No Silver Lining: Evaluating the Need for Consistent and Appropriate Functionality Assessments Among the Increasing and Incarcerated Elderly Population

AuthorChivon H. Fitch,Matthew Logan,Brandon C. Dulisse
Published date01 December 2020
Date01 December 2020
Subject MatterArticles
No Silver Lining: Evaluating
the Need for Consistent and
Appropriate Functionality
Assessments Among the
Increasing and Incarcerated
Elderly Population
Brandon C. Dulisse
, Chivon H. Fitch
, and Matthew Logan
Despite a recent decrease in the U.S. prison population, the proportion of offenders who might
classify as elderly has increased exponentially during the same period—the likes of which have
created new challenges for administrators tasked with the supervision of, and provision of resources
to, this demographic. We review the current literature regarding functionality assessments for
elderly inmates to highlight the difficulty associated with using existing instruments that are not
specifically designed for the prison setting. We further argue that current efforts to identify elderly
inmates are lacking, resulting in the potential misclassification of an already vulnerable group. We
propose that future functionality assessments within correctional facilities incorporate a number of
age-related factors that focus less on chronological age and more on the mental, physical, and social
aging processes of incarcerated individuals.
aging, corrections, criminal justice policy
The number of older inmates sentenced and housed in state and federal correctional facilities within
the United States has precipitously increased over the last three decades. As recent data from the
Bureau of Justice Statistics demonstrate, the number of state and federal inmates aged 55 or older
increased by 250%from 1999 to 2014—a period during which the nation’s overall prison population
dropped (McKillop & McGaffey, 2018; see also Fellner & Vinck, 2012; Human Rights Watch
[HRW], 2012; Porter et al., 2016). Likewise, of the approximately 1.5 mill ion adults currently
Department of Criminology and Criminal Justice, Indiana University of Pennsylvania, PA, USA
Department of Criminology, The University of Tampa, FL, USA
School of Criminal Justice, Texas State University, San Marcos, TX, USA
Corresponding Author:
Chivon H. Fitch, Department of Criminology, The University of Tampa, Tampa, FL 33606, USA.
Criminal Justice Review
2020, Vol. 45(4) 484-501
ª2020 Georgia State University
Article reuse guidelines:
DOI: 10.1177/0734016820939620
housed in the state and federal system, those aged 55 and older constitute approximately 12%, which
represents a 300%spike in the older population since the turn of the century (Ahalt et al., 2013).
Research also indicates that the number of older inmates will continue to rise over the next decade,
particularly within states housing a larger proportion of the prison population. According to a 2012
report from the American Civil Liberties Union, the number of older prisoners is expected to eclipse
400,000 by the year 2030, representing a 4,400%increase since 1981 (ACLU, 2012). Similar patterns
have been documented in other countries such as Canada and the United Kingdom; a pattern referred
to by some scholars as the “graying of prison popu lations” (Aday, 2003; Kakoullis et al., 2010;
Stoliker & Varanese, 2017). Despite this trend, older inmates remain an understudied population in
the criminological literature; indeed, from an academic standpoint, they remain largely a “forgotten
people” (Vito & Wilson, 1985). This is problematic for several reasons, three of which are addressed
in this article.
The first reason is that older inmates represent a sizable, vulnerable group of individuals who pose
unique budgeting challenges for prison administrators regarding the provision of basic amenities and
resources, relative to their younger counterparts. This is especially true with respect to health care, and
research shows that older inmates are particularly susceptib le to chronic physical illnesses (e.g.,
dementia, cancer, arthritis, hypertension) and mental health disorders (e.g., depression, anxiety,
nervousness; Aday, 2003; Barry et al., 2017; Williams et al., 2006). For example, older inmates
average three chronic conditions and as many as 20%have been diagnosed with some form of mental
illness (Mitka, 2004). Likewise, recent data from the Bureau of Justice Statistics regarding the medical
problems of state and federal prisoners show that older inmates (over 50) are approximately 3 times
more likely than younger inmates to have chronic conditions or infectious diseases while in custody
(Maruschak et al., 2015).
These conditions often emanate from, and are exacerbated by, prolonged lifestyle choices such as
smoking, drug and alcohol abuse, poor nutrition, and risky behaviors such as unprotected sex and
needle sharing (Aday, 2003; Anno et al., 2004; Shimkus, 2004). Many of the aforementioned
conditions are also often comorbid/co-occurring which, in turn, increases the probability of health
care use by older inmates including, among others, services provided by pharmacists, X-ray and lab
technicians, infirmary bedding, and 24-hr nursing coverage—all of which have proven costly for
prison administrators across the country (Bishop & Merten, 2011; Chiu, 2010).
Reports also show that older inmates tend to incur higher per-inmate health care spending.
For instance, recent estimates indicate that the cost of health care nationally for older inmates per
year is 2–3 times higher than younger inmates (Luallen & Kling, 2014). Individual-level patterns
among older inmates are further buttressed by macrolevel trends. A 2015 audit by the Department of
Justice’s Inspector General revealed that, at the federal level, facilities with the highest proportions of
older inmates spent approximately 5 times more per inmate on medical care (and 14 times more per
inmate on medication), relative to facilities with the lowest proportions of older inmates (Office of the
Inspector General, 2015).
Parallel observations have been made at the state level. In a 2014 joint report from the Pew
Charitable Trusts and MacArthur Foundation, researchers found that of the 42 states surveyed, 40
witnessed a significant increase in the number of older inmates housed in their facilities; these states
also tended to incur higher per-inmate health care spending. For example, median per-inmate spend-
ing was 37%higher among the 10 states with the largest share of inmates aged 55 and older, such as
California and Texas, relative to the 10 states with the smallest share of older inmates (see also Hill
et al., 2006).
A second and related problem is the way in which administrators define older inmates, the likes of
which may intensify their preexisting vulnerabilities. As several scholars have noted, the concept of
age is qualitatively different (i.e., “accelerated aging”) in the prison setting compared to the general
population (Aday, 2003; Bingswanger et al., 2009; HRW, 2012). Yet, as we discuss in subsequent
Dulisse et al. 485

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