Living With Dementia in Correctional Settings: A Case Report

Dementia care pathways in prisons - a comprehensive scoping review

BACKGROUND

The number of older people in prison is growing. As a result, there will also be more prisoners suffering from dementia. The support and management of this population is likely to present multiple challenges to the prison system.

OBJECTIVES

To examine the published literature on the care and supervision of people living in prison with dementia and on transitioning into the community; to identify good practice and recommendations that might inform the development of prison dementia care pathways.

METHODS

A scoping review methodology was adopted with reporting guided by the PRISMA extension for scoping reviews checklist and explanation.

RESULTS

Sixty-seven papers were included. Most of these were from high income countries, with the majority from the United Kingdom (n = 34), followed by the United States (n = 15), and Australia (n = 12). One further paper was from India.

DISCUSSION

The literature indicated that there were difficulties across the prison system for people with dementia along the pathway from reception to release and resettlement. These touched upon all aspects of prison life and its environment, including health and social care. A lack of resources and national and regional policies were identified as important barriers, although a number of solutions were also identified in the literature, including the development of locally tailored policies and increased collaboration with the voluntary sector.

CONCLUSION

To our knowledge, this is the most comprehensive and inclusive review of the literature on dementia care pathways in prison to date. It has identified a number of important areas of concern and opportunities for future research across the prison system, and its operations. This will hopefully lead to the identification or adaptation of interventions to be implemented and evaluated, and facilitate the development of dementia care pathways in prisons.

Canada's Aging Federal Prison Population: Health Disparity, Risk, and Compassionate Release for Persons Convicted of Sexual Offenses

ABSTRACT

The Canadian federal prison population is increasingly aging within institutions that were never intended or designed to meet the complex medical and mental health needs of older incarcerated persons. Increasing numbers of incarcerated persons are "aging in place," and many are dying within federal correctional institutions. Persons convicted of sexual offenses comprise a large-and growing-proportion of this aging population. The Correctional Investigator Canada has recently called for an expansion of access to compassionate release for the aging federal prison population, yet little progress has been made. In this article, we explore the significant challenges faced by the aging population in federal institutions, including insufficient access to appropriate care, challenges in application for compassionate release, and how questions of risk may affect the potential for community transfer. Questions of risk overshadow decisions on early release of incarcerated persons, especially those convicted of sexual offenses. Nurses play a central role in the provision of care to aging incarcerated persons and in advocacy for better access to services when a patient's needs cannot be met within the institution. This article presents a call to action for forensic nurses in Canada (and beyond) to advocate for both improved services within federal correctional institutions and for expedited access to compassionate release of aging incarcerated persons, especially those nearing end of life. The significant disparity in access to health care for aging incarcerated persons compared with their nonincarcerated counterparts represents a significant concern.

Palliative and Hospice Care in Correctional Facilities: Integrating a Family Nursing Approach to Address Relational Barriers

BACKGROUND

The need for palliative and hospice care for persons with life-limiting conditions who are incarcerated is increasingly common in correctional facilities worldwide.

OBJECTIVE

Through a family nursing lens, we critically analyze the unique challenges experienced by those requiring palliative care while incarcerated. Key concerns and implications for nursing are illustrated through the discussion of a representative case scenario.

METHODS

The case scenario was developed based on the findings of a scoping review of academic and gray literature (such as policy documents and editorials) about palliative, hospice, and end-of-life care in corrections.

RESULTS

The case scenario highlights multilevel barriers that were identified, including the individual, relational, institutional, and sociocultural contexts of palliative care in correctional facilities. Evidence is presented of how integration of a family nursing perspective can enhance specialized palliative and hospice care services in correctional settings.

CONCLUSIONS

By applying a family nursing approach, nurses practicing with correctional populations can ensure persons with life-limiting illnesses are not denied their right to appropriate end-of-life care by playing a key role in addressing barriers to palliative and hospice care access in corrections. Specific attention to relational issues and holistic care can contribute to enhanced palliative and hospice care, greater dignity in dying, and improved family and peer outcomes, which have benefits for individuals, families, communities, and society.

IMPLICATIONS FOR PRACTICE

Through the case scenario, we illustrate real issues emerging in correctional contexts and offer evidence of how family nursing relational principles can be applied to promote adequate palliative and hospice care.

Development of a Dementia Education Workshop for Prison Staff, Prisoners, and Health and Social Care Professionals to Enable Them to Support Prisoners With Dementia

The world's prison population is aging. Older prisoners, those aged 50 years and older, are at risk of poor health and developing a dementia. Prisoners with dementia may present challenges to the regime within the prison and require extra support. However, prison staff and health and social care professionals have reported a lack of skills and knowledge to identify and support prisoners with dementia. This may be due to a lack of dementia education programs developed specifically for the prison setting and delivered comprehensively for all who work with prisoners. The aim of this article is to describe the development and implementation of a dementia education workshop for the prison setting that is suitable for all prison staff, prisoners, and health and social care professionals.

Older persons with dementia in prison: an integrative review

PURPOSE

The number of prisoners over 55 years is increasing and many are at risk of developing dementia. This has generated new responsibilities for prisons to provide health and social care for older persons. The purpose of this paper is to synthesize the existing research literature regarding the phenomenon of the health and social care needs of older persons living with dementia in correctional settings.

DESIGN/METHODOLOGY/APPROACH

Using an integrative review method based on Whittemore and Knafl, the inclusion criteria for the review are: articles written in English; a focus on some form of dementia and/or older persons with discussion of dementia; to be set in a correctional context (correctional facility, prison and jail); be derived from a published peer-reviewed journal or unpublished dissertation/thesis; and be a qualitative, quantitative or mixed methods study. Based on those criteria, a search strategy was developed and executed by a health sciences librarian in the following databases: Medline, CINAHL, Embase, PsychINFO, Proquest Nursing and Allied Health and Web of Science; searches were completed up to April 2019. After data were extracted from included studies, synthesis of findings involved an iterative process where thematic analysis was facilitated by Braun and Clarke's approach.

FINDINGS

Eight studies met the inclusion criteria. Key findings of the eight studies include recognition of dementia as a concern for correctional populations, dementia-related screening and programming for older persons and recommendations for improved screening and care practices. Most significant is the paucity of research available on this topic. Implications for research are discussed.

ORIGINALITY/VALUE

This paper identified and synthesizes the limited existing international research on the health and social care needs of older persons with dementia living in correctional settings. Although existing research is scant, this review highlights the need for increased awareness of dementia as a concern among older persons living in correctional settings. As well, the review findings emphasize that enhanced screening and interventions, particularly tailored approaches, are imperative to support those living with dementia in correctional settings.