Aging in Correctional Custody

As crime in the United States continues to rise; so are the numbers of aging adults incarcerated in
correctional facilities. The US has the highest incarceration rate in the world largely due to
tougher more stringent sentencing guidelines. Life sentences have increased as death sentences
have decreased thus, creating aging inmates with increasing chronic and severe illnesses.
Inmates with disabilities, diabetes, congestive heart failure, dementia and liver failure are the
primary costly challenges within our criminal justice system. In western culture geriatric person
is considered over the age of 65. In US correctional facilities the aging adult or geriatric adult is
considered to be 55. The significance of this is that incarcerated adults are estimated to be 10 to
15 years older physiologically than their chronological age. This can be related to substance
abuse prior to imprisonment, stress incurred while imprisoned, inadequate nutrition, and medical
care.
Improving the healthcare management of the aging prisoner and to provide proper healthcare we
must implement at the beginning of the incarceration process evaluations of their functional
ability. Also, screening for dementia or other cognitive impairments or visual or hearing
impairments. This will provide prisoners with proper placement within the correctional facility
as well as baseline assessment. Annual reassessment and screenings will allow for monitoring of
progression of impairments. As care providers we assess on every admission our patients ability
to perform ADLs, we assess for safety. Prisoners have the right to timely and appropriate
medical care. Part of that care is correctional staff, officers, personnel that interact and observe
inmates. Providing training and education to staff on aging conditions like vision/hearing loss,
gait instability, incontinence and cognitive impairment can prompt correction staff to seek
medical attention for new changes in an inmates behavior. There are no specific functional
impairment assessment tools for prisoners since they dont provide for their individual daily
needs like shopping, cooking, driving and getting to appointments. Aging inmates functional
abilities involve getting from one location to another in a timely manner, following instructions
from officers and following prison protocols.
Education for the inmate is crucial to the success of their release from prison, it also provides
challenges for the aging inmate. Many inmates have low health literacy. Chronic illnesses have
developed for many during their incarceration. Inmates that have received health education
during their incarceration have better results with reentry to the community. Improvement in
medical or compassionate release policy could lift the financial burden on the correctional
system. This policy needs to develop and clear and consistent guideline as a country. Individual
states have developed guidelines for release, however other states have more difficult processes,
applications that most inmates feel they are unable to complete and inmates with dementia are
unable to comprehend the process. Palliative and End of life care management within the prison
system is inconsistent. Many correctional facilities in the United States have incorporated End
of Life Care facilities, staffed with professional hospice teams and inmate volunteers to care for
those at the end of life. Palliative care for those with new serious illness is and needing symptom
management care, many prison physicians have not been trained in pain management creating a
less than desirable outcome for the patient.

References
Williams, B. A., Stern, M. F., Mellow, J., Safer, M., & Greifinger, R. B. (2012). Aging in
Correctional Custody: Setting a Policy Agenda for Older Prisoner Health Care.
American Journal Of Public Health, 102(8), 1475-1481 7p.
doi:10.2105/AJPH.2012.300704