Age versus function in assessing aging on 'the inside'.

Author:Filinson, Rachel
Position:Correctional Health Perspectives

Anational study by the American Civil Liberties Union (ACLU) recently reported that 246,600 individuals aged 50 years and older were imprisoned in the U.S., and predicted there would be 400,000 elderly inmates by 2030. (1) The expansion reflects a 1,300 percent increase since the 1980s. The exponential growth in the absolute number of the incarcerated elderly stems from the twin surges in both the prison and older populations due to longer sentences, mandatory sentencing, tighter parole policies and the "greying" of America. The growth in the relative proportion of inmates who are elderly in prison is also the outcome of increases in first-time offenders and serious crime among older adults.

The impact of more senior citizens "on the inside" has been viewed as largely negative for penal institutions and the aged inmates themselves. It has been suggested that the older inmates are vulnerable to health and safety risks in a prison environment and are at a disadvantage compared to their younger counterparts (and to the aged in the community). (2) Correctional systems have been confronted with (or at least bracing for) the spiraling costs of a burgeoning geriatric population. The declining mental and physical functions of an older population places greater demands on carceral health care so that facilities must be restructured and staff retrained to meet the growing demand. In recent years, assisted living, hospice and cognitive care units have opened in prisons in Iowa, Louisiana, New York, Washington and other states in response to the accelerated aging of their occupants. A 2008 national survey of corrections found that approximately 32 percent of the prison respondents reported having separate units within the prison dedicated solely to the management of older offenders. (3)

In order for correctional systems to appropriately introduce innovations for their older inhabitants, an accurate portrait of the unique hardships that aged inmates experience is required. Assessing the quality of life for those behind bars is made difficult from the outset by the conflicting definitions of "old" and "old inmate," and the variability of aging itself. Many academic studies (and the Bureau of Justice Statistics) have tended to select the age of 55 as a starting point for old age rather than the more conventional ages of 60 or 65. The choice for a younger age is based on the assumption that an older offender ages more rapidly due to an impoverished background, unhealthy lifestyle and deficient health care utilization. However, such a definition eliminates nearly half of the population of "older inmates" (ages 50-55) studied in the aforementioned ACLU report. No single definition of "older inmate" has been uniformly used. A meeting of 29 national experts in correctional health care, academic medicine, nursing and civil rights advocated the following: "A consistent, national definition of the older prisoner is of paramount importance ... to better quantify health care and custodial costs for this high-intensity population. A consistent definition would facilitate the creation and assessment of guidelines...

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