The healthcare of older inmates in the correctional setting

Best care options for older prisoners with dementia: a scoping review

INTRODUCTION

The prisoner population is ageing, and consideration is needed for how to best support those with age-related health conditions in the system. Existing work practices and organizational structures often fail to meet the needs of prisoners with dementia, and prison staff experience high levels of burden because of the increased needs of these prisoners. Little is known about the best method of responding to the needs of this growing subpopulation of prisoners.

METHOD

A scoping review was conducted to answer the question: what are the perceived best care options for prisoners with dementia? To be included, publications had to be publicly available, reported on research findings, or viewed opinions and commentaries on care practices relevant to older prisoners with dementia. Searches were conducted in 11 databases to identify relevant publications. Data from the included publications were extracted and summarized into themes.

RESULTS

Eight themes were identified that could support better care practices for prisoners with dementia: (1) early and ongoing screening for older prisoners; (2) specialized services; (3) specialized units; (4) programs or activities; (5) adaptations to current contexts; (6) early release or parole for older prisoners with dementia deemed at low risk of reoffending; and (7) training younger prisoners (8) as well as staff to assist older prisoners with dementia. Besides practical strategies improving care practice, costs, prison-specific resources, and staff skills were highlighted as care barriers across all themes. A lack of empirical evidence supported these findings.

CONCLUSION

One of the implications of the international ageing prison population is the higher number of people living with dementia being incarcerated. Suggestions for best care approaches for prisoners with dementia now need to move from opinion to empirical approaches to guide 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.

Old and dangerous: Prison and dementia

Older prisoners are the fastest growing group of prisoners in many countries. The purpose of this study is to explore the phenomenon of detention of persons suffering from dementia. Medline searches were conducted for relevant articles, chapters and books published until August 2016. Search terms included dementia, elderly, prison and criminal. Publications found through this indexed search were reviewed for further relevant references. As results, there is a lack of data about elderly with dementia in prisons. Given the rise in the average age, it is reasonable to hypothesize that the number of older prisoners is growing. Moreover, some elderly are imprisoned with a concomitant cognitive impairment or psychiatric disorder while others will develop such diseases once incarcerated. At the present time, legal and social systems seem unprepared to handle the phenomenon of dementia in prison. As proposal, health assessments for older first time offenders should become a practice inside the correctional facilities and include an evaluation for specific health issues, such as psychiatric comorbidity and cognitive impairment.

Improving the care of older persons in Australian prisons using the Policy Delphi method

There are currently no internationally recognised and approved processes relating to the care of older persons with dementia in prison. This research aimed to develop tools and procedures related to managing the care of, including the identification and assessment of, older persons with dementia who are imprisoned in New South Wales, Australia. A modified approach to the Policy Delphi method, using both surveys and facilitated discussion groups, enabled experts to come together to discuss improving the quality of care provision for older persons with dementia in prison and achieve research aims.

Prison Experiences and Psychological Distress among Older Inmates

This study investigates relationships between older prisoners' social experiences and their levels of distress. One hundred and seventy-three older prisoners (aged ≥ 50 years) from 8 Australian prisons were administered the Kessler Psychological Distress (K10) Scale, with additional information collected via individual interviews. Psychological distress scores were significantly associated with measures of self-reported safety (p < .001), prison victimization (p < .05), perceived social support from staff (p < .01) and inmates (p < .001), current employment (p < .05), and level of exercise (p < .001) among older inmates. Findings suggest that strategies for improving sense of safety, social support and level of exercise may ameliorate distress among older prisoners.

Chronic health conditions reported by male inmates newly admitted to Canadian federal penitentiaries

BACKGROUND

International health studies have shown that inmates have higher rates of infectious diseases, chronic diseases and psychiatric disorders relative to the general population. We conducted a systematic collection of data on chronic physical health conditions reported by newly admitted inmates in Canadian federal penitentiaries.

METHODS

Over a 6-month period from April to September 2012, we collected and analyzed data from a standardized health interview routinely conducted with consenting incoming male inmates (n = 2273). Prevalence rates of health conditions were determined and disaggregated by age (< 50 yr and ≥ 50 yr) and by Aboriginal status.

RESULTS

The most common health conditions reported by respondents were head injury (34.1%), back pain (19.3%), asthma (14.7%) and hepatitis C virus (HCV) infection (9.4%). Rates of many health conditions were higher among inmates 50 years of age or older than among younger inmates. Compared with their non-Aboriginal counterparts, Aboriginal inmates had higher rates of head injury and HCV infection.

INTERPRETATION

Our study provides a benchmark that can be used to examine health trends within Canada's federal penitentiaries over time and points to subgroups of newly admitted inmates for whom health services may need to be concentrated.

Older prisoners: Challenges for inmates and prison management

There is considerable evidence pointing towards the growth of older prisoner populations in Australia. This article presents findings from the first large-scale study of older prisoners in Australia ( N = 173), examining functional independence, aspects of the prison environment which present difficulties for less able older prisoners, the uptake of prison programs and social functioning from the perspective of older prisoners. Results indicate that 22% of prisoners aged 50 years and older required assistance in day-to-day tasks, and that bunks, stairs and bathroom facilities presented the greatest difficulties for older inmates. The majority of older prisoners (77%) engaged in prison work and approximately one half of those nearing release had attended offending behaviour programs. Prisoners aged 65 years and older were more likely to describe social disconnection, were more likely to be experiencing functional impairments and victimisation in prison, and those experiencing functional impairment were more likely to report feeling unsafe in prison compared to prisoners aged 50 to 64 years. Implications for corrections planning and prison management are discussed.