Dementia in prisons – enabling better care practices for those ageing in correctional facilities

Abstract

The number of older people with dementia who are 'ageing in place' in prisons across the world is rapidly increasing. Within the broader prison population these older people are particularly vulnerable to poorer outcomes as a result of inadequate access to appropriate health services. There is an urgent need for occupational therapists to collaborate with prison services to develop evidence-based care practices that provide viable, cost-effective options for prisoners who are ageing with dementia. We identify priorities for research and practice and set out a call for action for occupational therapists worldwide to address this growing need. KeywordsPrisons, prisoners, dementia, ageing Received: 30 June 2017; accepted: 30 October 2017 Context Population ageing is a well-recognised trend and prison populations are no exception. Parliamentary reports indicate that, by the end of 2016 in the United Kingdom (UK) the prison population aged 50 years 1 and over had increased proportionally not more than any other age group. Indeed, since 2002 there has been a 169% increase in the numbers of prisoners aged 50 years and above (Parliament House of Commons, 2017). Older prisoners have a higher risk of developing dementia when compared with other older people due to their overall poorer physical and mental health (Maschi et al., 2012) and while the exact number of prisoners with dementia in the UK is unknown, estimates suggest prevalence rates of up to 5% among older people in prison (Parliament House of Commons Justice Committee, 2013).Prisoners with dementia are a particularly vulnerable sub-group within the prison population. Neither the physical nor social environment of the prison setting was designed for people with dementia. As Maschi et al. (2012) note, from the outset the primary purpose of a prison is punishment and confinement. Prisoners are expected to use their time in prison to reflect upon and change their criminal behaviour. With this purpose in mind, the traditional design of the physical environment prioritises incarceration over quality of life, personal safety and wellbeing. For people with dementia and its associated cognitive impairment, prison environments can be experienced as noisy and overwhelming, lacking in natural light or opportunities for privacy. While increasing attention has been paid to these issues in the design of modern prisons, a large proportion of prisons in the UK and elsewhere have not been modified or adapted to accommodate the needs of older people (Parliament House of Commons Justice Committee, 2013).The prison social environment, with its heavily structured rules and routines, may also pose challenges for prisoners with cognitive impairment. Behaviours associated with moderate to advanced dementia such as failure to follow instructions, pacing about and aggressive outbursts may be interpreted by prison staff as infringement of prisoner rules and may result in further punishment (Gaston, 2017). Organisational routines, including frequent moving of prisoners from one l...

Dementia care pathways in prisons – a comprehensive scoping review

“…Dedicated library sessions have been designated in some prisons, and some libraries can and do stock specialist resources including books, audiobooks, (Brown, 2016;Dillon et al, 2019;The King's Fund, 2013;Forsyth, Heathcote and Senior et al 2020;Treacy et al, 2019;Department of Health, 2007;Her Brown, 2014;Christodoulou, 2012;Goulding, 2013;Maschi et al, 2012;Murray, 2004). Physical stimulation and exercise were also considered important (Brown, 2016;Moll, 2013;Her Majesty's Prison & Probation Service, 2018;Brown, 2014;Christodoulou, 2012;du Toit & McGrath, 2018;Maschi et al, 2012), with special, adapted and separate gym activities recommended Treacy et al, 2019;Department of Health, 2007;Her Majesty's Prison & Probation Service, 2018;Welsh Government and Ministry of Justice, 2011;Goulding, 2013), including yoga, pilates and tai chi (Moll, 2013;Department of Health, 2007), badminton and bowls (Moll, 2013), chair-based exercises (Moll, 2013), and activities to assist memory (Her Majesty's Inspectorate of Prisons, 2015). Rehabilitation activities (Goulding, 2013), therapeutic activities (Brown, 2016;Goulding, 2013;Maschi et al, 2012], reminiscence or life stories (Dillon et al, 2019;Moll, 2013;Brown, 2014;du Toit & McGrath, 2018;Goulding, 2013) memory cafes, holistic care and support, an over...…”

“…Physical stimulation and exercise were also considered important (Brown, 2016;Moll, 2013;Her Majesty's Prison & Probation Service, 2018;Brown, 2014;Christodoulou, 2012;du Toit & McGrath, 2018;Maschi et al, 2012), with special, adapted and separate gym activities recommended Treacy et al, 2019;Department of Health, 2007;Her Majesty's Prison & Probation Service, 2018;Welsh Government and Ministry of Justice, 2011;Goulding, 2013), including yoga, pilates and tai chi (Moll, 2013;Department of Health, 2007), badminton and bowls (Moll, 2013), chair-based exercises (Moll, 2013), and activities to assist memory (Her Majesty's Inspectorate of Prisons, 2015). Rehabilitation activities (Goulding, 2013), therapeutic activities (Brown, 2016;Goulding, 2013;Maschi et al, 2012], reminiscence or life stories (Dillon et al, 2019;Moll, 2013;Brown, 2014;du Toit & McGrath, 2018;Goulding, 2013) memory cafes, holistic care and support, an over '45 s' focus group, over 50 s well-being and mindfulness (Forsyth, Heathcote and Senior et al 2020), sensory stimulation , and cognitive stimulation groups (Forsyth, Heathcote and Senior et al 2020;Treacy et al, 2019;Her Majesty's Prison & Probation Service, 2018; have also been provided and recommended. It was also noted that it would be useful for people in prison LWD to have some autonomy such as being able to prepare drinks and snacks for themselves (Dementia Action Alliance, 2017;Maschi et al, 2012;Treacy et al, 2019) reminiscence packs and archives of local photos, music and DVDs (Department of Health, 2007;…”

COVID-19 and incarcerated older adults: a commentary on risk, care and early release in Australia

“…Best care approaches for prisoners with dementia include screening, access to specialised services and early release or parole for those deemed a low risk of re-offending, although the evidence base for these approaches is quite poor (du Toit and McGrath, 2018). At the least, staff must be adequately trained to recognise the potential cognitive, behavioural and/or communication difficulties that may signal a cognitive disorder and thus preclude an older person's ability to recognise and express any symptoms that may indicate COVID-19.…”

Special issue: The ageing population – challenges and opportunities (I)

“…Moreover, they recommend that occupational therapists focus on the use and transfer of problem-solving strategies. Highlighting a new area of practice for occupational therapists, an opinion piece by Du Toit and McGrath (2018) argues that there is a need for occupational therapy to support people ageing with dementia in prisons. The authors draw our attention to those vulnerable groups in society that previously may not have had access to occupational therapy.…”