Health care providers are increasingly managing the health of older persons who are currently or recently involved in the criminal justice system. These interactions occur in a variety of clinical arenas. Many correctional systems contract with community clinics to provide patients in their custody with specialty services, such as cardiology, neurology, and dialysis. When acute care is required that extends beyond the capacity of the correctional health care service in their prison or jail, patients are triaged to hospitals with prison/jail health care contracts or to the nearest appropriate community facility. As a result, people who are currently incarcerated are seen daily at community clinics, specialty clinics, hospitals, and emergency departments around the country. In addition, the number of older adults who are arrested, incarcerated, and released has increased markedly over the past decades. Consequently, community primary care providers are increasingly providing care to older adults who have been arrested for the first time and to older adults who have been released from jail or prison and are returning to the community.
Increased attention from the press, nonprofit advocacy groups, and policymakers has spurred a growing literature in health and criminal justice research aimed at addressing the rapid aging of the US correctional population. Studies have shown that currently and recently incarcerated older adults are a medically vulnerable group and that having a history of incarceration is an important life event for health care practitioners to consider when caring for older patients.
Prisoners age 55 years or older (“older prisoners”) are the fastest growing segment of the criminal justice population, both as a result of a wave of strict sentencing policies in the 1980s and 1990s and an increasing number of older adult arrests. Between 1993 and 2016, the number of sentenced prisoners age 55 or older increased nearly 300%, from 3% of the total state prison population in 1993 to 11.3% in 2016, and it has been estimated that older adults could compose up to one-third of the total US prison population by 2030 if current sentencing and release policies remain unchanged. Approximately 10% of individuals incarcerated in local jails are age 55 or older.
The percentage of new parolees who are older has also grown substantially. Between 1991 and 2012, the percentage of state prisoners released to the community on parole increased from 1.5% to approximately 6%. Patients transitioning from incarceration to the community in later life may experience severed relationships with family and friends and termination of housing and employment. In addition, reinstatement of government entitlement programs that are suspended during incarceration, including Medicare, Medicaid, Social Security Insurance, and Veterans Health Administration benefits, may take several months, causing considerable stress for many patients upon their return to the community. “Prisonization,” or excessive dependence on the institutional routines of prison life, is also common among older adults who have spent much of their ...