Research analysis: Identifying elderly inmates’ healthcare needs

Providing healthcare to a growing elderly inmate population poses many challenges for correctional facilities

December 19, 2018 02:37 PM

In this Sept. 12, 2012, file photo, Dr. David Mathis, visits with an inmate in the hospital unit at the California Medical Facility in Vacaville, Calif.

By C1 Staff

Editor’s note: When it comes to inmate healthcare, correctional facilities are facing a perfect storm. A growth in geriatric inmates poses significant challenges in regard to management of chronic diseases and environmental modifications; drug-addicted inmates are flooding correctional facilities; and in many jurisdictions, jails and prisons are now the largest providers of mental healthcare services. This special coverage series reviews key ways facilities can prepare to battle the storm.

In 2016, the International Committee of the Red Cross hosted a conference on “Ageing and Imprisonment: Identifying the Needs of Older Prisoners,” which discussed the institutional, legal and healthcare needs of geriatric inmates. Following the conference, researchers published a paper (available in full below) in the “International Review of the Red Cross” describing the challenges correctional systems face providing healthcare to older inmates and highlighting strategies to improve the delivery of care.

The paper begins with an overview of geriatric healthcare in the correctional setting.

While healthcare professionals generally classify “older adults” as individuals over the age of 65, this definition is not as easy to determine in a correctional setting. Several factors contribute to what is termed “accelerated ageing”:

Chronic physical and mental health conditions at a young age;
Emotional stress and trauma;
A history of drug abuse;
Lack of access to healthcare prior to incarceration.

For these reasons, write the researchers, jurisdictions may classify inmates in their 50s as “older prisoners.”

While the general prison population has decreased, the number of prisoners aged 50 or older increased by 25 percent from 2009-2013 and currently makes up 10 percent of the U.S. state prison population.

Correctional facilities are not generally designed to provide optimal care for the aged, write the researchers. Older inmates face several environmental challenges including:

Poor lighting and dimly lit walkways;
Steep staircases;
High bunk beds;
Low toilets.

Facility modifications to accommodate the needs of elderly inmates add to correctional costs.

Geriatric medicine in corrections

Geriatric medicine prioritizes risks and benefits of interventions for individuals with multiple medical conditions and disability. The authors of the paper recommend that correctional facilities take a similar patient-centric approach when assessing the needs of elderly inmates. This approach requires an assessment of the inmate’s functional ability to perform daily activities such as dressing, feed and toileting. It also involves identifying the presence of geriatric syndromes that can contribute to poor health outcomes. These include:

1. Falls

According to the CDC, falls are the leading cause of injury-related deaths among persons aged 65 and older. The risk of a fall is increased in the correctional setting for several reasons:

Dimly lit or crowded walkways;
Use of ankle and wrist restraints;
Insufficient sun exposure causing vitamin D deficiency, which can lead to poor muscle and bone health.

2. Cognitive impairment

As we age, we experience cognitive changes that slow our reaction times and performance on tasks. Abnormal cognitive changes result in dementia, which the researchers say was listed as a diagnosis in 40 percent of adults in one state prison system in the US.

The daily routine of inmate life in a correctional facility may mask early signs of dementia like getting lost or misplacing belongings, caution the researchers, so correctional staff should look for personality changes that may occur with dementia and other behaviors like wandering, fighting and a lack of impulse control.

Training correctional officers to detect such signs could be a vital way to identify inmates with dementia. The researchers cite one study where even correctional officers without any special training suspected the presence of cognitive impairment in five times as many individuals as clinical staff.

3. Urinary incontinence

As it is rare for an individual to admit to urinary incontinence, correctional healthcare providers should ask all older adults about incontinence. Soiled clothing can lead to victimization so incontinence supplies should be available for older adults.

4. Sensory impairment

One third of individuals over the age of 60 have some degree of hearing loss, with one in 3 over the age of 80 experiencing vision impairment. Inmates with hearing or vision difficulties may not be able to respond to a correctional officer’s orders. Annual hearing and vision testing is key to improving social and emotional well-being, say researchers, as well as helping lower the risk of inmate falls.

5. Polypharmacy

The simultaneous prescription of multiple medications – polypharmacy – can cause adverse effects in older adults. One study showed inmates over the age of 67 were taking an average of nine different types of medication in one state prison system.

Memorable quotes about geriatric inmate healthcare

Here are four memorable quotes from the paper:

“Improving care for this population depends on interprofessional partnerships including correctional leadership and front-line staff, public health researchers, community agencies, neighborhood associations, formerly incarcerated individuals and their families, law enforcement, and community and correctional clinicians.”

“It is important to identify the physical tasks required to maintain independence (‘activities of daily living for prison’) in each housing unit and assign individuals according to their ability to perform these required tasks.”

“Correctional facilities that significantly restrict freedom of movement for much of the day may run the risk of contributing to physical deconditioning in older adults, an additional risk factor for falls, morbidity and mortality.”

“One important resource for detecting cognitive impairment in its early stages is to educate those who spend the most amount of time with individuals in prison – such as correctional officers – to recognize early warning signs.”

Key takeaways for correctional facility leaders

The researchers recommend correctional leaders consider the following best practices to improve elderly inmate healthcare:

Adapt effective community-based geriatric care programs to the correctional setting;
Train clinical staff to recognize and manage geriatric conditions;
“Geriatricize” clinical spaces within correctional medical units.

Related resources on correctional healthcare

Learn more about the healthcare challenges facing correctional facilities with these resources from CorrectionsOne:

Ageing prisoners: An introd... by on Scribd