Forget Me Not: Dementia in Prison

Abstract

The number of older adults with dementia in U.S. prisons is rapidly rising. Yet, the vast majority of this marginalized subgroup of the aging population is left neglected behind bars without access to adequate medical and mental health care services. We assert that proactive, interdisciplinary collaborative efforts to improve practice, policy, and research and to develop a high-quality evidence-based continuum of care for this aging population are urgently needed. The overarching goals of this paper are to raise awareness of the life and experiences of persons with dementia in prison and to stimulate discussion, research, and advocacy efforts for this forgotten subgroup of older Americans. We describe the growing number of older adults with dementia in U.S. prisons, high-risk factors for dementia present in the prison population, and the life and experience of persons with dementia in the culture and environment of prison that is primarily not designed for them. We review the current state of services and programs for dementia in prison. We conclude by proposing practice, policy, and research-related priority areas and strategies for interdisciplinary gerontological responses.

Bridging community and prison for older adults: invoking human rights and elder and intergenerational family justice

“…Palliative care and information and counseling about end-of-life options are needed in prison, especially since many older adults in prison are chronically ill, including with dementia, and a sizable number (e.g. 5,000 in the USA) die each year while in prison (Loeb et al, 2008;Maschi et al, 2012c;Williams and Abraldes, 2007).…”

The Social Determinants of Health and Justice and the Aging in Prison Crisis: A Call for Human Rights Action

“…This rapid decline of incarcerated older adults' health has been attributed largely to their high risk personal histories, chronic health conditions, poor health practices, such as poor diets and smoking, alcohol and substance abuse, coupled with the stressful conditions of prison confinement, such as prolonged exposure to overcrowding, social deprivation, and prison violence (Aday & Krabill, 2012). Theses combined personal and social environmental risk factors significantly increase the likelihood of the early onset of serious physical and mental illnesses, including dementia, among people in prison (Maschi, Kwak, Ko, & Morrissey, 2012 Jorge is a 56-year-old male from Puerto Rico and the youngest of nine children. He has a history of trauma and criminal offending that has included the unexpected death of his father at age 5, childhood sexual victimization, poverty, prostitution, drug dealing, substance abuse (heroin addiction), and recidivism (incarcerated two times).…”

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

“…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.…”

“…Person-centred dementia care is built on the understanding that a sense of belonging and opportunity for meaningful engagement are critical to the success of all human communities (Du Toit and McGrath, 2017;Low et al, 2017). Key principles for successfully implementing person-centred dementia care in other institutional settings should be applied to prisons including: (a) understanding the environmental context of the specific correctional setting and the barriers and enablers for dementia care within this context (Brown, 2014); (b) education for prison staff about dementia -for example, including communication strategies, basic techniques to enable self-care in bathing, eating and toileting, and simple environmental adaptation to reduce the potential for confusion and agitation (Maschi et al, 2012); (c) creating a firm understanding of who prisoners with dementia are as individuals, to promote access to meaningful engagement tailored to suit that person (Williams et al, 2012) ; and (d) introducing collaborative approaches for shared responsibility to ensure the safety of the prisoner with dementia, the correctional staff and the other inmates (Brown, 2014).Meaningful engagement of older people within residential dementia care is best enabled by a united approach (Du Toit and Surr, 2011) and therefore prison staff and fellow inmates should share responsibility for the day-to-day care and support of prisoners with dementia. Congregate social environments offer a first step towards implementing this shared approach to care.…”

“…Furthermore, reduced cognitive capacity makes prisoners with dementia more vulnerable to bullying and harassment by other prisoners (Wilson and Barboza, 2010) and more likely to be victims of sexual violence (Stojkovic, 2007). Lack of age-appropriate activities has also been highlighted as a significant issue resulting in increased levels of isolation and disengagement among older prisoners (Brown, 2014; Parliament House Prison staff report varying levels of knowledge and confidence in working with people with dementia, and often struggle to balance the demands of maintaining prison management with responding to the specific needs of prisoners with dementia (Maschi et al, 2012). Finally, prison settings rarely have access to the range of health care and community services including specialist services that have been identified as crucial to ensuring early diagnosis and intervention for people with dementia.…”