Up to date service evaluations and needs assessments would be useful in caring for elderly prisonersBMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e7578 (Published 13 November 2012) Cite this as: BMJ 2012;345:e7578
- Annie Bartlett, reader in forensic psychiatry1,
- Sandra Evans, consultant in general and old age psychiatry2
We disagree with some of Ginn’s conclusions about elderly prisoners.1
The prison service calls 50 years and over “elderly”; this is stigmatising and inadvertently reduces expectations. External health services call over 65 year olds “older adults,” and the Prison Reform Trust suggests that “older” starts at 60 years.2 Prisoners may be functionally older, but imprisonment can reduce risks associated with unhealthy lifestyles. Excess alcohol, illicit drug use, poor diet, no exercise, and erratic adherence to drugs for long term conditions contribute to premature ageing and are common in offenders. Nacro suggests that the structure and discipline of prison alters decline.3 Ironically, older prisoners may fare better in prison than when free.
Ginn argues that “older prisoners” are specifically vulnerable. Age may contribute, but the nature of some offences (such as child sex offences) may result in bullying. Prisons are required by law to make reasonable adjustments for disability, regardless of the person’s age. Diagnosing dementia is important,4 and care pathways must work to avoid the detention of prisoners with moderate or severe dementia.
NHS local commissioners have had six years to introduce healthcare based on the principle of equivalence.5 Electronic records have improved the efficient transfer of prisoner information when prisoners move. Primary care trusts take commissioning seriously. Prison contracts can be closely scrutinised through partnership boards and the use of extensive reporting frameworks, to ensure that key health targets are attained. This is not to be complacent. Rather, it suggests that up to date service evaluations and national needs assessments would be timely. This would enable the current state of healthcare delivery to this growing group of older adults to be assessed and cease reliance on piecemeal and sometimes dated research.
Cite this as: BMJ 2012;345:e7578
Competing interests: AB is clinical director (joint) of Offender Care, Central and North West London NHS Foundation Trust, which provides healthcare in several prisons in London and the South East.