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WEPHREN supports International Day of Older Persons on 1st October 2018 by collecting and sharing resources from around the world for prisons on the WEPHREN website.
OLDER PEOPLE IN PRISON
There are over 10 million people in prisons or other prescribed places of detention worldwide but it is uncertain how many of these are older people. We can however be reasonably confident that there are millions of older people in prison across the world. Of course exactly when someone is classified as an ‘older person’ in prison is also unclear although consensus is emerging around the age of 50 years and over because people in prison often have rates of morbidity and functional abilities similar to peers in the community 10 years their senior.
What is clear is that in many countries the number of people in prison defined as “older” is increasing at a disproportionately high rate. In the United Kingdom the proportion of older people in prison has increased by 169% over the last 15 years to 15.6% of the whole prison population and it is estimated that by 2021, nearly 1 in 5 prisoners will be 50 years or over. In the United States of America, the proportion of older people in prison has increased from 10.3% to 19.2%. It is unlikely to be a phenomenon confined to high income countries; it is simply that data is more readily available in these countries. If you work with older people in prison in a low or middle income country, please do contact WEPHREN WEPHREN@phe.gov.uk.
Older people in prison in Switzerland
by Dr Tenzin Wangmo
Older prisoners, defined as those 50 years and older, constituted 14.6% of the Swiss prison population in 2016. When 60 years is used to demarcate old from young, only 4.5% of the total prison population is ‘older’. Like elsewhere, the age from which a prisoner is an ‘older prisoner’ is yet to be standardized in Switzerland. For the research project ‘Agequake in Prisons’, we used 50 years of age and older to denote older prisoners, and 49 years and younger for younger prisoners. Our nationwide study (2011 – 2016) collected data from medical records of older and younger prisoners in addition to interviews with older prisoners. Our study revealed new and lacking findings on the health, healthcare, and age-related needs of older prisoners in Switzerland. First, study findings highlight that older prisoners live with more somatic conditions and that their disease burden increases with age group. Consequently they need greater access to healthcare than younger prisoners. Second, the discussions with older prisoners brought out different recommendations on their environmental, social, and end-of-life needs. As prisons are designed for young individuals who are expected to leave after serving their time, the prison environment is poorly adapted for the health and social needs of older prisoners, who either enter prison at old age, or have aged there. Thus, questions such as how the prison infrastructure should be adapted, where older prisoners should be placed, or whether they should be separated from younger prisoners require critical and more in-depth analysis. Related to aging in prison is the imminent issue of death and dying, and the (im)possibility of obtaining early/compassionate release. End-of-life brings forth the question if a prisoner should die in prison or outside. Older prisoners who have lived many years in prison, lack social support in the community, and for whom other prisoners are their support group, could consider prison as their ‘home’. Thus, end-of-life wishes - including the question of assisted suicide, which is available to older and ill persons in Switzerland - remain an open issue requiring further attention. Specific concerns of older female prisoners and older prisoners with mental health problems and/or serving therapeutic or security measures remained unexplored and are currently being addressed (Agequake in Prisons II). Much attention is needed to translate existing knowledge on older prisoners into practical solutions that respond to their health, social, and end-of-life needs, and ensure the balance between protecting the population and respecting the dignity of older prisoners.
Dr. Tenzin Wangmo is a Senior Researcher at the Institute for Biomedical Ethics, University of Basel. She has PhD in Gerontology and Venia Docendi in Biomedical Ethics. Her research interests are in the intersection of aging, vulnerability, and social policy.
 Prisons should mirror society: the debate on age-segregated housing for older prisoners. https://www.cambridge.org/core/journals/ageing-and-society/article/prisons-should-mirror-society-the-debate-on-age-segregated-housing-for-older-prisoners/242A66CE9CE5B725AD3D90A0C0B04A01
INTERNATIONAL COMMITTEE OF THE RED CROSS
Ageing and Detention - ref. 4332-ebook
Although all older people have the same basic needs, failure to meet these needs – and the additional needs that arise in detention – can have particularly severe consequences, and take a heavy toll on both detainees and the people who work with them. This booklet is intended to help States and others improve conditions for older detainees and detention-facility staff alike. The booklet focuses on prisons, but will provide a useful resource for other types of detention too.
For the International Day of Older Persons, the ICRC regional delegation in Paris have published a multimedia project focusing on older prisoners. This multimedia article contains insights from experts - prison directors, health care specialists, criminologists and staff in charge of “Detention” at the International Committee of the Red Cross (ICRC) – who participated in a workshop organised by the ICRC regional delegation in France. Mobility loss, dementia, sensory impairment, loss of family ties are some of the issues these experts underline. Recommendations are also detailed in order to improve responses to older prisoners' specific needs.
The National Health and Justice team in Public Health England have recently published guidance on older people in prison; Health and social care needs assessments of the older prison population: a guidance document https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/662677/Health_and_social_care_needs_assessments_of_the_older_prison_population.pdf
Brie Williams is a Professor of Medicine in the UCSF Division of Geriatrics, Director of the Criminal Justice & Health Program at UCSF and Director of the Criminal Justice and Aging Project of Tideswell at UCSF. She is the leading academic researcher on the health of older people in prison and has published widely on this issue – see https://profiles.ucsf.edu/brie.williams#toc-id1. Some selected publications and links can be found below:
Ahalt C, Stijacic-Cenzer I, Miller BL, Rosen HJ, Barnes DE, Williams BA. Cognition and Incarceration: Cognitive Impairment and Its Associated Outcomes in Older Adults in Jail. J Am Geriatr Soc. 2018 Sep 19. View in: PubMed
Greene M, Ahalt C, Stijacic-Cenzer I, Metzger L, Williams B. Older adults in jail: high rates and early onset of geriatric conditions. Health Justice. 2018 Feb 17; 6(1):3. View in: PubMed
Humphreys J, Ahalt C, Stijacic-Cenzer I, Widera E, Williams B. Six-Month Emergency Department Use among Older Adults Following Jail Incarceration. J Urban Health. 2017 Dec 04. PMID: 29204845. View in: PubMed
Bedard R, Metzger L, & Williams B. .Ageing prisoners: An introduction to geriatric health-care challenges in correctional facilities. International Review of the Red Cross View Publication
Metzger L, Ahalt C, Kushel M, Riker A, Williams B. Mobilizing cross-sector community partnerships to address the needs of criminal justice-involved older adults: a framework for action. Int J Prison Health. 2017 Sep 11; 13(3-4):173-184.View in: PubMed
Brown RT, Ahalt C, Rivera J, Stijacic Cenzer I, Wilhelm A, Williams BA. Good Cop, Better Cop: Evaluation of a Geriatrics Training Program for Police. J Am Geriatr Soc. 2017 Aug; 65(8):1842-1847. PubMed
Williams BA. Older Prisoners and the Physical Health Effects of Solitary Confinement. Am J Public Health. 2016 Dec; 106(12):2126-2127. View in: PubMed
Bolano M, Ahalt C, Ritchie C, Stijacic-Cenzer I, Williams B. Detained and Distressed: Persistent Distressing Symptoms in a Population of Older Jail Inmates. J Am Geriatr Soc. 2016 Nov; 64(11):2349-2355. View in: PubMed
Flatt JD, Williams BA, Barnes D, Goldenson J, Ahalt C. Post-traumatic stress disorder symptoms and associated health and social vulnerabilities in older jail inmates. Aging Ment Health. 2017 Oct; 21(10):1106-1112. View in: PubMed
Williams BA, Ahalt C, Stijacic-Cenzer I, Smith AK, Goldenson J, Ritchie CS. Pain behind bars: the epidemiology of pain in older jail inmates in a county jail. J Palliat Med. 2014 Dec; 17(12):1336-43. PMID: 25265035; PMCID: View in: PubMed, PubMed Central