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General Principles in Older Adults

Health care providers are increasingly managing the health of older patients who are currently or recently involved in the criminal justice system. These interactions occur in a variety of arenas. Many correctional systems contract with community clinics to provide prisoner-patients with specialty services, such as cardiology, neurology and dialysis. For acute care, prisoners are generally triaged to those hospitals with prison health care contracts, although in urgent or critical situations, a prisoner is brought to the nearest appropriate facility for care. As a result, current and former prisoners are seen daily at community clinics, specialty clinics, hospitals, and emergency departments around the country. Primary care providers are also increasingly taking care of patients who are arrested for the first time, as well as recently released older adults who are reintegrating into the community from prison or jail.

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 aging crisis in U.S. correctional systems. Studies suggest that currently and recently incarcerated older adults are a medically vulnerable group and that a history of incarceration is an important life event for health care practitioners to consider when caring for older patients.

Epidemiology

Prisoners age 55 years or older (“older prisoners”) are the fastest growing segment of the criminal justice population, both as a result of stricter sentencing policy and an increasing number of older adult arrests. Since 1990, the number of older prisoners in the United States has more than tripled, and it is estimated that older prisoners could comprise up to one-third of the total U.S. prison population by 2030 if current sentencing policies remain unchanged. The percentage of new parolees who are older is also growing. Between 1990 and 1999, the number of state prisoners released to the community on parole nearly doubled and is expected to continue to increase.

Physical Health

In general, older prisoners age prematurely and their physiologic age appears to be about 10–15 years older than their chronologic age. This “accelerated aging” can result from multiple factors—an unhealthy lifestyle prior to prison entry (eg, alcohol abuse, homelessness) and during incarceration (eg, poor diet, minimal exercise), limited lifetime access to preventive health care, and chronic stress during incarceration.

On average, older prisoners tend to have high rates of multimorbidity, geriatric syndromes, and functional impairments. Older prisoners have considerably higher rates of chronic illnesses, such as diabetes, hepatitis C, hypertension, and chronic obstructive pulmonary disease as compared with younger prisoners and age-matched community-living older persons, and they are also likely to take multiple medications. Geriatric syndromes, including vision and hearing impairment, falls, chronic pain, and urinary incontinence are also common in this population and may lead to unique challenges. For example, an older prisoner may be at increased risk for physical ...

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