Medical Multimorbidity, Mental Illness, and Substance Use Disorder among Middle-Aged and Older Justice-Involved Adults in the USA, 2015–2018

Abstract

BACKGROUND: Adults age ≥ 50 are among the fastest growing populations in correctional supervision and are medically underserved while experiencing unique health disparities. Community-living older adults, referred to as "justice-involved," are people who have been recently arrested, or are on probation or parole. Although medical complexity is common among incarcerated older adults, the occurrence of medical morbidity, substance use disorder (SUD), and mental illness among justice-involved older adults living in US communities is poorly understood. OBJECTIVE: To estimate the prevalence of medical multimorbidity (≥ 2 chronic medical diseases), SUDs, and mental illness among justice-involved adults age ≥ 50, and the co-occurrence of these conditions. DESIGN: Cross-sectional analysis. PARTICIPANTS: A total of 34,898 adults age ≥ 50 from the 2015 to 2018 administrations of the US National Survey on Drug Use and Health. MAIN MEASURES: Demographic characteristics of justice-involved adults age ≥ 50 were compared with those not justice-involved. We estimated prevalence of mental illness, chronic medical diseases, and SUD among adults age ≥ 50 reporting past-year criminal justice system involvement. Logistic regression was used to estimate the odds of these conditions and co-occurrence of conditions, comparing justice-involved to non-justice-involved adults. KEY RESULTS: An estimated 1.2% (95% confidence interval [CI] = 1.1-1.3) of adults age > 50 experienced criminal justice involvement in the past year. Compared with non-justice-involved adults, justice-involved adults were at increased odds for mental illness (adjusted odds ratio [aOR] = 3.04, 95% CI = 2.09-4.41) and SUD (aOR = 8.10, 95% CI = 6.12-10.73), but not medical multimorbidity (aOR = 1.15, 95% CI = 0.85-1.56). Justice-involved adults were also at increased odds for all combinations of the three outcomes, including having all three simultaneously (aOR = 8.56, 95% CI = 4.10-17.86). CONCLUSIONS:Community-based middle-aged and older adults involved in the criminal justice system are at high risk for experiencing co-occurring medical multimorbidity, mental illness, and SUD. Interventions that address all three social and medical risk factors are needed for this population.

Co-occurring Medical Multimorbidity, Mental Illness, and Substance Use Disorders Among Older Criminal Legal System-Involved Veterans

“…[11][12][13] In addition, this study found a higher prevalence of co-occurring mental illness, SUDs, and MM compared with those reported among non-veteran CLS-involved older adults in a national study. 3 While multimorbidity is common among older veterans and represents a high-cost patient population within the VHA system, 16 CLS-involved older veterans have unique health care needs because of the complex interplay between SUD, mental illness, and MM.…”

“…Our study found that being CLS involved was strongly associated with being diagnosed with a stimulant use disorder. Despite the high prevalence of methamphetamine use among CLS-involved older adults in general, 3 most research on SUD interventions for CLS populations focuses on alcohol or opioid use disorders. [17][18][19][20] Meanwhile, the prevalence of co-occurring opioid and methamphetamine use disorder is increasing sharply among veterans, 21 and methamphetamine use itself is associated with multimorbidity.…”

“…T he prevalence of psychiatric disorders and disabilities is higher among correctional populations than in the general population, leading many to consider age 50 to be the start of "older age" among people in the criminal legal system (CLS) (ie, jail, prison). [1][2][3][4] Older adults are among the fastest-growing populations in correctional supervision, 5 and despite having multiple chronic diseases, often receive sub-standard care while incarcerated 6 while experiencing barriers to care upon release. 7 CLS-involved adults who served in the US armed forces have potentially traumatic experiences, including adverse childhood events, 8 trauma exposure during military service, and traumatic incarceration experiences.…”

The role of substance use in the lives of incarcerated older adults: A qualitative study

“…Moreover, specific research that qualitatively examines subjective accounts of drug abuse among IOAs is lacking. This type of evaluation is critical given the complex and nuanced evidence regarding the exclusive characteristics of drug abuse among these individuals ( 6 ).…”

“…As noted, limited studies have examined IOAs coping with drug abuse issues ( 15 ). Previous research has suggested that IOAs are atypical in their drug abuse habits ( 16 ), meaning that although IOAs tend to use more drugs than their age peers living in the community ( 6 ), their drug use is markedly lower than that of younger incarcerated individuals ( 17 ). In addition, alcohol abuse is the most prevalent substance used by IOAs ( 5 ), followed by opioids ( 18 ).…”