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A systematic review with meta-analysis was performed to: 1) estimate the prevalence of both mental and physical health problems in older offenders; 2) calculate relative risks for the health conditions in relation to non-offender older adults and; 3) explore the potential confounding role of several variables. We searched five databases up to Augus...
Citations
... Certain coping strategies can be classified as either healthy or unhealthy [63,64], for instance, the use of adaptive versus maladaptive coping strategies is associated with varying levels of psychological symptoms, adjustment, and overall well-being [65,66]. For this reason, the promotion of using healthy and adaptive coping strategies such as problem-solving, seeking social support, or engaging in physical activity is important due to its link between stress and health [67], particularly in view of the high prevalence of mental and physical illnesses in older incarcerated adults [68][69][70]. ...
Background
Imprisonment has a major impact on a person’s psychological well-being. The proportion of older imprisoned persons is dramatically increasing worldwide, and they are likely to have greater physical and mental health needs compared to younger persons in prisons. However, there is currently a lack of research on the psychological stressors and the coping strategies of older imprisoned persons. This study therefore aims to explore the key psychological stressors experienced by older imprisoned persons and their coping strategies.
Methods
Individual semi-structured qualitative interviews were conducted between April 2017 and December 2018 with a purposive sample of 79 participants from 2 different groups in Switzerland: older imprisoned persons (n = 50) and mental health professionals (n = 29) with experience working in prisons. Transcripts were analysed using conventional content analysis.
Results
This study has identified various ways in which the prison environment not only undermines older incarcerated persons´ psychological well-being, but also their ability to manage the stress they are experiencing. Two overarching psychological stressors identified were a lack of physical and emotional closeness in social relationships (with prison staff, with other incarcerated persons, and outside of prison), and the loss of autonomy in prison. Participants reported five main ways that older incarcerated persons coped with the psychological stressors in prison: 1) recognising a lack of control over situation, 2) withdrawing and isolating, 3) self-improvement, 4) staying connected to the outside world, and 5) self-expression.
Conclusions
To improve the psychological well-being of older incarcerated persons, there is a need for: specialised training of prison staff regarding hardships that elderly persons can face in prison relationships, encouragement and enablement of social contacts with the outside world, and increasing possibilities for autonomy, new challenges, and thus stimuli within a limited setting.
... The incidence and complexity of mental health problems found in OPiP are related to a combination of biopsychosocial factors (Kakoullis, Le Mesurier, and Kingston 2010). Many older prisoners have complex health needs which, in the absence of optimal healthcare, can precipitate and perpetuate mental health problems (Solares et al. 2020). Additionally, in comparison to community-dwelling peers, OPiP are more likely to experience dementia (Verhülsdonk et al. 2021). ...
... The complex mental and physical health needs of OPiP require an integrated approach (Tronick et al. 2022;Solares et al. 2020;Barry et al. 2020;Di Lorito, Vollm, and Dening 2018b;Sun 2013a, 2013b). Prison care services should involve coordination between healthcare providers, prison staff, and community agencies, who are aware of their roles and responsibilities, to encourage shared decision making, care planning and seamless transitions between prison and community teams upon release. ...
The mental health needs of older people in prison (OPiP) are considerable but remain overlooked. This review aimed to develop an Initial Programme Theory (IPT) to understand how the mental health needs of OPiP can be addressed and how mental health care for older people in the community could be adapted for the prison environment. A review and realist synthesis pertaining to the mental health needs of OPiP was conducted across three stages, including: (1) a systematic review of empirical work; (2) a scoping review of prison guidance documents; and (3) a scoping review of community mental health guidance documents. Synthesis of eligible literature and development of the IPT followed realist principles and was supplemented by a stakeholder workshop of experts by personal and occupational experience. Overall, 122 sources were included. The IPT suggested that prisons can address the mental health needs of OPiP via micro‐level mechanisms (i.e., screening, assessment, care planning, intervention, continuity of care/release), meso‐level mechanisms (i.e., accommodation, environment, activities, religion/spirituality, peer support, family support) and macro‐level mechanisms (i.e., staff training/education, governance). Each mechanism is underpinned by trauma‐informed, integrated and patient‐centered care principles and their implementation should be guided by a local assessment of prison‐specific needs. Our IPT provides a framework for how prisons can address the mental health needs of OPiP, informed by community care provision, via several mechanisms across different levels. Future research should build on this work to inform a full evaluation of its impact on meaningful outcomes to promote equivalency of care for OPiP and non‐discriminatory access to mental health support for those at risk of marginalization.
... Specifically, in comparison to younger prisoners or age-matched community peers, older prisoners experience elevated rates of depression (Fazel et al., 2001), post-traumatic stress disorder (Prost et al., 2021), somatic disorders (Moschetti et al., 2015), schizophrenia, and personality disorders (DiLorito et al., 2018). These can be compounded by physical and cognitive decline associated with normal ageing, the presence of chronic cardiovascular, respiratory, and musculoskeletal conditions (Solares et al., 2020) and experience of dementia (Verhülsdonk et al., 2021), which are common in older people in prison. Consequently, older prisoners require access to specialised treatment to adequately meet their mental health needs. ...
... Our findings lend support for previously published literature. Specifically, the nominal group confirmed that mental health problems in older people in prison are characterised by significant complexity (Kakoullis et al., 2010) and comorbidity (Solares et al., 2020;Verhülsdonk et al., 2021). We also found that the provision of effective multidisciplinary mental health care for older people across UK prisons is lacking. ...
... Importantly, there is a knowledge gap concerning the interplay between SUD and violent criminal behavior in different age groups, controlling for other important risk factors. Based on previous research, we would expect synergistic effects of violent offenses and SUD on the propensity for early death, but this effect might be altered with age due to a number of moderators, among them are biological factors such as reaching cognitive maturity (26), the increased likelihood of desisting from crime with age (27), and the increased somatic morbidity and health issues among older offenders (28). ...
Introduction
Understanding violent criminality and its impact on health and eventually the risk of premature mortality is important for efficient future interventions. This study aimed to explore the effect violent criminality had on premature mortality (i.e., death before the age of 65) among individuals with substance use disorders (SUDs).
Methods
The cohort was created by identifying all Swedish patients diagnosed with SUD between the first of January 2013 and 31st of December 2014. The individuals were split into three age categories.
Results
There were significant differences in standard mortality rates (SMR) in the cohort compared to the general Swedish population across the three age categories. We found differences between the SMRs for individuals convicted of violent and nonviolent crimes in the two younger age categories [age 15–29: violent crime (42.4) vs. non-violent crime (36.6), age 30–44: violent crime (28.0) vs. non-violent crime (23.0)]. A Cox regression analysis showed that each conviction of a violent crime increased the hazard ratio (HR) of premature mortality significantly [age 15–29; HR = 1.10 (95% CI: 1.04–1.17), age 30–44; HR =1.06 (95% CI: 1.03–1.09)]. After correcting for non-violent crimes, the increased risk only remained for the youngest group [HR = 1.06 (95% CI: 1.00–1.13)].
Discussion
This study suggests that criminal behavior constitutes a proxy for the risk behaviors that increase the risk of premature mortality among young individuals with SUD even after controlling for confounders. Longitudinal studies, examining time-dependent risks and protective influences, are needed to explain the different pathways and processes leading to the amplified premature mortality in the groups.
... The meta-analysis explains the prevalence of dementia in elderly inmates, estimating that 6.9% of people living in prison have dementia. The study reveals that older people with an offender background, especially those involved in severe criminal activities, are at a higher risk of both dementia and mild cognitive impairment (Solares et al., 2020;Solares et al., 2023). The study mainly emphasizes the link between alcohol use and crime levels among inmates. ...
Adjustment strategies of elderly prisoners living with dementia in central prisons of Tamil Nadu. There is a growing trend of ageing individuals who have been convicted of crimes and subsequently become elderly inmates. Many of these older inmates suffer from dementia within the central prisons of Tamil Nadu. According to a WHO report, there are 55 million people worldwide living with dementia. It leads to increased levels of depression, anxiety, and stress. Dementia also has profound physical, psychological, social, and economic impacts. The research utilizes both qualitative and quantitative data. The research design employs descriptive methods, and the sample consists of five central prisons conveniently selected from Cuddalore, Madurai, Trichy, Tirunelveli, and Vellore, with a total sample size of 213. The study aims to explore how recent assistive technologies can support and improve the lives of elderly inmates affected by dementia in central prisons.
... The development of any intervention should therefore consider the gendered health needs and voice of the service user within both these custodial settings (Lee et al., 2019;Simpson et al., 2021). Randomised controlled trials (RCTs) and evidence generated from systematic reviews present information on the prevalence of health (Solares et al., 2020) and social care needs (Lee et al., 2019) but highlight a lack of focused psychological interventions (Beaudry et al., 2021). Historically, systematic reviews have not reported exclusively on this older population (Stevens et al., 2018). ...
A growing number of older people remain in custody each year resulting in an increasing number of common mental and physical health concerns. No prior evidenced-based targeted psychological interventions support this group of people, and little is known about their needs, current activities, and health-related problems. We addressed these gaps through a project involving older prisoners, prison staff and a project advisory group in one male and one female prison site in the North of England. Systematic review evidence supports the development of an implementation tool kit addressing strategies to develop and deliver interventions that are sustainable, acceptable, and feasible in the prison environment. Prison strategies need to specifically address the needs of older people in custody. Relatively inexpensive activities, with some thought to delivery and flexibility have the potential to benefit common mental and physical health, increasing quality of life, reducing high economic and social cost, mortality, and reoffending in this age group.
... Most people in prison will be released back into the community, and successful reintegration of this group is a challenge with older people in prison having poorer physical and mental health, and higher unmet health and social needs compared to both younger people in prison, and older people in the community (Australian Institute of Health & Welfare, 2019; Lee et al., 2019;Solares et al., 2020;Stevens et al., 2018). This challenge is exacerbated by prison systems that have been traditionally focused on security rather than care, and the stereotypical 'young' inmate (Davies, 2011;Hwang et al., 2021). ...
Background
As populations age globally, cooperation across multi-sector stakeholders is increasingly important to service older persons, particularly those with high and complex health and social needs. One such population is older people entering society after a period of incarceration in prison. The ‘ageing epidemic’ in prisons worldwide has caught the attention of researchers, governments and community organisations, who identify challenges in servicing this group as they re-enter the community. Challenges lie across multiple sectors, with inadequate support leading to dire consequences for public health, social welfare and recidivism. This is the first study to bring together multi-sector stakeholders from Australia to form recommendations for improving health and social outcomes for older people re-entering community after imprisonment.
Results
A modified nominal group technique was used to produce recommendations from N = 15 key stakeholders across prison health, corrections, research, advocacy, aged care, community services, via online workshops. The importance and priority of these recommendations was validated by a broader sample of N = 44 stakeholders, using an online survey. Thirty-six recommendations for improving outcomes for this population were strongly supported. The key issues underlying the recommendations included: improved multi-stakeholder systems and services, targeted release preparation and practices that ensure continuity of care, advocacy-focused initiatives in the community, and extended funding for effective programs.
Conclusions
There is consensus across stakeholders on ways forward, with intervention and policy updates required at the individual, systems and community levels. These recommendations entail two important findings about this population: (1) They are a high-needs, unique, and underserved group at risk of significant health and social inequity in the community, (2) Multi-sector stakeholder cooperation will be crucial to service this growing group.
... Older people in prison are a unique and high-needs group for whom intersectionality of old age and imprisonment introduces additional challenges for reintegration [24][25][26]. First, social isolation is a commonly discussed consequence of digital illiteracy [23]. The heightened risk of social exclusion for prison leavers of all ages with poor digital literacy has already been recognized by researchers [27]. ...
... Older prisoners also have heightened and complex health needs. Older prisoners have significantly higher rates of chronic conditions compared to both younger prisoners and people of similar age in the community [26,[31][32][33]. Given their high and acute health needs, the shift towards electronic health systems, and online means of accessing health services and information in many countries creates an additional barrier for this group where digital literacy may not be adequate. ...
Background
Digital inequity refers to the inequality and exclusion experienced by those who lack the same opportunities or circumstances to support the development of digital skills as the rest of modern society. One rapidly growing and highly vulnerable group to digital inequity is older people attempting to reintegrate into society after release from prison, where technology access is limited. Inadequate support for digital skills in this population entails widespread consequences for public health, human rights, social welfare and recidivism. This qualitative study is the first to: examine digital inequity experienced by older people who have been incarcerated, understand the effects of this on reintegration to society, and begin informing appropriate solutions.
Method
Semi-structured interviews were conducted with N = 15 older people (mean age = 57) who had been released from an Australian prison in the last two years, regarding their experiences of digital literacy since leaving prison. Reflexive thematic analysis was conducted under a critical realist lens.
Results
The analysis resulted in six themes that illustrated the extent of digital inequity experienced by this population, and key challenges for improving digital literacy: ‘surviving in a digital world’, ‘stranger in a foreign world’, ‘questioning the digital divide’, ‘overcoming your “old” self’, ‘don’t like what you don’t know’, and ‘seeking versus finding help’.
Conclusions
The digital inequity that older people experience during and after incarceration creates additional challenges for a growing group who are already medically and socially marginalised. Prioritisation of this group for digital literacy initiatives both during incarceration and in the community will have benefits for their health, social and financial reintegration. Their unique life experiences should be considered in designing and delivering these programs. Simultaneously, prisons should be cognizant of the potential detrimental effects of technology restriction on reintegration and criminogenic outcomes.
... Older offenders are more likely to be diagnosed with dementia [4,5], physical illnesses [5,6], affective disorders [7], and affective psychoses [4] and less likely to have personality disorders [4,5], drug dependence [5,7], or schizophrenia [4] than younger criminal offenders. In a recent meta-analysis, the pooled prevalence of dementia in older offenders was estimated to be 6.9%, with high heterogeneity between studies [8]. Older adults with a criminal background, especially those with severe criminality, were at higher risk of both dementia and mild cognitive impairment [9]. ...
Background
Chronic heavy alcohol use may lead to permanent brain damage, cognitive impairment, and dementia. While the link between alcohol use and crime is strong, virtually no research exists on the criminal behavior of patients with the alcohol-related neurocognitive disorders of Wernicke-Korsakoff syndrome (WKS) and alcohol-related dementia (ARD).
Methods
The study population included all persons diagnosed with WKS (n = 1149) or ARD (n = 2432) in Finland in 1998–2015. Data on diagnoses, mortality, and crime were obtained from Finnish nationwide registers. Crime incidences were calculated 4 years before and after diagnosis. Crime types, incidences, and mortality were compared between disorders and with the general population.
Results
Altogether 35.6% of WKS patients and 23.6% of ARD patients had committed crimes in the 4 years preceding diagnosis, most commonly property and traffic crimes, followed by violent crimes. The incidence of criminal behavior decreased significantly after diagnosis; in WKS patients, the standardized criminality ratio (SCR), the ratio of observed to expected number of crimes (95% CI), was 3.91 (3.72–4.10) in 4 years before and 2.80 (2.61–3.00) in 4 years after diagnosis. Likewise, in ARD patients, the SCRs were 2.63 (2.51–2.75) before and 0.84 (0.75–0.92) after diagnosis. No significant difference emerged in mortality between persons with and without a criminal history.
Conclusions
Persons with alcohol-related neurocognitive disorders frequently engage in criminal behavior prior to diagnosis, especially multiple offending. In the 4 years before and after diagnosis, crime rates declined in a linear fashion, with a marked reduction after diagnosis.
... Addressing the health needs of incarcerated people has the potential to improve public health and safety. sentences) 24 were beyond the scope of this review. Meta-analyses that were restricted to a single country were also excluded because these would limit the generalisability of the findings. ...
Background: People who experience incarceration are characterised by poor health profiles. Clarification of the disease burden in the prison population can inform service and policy development. We aimed to synthesise and assess the evidence regarding the epidemiology of mental and physical health conditions among people in prisons worldwide. Methods: In this umbrella review, five bibliographic databases (Web of Science, PubMed, PsycINFO, Embase, and Global Health) were systematically searched from inception to identify meta-analyses published up to Oct 31, 2023, which examined the prevalence or incidence of mental and physical health conditions in general prison populations. We excluded meta-analyses that examined health conditions in selected or clinical prison populations. Prevalence data were extracted from published reports and study authors were contacted for additional information. Estimates were synthesised and stratified by sex, age, and country income level. The robustness of the findings was assessed in terms of heterogeneity, excess significance bias, small-study effects, and review quality. The study protocol was pre-registered with PROSPERO, CRD42023404827. Findings: Our search of the literature yielded 1909 records eligible for screening. 1736 articles were excluded and 173 full-text reports were examined for eligibility. 144 articles were then excluded due to not meeting inclusion criteria, which resulted in 29 meta-analyses eligible for inclusion. 12 of these were further excluded because they examined the same health condition. We included data from 17 meta-analyses published between 2002 and 2023. In adult men and women combined, the 6-month prevalence was 11·4% (95% CI 9·9–12·8) for major depression, 9·8% (6·8–13·2) for post-traumatic stress disorder, and 3·7% (3·2–4·1) for psychotic illness. On arrival to prison, 23·8% (95% CI 21·0–26·7) of people met diagnostic criteria for alcohol use disorder and 38·9% (31·5–46·2) for drug use disorder. Half of those with major depression or psychotic illness had a comorbid substance use disorder. Infectious diseases were also common; 17·7% (95% CI 15·0–20·7) of people were antibody-positive for hepatitis C virus, with lower estimates (ranging between 2·6% and 5·2%) found for hepatitis B virus, HIV, and tuberculosis. Meta-regression analyses indicated significant differences in prevalence by sex and country income level, albeit not consistent across health conditions. The burden of non-communicable chronic diseases was only examined in adults aged 50 years and older. Overall, the quality of the evidence was limited by high heterogeneity and small-study effects. Interpretation: People in prisons have a specific pattern of morbidity that represents an opportunity for public health to address. In particular, integrating prison health within the national public health system, adequately resourcing primary care and mental health services, and improving linkage with post-release health services could affect public health and safety. Population-based longitudinal studies are needed to clarify the extent to which incarceration affects health. Funding: Research Foundation–Flanders, Wellcome Trust, National Institutes of Health.
