A new (20 April 2023) report from the Nuffield Trust “Living (and dying) as an older person in prison” sets out to understand the biggest health care challenges for our ageing prisoner population. The report analyses admitted patient care data and outpatient data from 2019/20 to examine how people in prison aged 50 or older use hospital services. The research also involved consultation with a range of stakeholders.
As most readers will be well aware, the number of older people in prison has grown disproportionately over recent years, those aged over 50 increasing by 67% between 2010 and 2022 and is predicted to reach 14,800 people by July 2025.
Prisoners also tend to be in poorer health than the general population, and this is particularly the case for older prisoners, who are considered to be ‘older’ from the age of 50 in recognition of their additional health care needs. Tough conditions in prison – regime constraints, poor living conditions and the threat of violence – disproportionately affect older prisoners, but these are not new problems. The researchers are perhaps overly polite when they describe the extent to which the needs of older people in poor health can be met effectively in a prison setting as “questionable”.
One of the headline findings from the data analysis is that more than 40% of men in prison aged 50 or more who were admitted to hospital in an emergency showed signs of frailty, risking poorer health outcomes. This is concerning among people much younger than we would normally consider as frail.
Prisoners who were frail were found to be more likely to suffer from mobility problems, anxiety and depression, incontinence and dementia. Of men classified as having high-risk frailty, 29% had at least one hospital admission where dementia was recorded as a diagnosis. There are clearly practical challenges managing frailty in a prison setting.
For prison staff, the reality of an ageing prisoner population is that they have to manage death, dying and ill-health associated with old age as a part of their job role, something for which they receive little or no training.
There are people in prison receiving palliative care. Between 2016 and 2020, 190 older men with a palliative care diagnosis were admitted to hospital (including 50 in the most recent year of data, 2019/20). This was for a variety of reasons but in 40% of cases they had a primary diagnosis of cancer when admitted to hospital.
High blood pressure
The researchers found that a lower proportion than expected of older male prisoners admitted to hospital were found to have high blood pressure. This suggests that high blood pressure among people in prison is not being identified or treated, putting them at high risk of stroke and heart disease.
Older women in prison
Older women in prison have different health care needs from those of older men in prison. More than 20% of admissions to hospital by older women in prison had a diagnosis of depression recorded, while for their male counterparts this was under 8%.
Conclusions and recommendations
The research concludes that prisons are not currently set up to support the significant and varied health care needs of older people in the prisoner population. The upcoming (and much overdue) Older Offenders strategy provides an opportunity to highlight the needs of older
prisoners and ensure that the prison system is equipped and supported to address them.
But success requires a coordinated response. Action is required from across the system to equip prisons and prison staff with the resources they need, particularly in light of the increasing number of older people in prison. The researchers highlight three key recommendations:
- ensuring prisons have access to the resources and equipment necessary to support older people in prison living with frailty
- supporting prison staff to develop the skills and confidence to manage older people in prison
- sharing best-practice examples of health care support for older people in prison.
Thanks to Andy Aitchison for kind permission to use the images in this post. You can see Andy’s work here