A perfect storm is brewing in US correctional facilities, according to mental health experts John Wilson and Sharen Barboza, psychologists with MHM Services, Inc. and presenters at a recent National Commission on Correctional Health Care (NCCHC) conference. Demographics and early reports indicate that we are on the cusp of a wave of dementia development in our aging inmate population. Dementia, which involves loss of memory, language, recognition, planning and purposeful behavior, is progressive and ultimately fatal. There are no known cures. And time is not on our side. The average age of inmates is growing rapidly. Physically, inmates are thought to age an average of 10 years faster than the community population.
An inmate stands on a balcony overlooking the Hudson Valley in a dementia unit at Fishkill State Prison in Fishkill, N.Y. (AP photo)
Age is not the only factor that contributes to dementia. Chronic illnesses, brain trauma and substance abuse also “age the brain” and raise the risk of dementia. These factors are much more frequent in inmate populations than in the community. In addition, factors proven to protect against dementia are mostly absent in the inmate population. A sense of purpose, social engagement and increased education level, factors shown to assist in preventing dementia, are often missing from this group.
With this in mind, begin now to consider dementia as a possible condition when evaluating erratic behavior by an older inmate. Dementia disrupts thought processes, emotion and self-control. What might that look like in your cellblock?
Early Storm Warnings Watch for subtle changes in your older inmates. Things to look for include:
• Misplacing personal items • Change in mood and behavior • Change in personality and initiative • Handwriting problems
Consider arranging a mental health evaluation for dementia if any of these changes become regular observations. Early intervention can delay dementia progression.
Lightning and Thunder Inmates in middle dementia may exhibit:
• Overreaction and emotional outbursts • Anger, frustration or withdrawal • Shuffling walk • Incontinence
By the time these behaviors emerge, the storm is under way; however, intervention can reduce the disruption possible in the institution. Demented inmates need protective housing and an adjusted environment to reduce agitation and confusion, which can lead to escalated aggression and possible violence.
Storm in Progress The signs of late dementia are unmistakable. Inmates in this state will be mostly unintelligible and lose gross motor skills like sitting and walking. These inmates no longer have the ability to swallow and need total care. Correctional systems may need to consider creating nursing care facilities or outsource options to provide 24/7 health care.
Staying Afloat Consider the implications of dementia in your inmate population and take measures to prepare to weather it. Educate your colleagues about the possibilities of dementia. Mental health staff can help manage inmates with dementia. Demographic trends indicate a perfect storm may be in our future.
Information for this post was obtained from the NCCHC Updates in Correctional Healthcare Seminar "The Looming Challenge: Dementia in Corrections" presented by John Wilson, PhD, and Sharen Barboza, PhD, MHM Services, Inc., April 25, 2010, Nashville, TN
About the author
Dr. Schoenly has been a nurse for over 25 years and is currently specializing in correctional healthcare. She is a clinical education specialist and author actively advocating for excellence in this practice setting. Her web-presence www.correctionalnurse.net provides a forum to interpret correctional healthcare to the public and healthcare community. Lorry is a strong advocate for development of the specialty practice of correctional nursing. She speaks and writes frequently on correctional nursing practice issues. Her book, Essentials of Correctional Nursing, will be published in July, 2012.