcare needs and higher healthcare costs. Consideration of available measures and interventions to address functional decline, are therefore imperative given the importance of disability to healthcare spending.

PURPOSE

To identify the existing literature describing the functional health needs of older incarcerated individuals.

METHODS

This rapid review synthesized existing literature on the functional health of older incarcerated individuals. Three electronic databases and two correctional service health-related journals were searched. Bibliographic searches of seminal articles and key authors were conducted for thoroughness.

RESULTS

Fifteen articles were retained in the final analysis. The methods of the included studies were heterogenous. Consideration of basic self-care (activities of daily living) and functional mobility were the primary ways of capturing functional health. The concept of 'Prison ADLs' emerged and measured the unique aspects of correction-specific functional activities.

CONCLUSIONS

This review identified the existing literature on how the functional health of older incarcerated persons is operationalized and measured, and how it is considered within this unique context. The concept of 'Prison ADLs' provides insight into the functional experiences of this population. Additionally, performance across PADLs typically declines before abilities across traditional ADLs.

Age and COVID-19 mortality in the United States: a comparison of the prison and general population

PURPOSE

The USA has a rapidly aging prison population that, combined with their poorer health and living conditions, is at extreme risk for COVID-19. The purpose of this paper is to compare COVID-19 mortality trends in the US prison population and the general population to see how mortality risk changed over the course of the pandemic. The authors first provide a national overview of trends in COVID-19 mortality; then, the authors assess COVID-19 deaths among older populations using more detailed data from one US state.

DESIGN/METHODOLOGY/APPROACH

The authors used multiple publicly available data sets (e.g. Centers for Disease Control and prevention, COVID Prison Project) and indirect and direct standardization to estimate standardized mortality rates covering the period from April 2020 to June 2021 for the US and for the State of Texas.

FINDINGS

While 921 COVID-19-related deaths among people in US prisons were expected as of June 5, 2021, 2,664 were observed, corresponding to a standardized mortality ratio of 2.89 (95%CI 2.78, 3.00). The observed number of COVID-19-related deaths exceeded the expected number of COVID-19-related deaths among people in prison for most of the pandemic, with a substantially widening gap leading to a plateau about four weeks after the COVID-19 vaccine was introduced in the USA. In the state population, the older population in prison is dying at younger ages compared with the general population, with the highest percentage of deaths among people aged 50-64 years.

RESEARCH LIMITATIONS/IMPLICATIONS

People who are incarcerated are dying of COVID-19 at a rate that far outpaces the general population and are dying at younger ages.

ORIGINALITY/VALUE

This descriptive analysis serves as a first step in understanding the dynamic trends in COVID-19 mortality and the association between age and COVID-19 death in US prisons.

Standardized outcome measures of mental health in research with older adults who are incarcerated

PURPOSE

The targeted use of standardized outcome measures (SOMs) of mental health in research with older adults who are incarcerated promotes a common language that enables interdisciplinary dialogue, contributes to the identification of disparities and supports data harmonization and subsequent synthesis. This paper aims to provide researchers with rationale for using "gold-standard" measures used in research with community-dwelling older adults, reporting associated study sample psychometric indexes, and detailing alterations in the approach or measure.

DESIGN/METHODOLOGY/APPROACH

The authors highlight the mental health of older adults who are incarcerated. They also discuss the benefits of SOMs in practice and research and then identify gold-standard measures of mental health used in research with community-dwelling older adults and measures used in research with older adults who are incarcerated. Finally, the authors provide several recommendations related to the use of SOMs of mental health in research with this population.

FINDINGS

Depression, anxiety and post-traumatic stress disorder are common among older adults who are incarcerated. Researchers have used a variety of measures to capture these mental health problems, some parallel to those used with community-dwelling samples. However, a more targeted use of SOMs of mental health in research with this population will contribute to important strides in this burgeoning field.

ORIGINALITY/VALUE

This review offers several practical recommendations related to SOMs of mental health in research with older adults who are incarcerated to contribute to a rigorous evidence base and thus inform practice and potentially improve the health and well-being of this population.

Visitation and quality of life among older adults in jail

PURPOSE

The purpose of this paper aims to examine differences in measures of and relationships between visitation and quality of life (QOL) among older and younger jailed adults. The authors also explored the contribution of visitation to QOL among adults in this setting. The authors anticipated fewer visits and lower QOL among older adults. Framed by psychosocial developmental theory, the authors also anticipated a larger effect in the relationship between visitation and QOL among older rather than younger adults and that visitation would contribute most readily to psychological QOL.

DESIGN/METHODOLOGY/APPROACH

Cross-sectional data from a large US jail were used (n = 264). The authors described the sample regarding visitation and QOL measures among older (≥45) and younger adults (≤44) and examined differences in measures of and relationships between visitation and QOL using independent sample t-tests and bivariate analyses. The authors explored the contribution of visitation to psychological, social relationships, physical and environmental QOL among jailed adults using hierarchical multiple linear regression.

FINDINGS

Older adults had fewer family visits and lower physical QOL than younger adults, disparities were moderate in effect (d range = 0.33-0.35). A significant difference also emerged between groups regarding the visitation and environmental QOL relationship (z = 1.66, p <0.05). Visitation contributed to variation in physical and social relationships QOL among jailed adults (Beta range = 0.19-0.24).

ORIGINALITY/VALUE

Limited research exists among jailed older adults and scholars have yet to examine the relationship between visitation and QOL among persons in these settings.

Prison Population Reductions and COVID-19: A Latent Profile Analysis Synthesizing Recent Evidence From the Texas State Prison System

People in prison are particularly vulnerable to infectious disease due to close living conditions and the lack of protective equipment. As a result, public health professionals and prison administrators seek information to guide best practices and policy recommendations during the COVID-19 pandemic. Using latent profile analysis, we sought to characterize Texas prisons on levels of COVID-19 cases and deaths among incarcerated residents, and COVID-19 cases among prison staff. This observational study was a secondary data analysis of publicly available data from the Texas Department of Criminal Justice (TBDJ) collected from March 1, 2020, until July 24, 2020. This project was completed in collaboration with the COVID Prison Project. We identified relevant profiles from the data: a low-outbreak profile, a high-outbreak profile, and a high-death profile. Additionally, current prison population and level of employee staffing predicted membership in the high-outbreak and high-death profiles when compared with the low-outbreak profile. Housing persons at 85% of prison capacity was associated with lower risk of COVID-19 infection and death. Implementing this 85% standard as an absolute minimum should be prioritized at prisons across the USA.

Prison Unhealthy Lifestyle and Poor Mental Health of Older Persons-A Qualitative Study

Background: Mental healthcare and lifestyle habits in prison, especially for older individuals, has been shown to be suboptimal. Most psychiatric conditions left untreated worsen food choices, physical inactivity, and substance abuse. In turn, bad habits lead to poorer mental health. Methods: To comprehensively illustrate this downward spiraling, we completed a thorough analysis of data obtained through semi-structured qualitative interviews. There were 50 interviews of aging incarcerated people included in this article. They were analyzed following a classical six-stepped thematic analysis. Results: According to our participants, sports are not well-adapted to aging individuals, nor to people with medical conditions. Prison is even more unadapted for those who both are aging and have medical conditions. Also, food served is less than optimal. According to our interviews, the older imprisoned individual often does not have access to food adapted to his or her medical conditions. Sport is maladapted for older incarcerated individuals and mostly tailored for younger ones. Finally, boredom and lack of responsibility hinder change toward a better lifestyle for older adults in prison. Conclusion: Our paper shows why prison environmental modifications are needed to help older adults with their lifestyle habits. It also exposes an original way to see the relationship between mental health and lifestyle habits.