Prisons not adapting to needs of aging inmate population

March 13, 2006

The prison inmate population is aging rapidly, but prisons have not yet adapted to the physical and mental needs of geriatric prisoners, according to a study conducted by researchers at the San Francisco VA Medical Center.

The study, which analyzed questionnaire responses by 120 female prisoners aged 55 or older in the California prison system, appears in the April 2006 issue of the Journal of the American Geriatrics Society. It is currently available in the Online Early issue of the journal.

"Prison is a not a safe place for vulnerable older people to be," says lead author Brie Williams, MD, a geriatrician at SFVAMC. "Prisons aren't geared to the needs and vulnerabilities of older people. In the prison environment, there are a number of unique physical tasks that must be performed every day in order to retain independence. They're not the same tasks that are called for in the community."

According to the study, while many aging prisoners share the same challenges faced by their counterparts in the community - such as bathing, dressing, and using the bathroom - they also must perform activities of daily living that are specific to prison. These include dropping to the floor rapidly when an alarm goes off, climbing onto a top bunk, hearing orders from correctional officers, standing in line to be counted, and walking to the dining hall, which may be a considerable distance from a prisoner's cell

"When an alarm goes off, every inmate has to get down on the floor immediately, in order for the staff to maintain control of the inmates. Even some people in wheelchairs are expected to get out of their chairs and onto the floor," explains Williams, who is also a fellow in aging research at the University of California, San Francisco. "You can imagine that for someone who has trouble walking, or with brittle bones, a very quick drop to the floor can be quite hazardous. And alarms may sometimes go off several times a day."

The study found that 69 percent of the women reported that at least one prison activity of daily living was very difficult to perform. Sixteen percent reported needing help with one or more daily activity - twice the rate of the general U.S. population aged 65 and older - and 51 percent reported falling in the previous year.

The women were also less healthy than the general population, reporting significantly higher rates of hypertension, asthma or other lung disease, and arthritis.

According to Williams, the issue of physical independence for older prisoners is becoming increasingly urgent. She observes that the prison system was never designed or built for geriatric prisoners, yet the population of older prisoners in the United States is increasing "exponentially," with the number of geriatric female prisoners in California up 350 percent in the last decade. "It is projected that by 2030 ... one third of the U.S. prison population will be geriatric," write the study authors.

Williams says that since the study was conducted, she has visited a number of men's prisons throughout California, spoken with correctional officers and prisoners, and concluded that many of the same issues of aging and safety apply to male prisoners as well. She says that she would like to see the present study replicated and validated by a study conducted in men's prisons.

For the short term, Williams makes several recommendations that she says would help make prisons safer for older inmates: "Every prisoner 55 and over should be assigned to a bottom bunk unless the person specifically requests otherwise, and should be in a cell with grab bars near the toilets. They should be housed closer to the dining hall, and given more time to drop to the floor during alarms. There should be grab bars in showers, and rubber mats on shower floors."

She points out that these modifications would make prison safer for younger inmates with physical impairments as well.

Williams also expresses broader, more long-term concerns. "As three-strikes laws and mandatory minimum sentencing laws become stricter, more and more people will be spending their entire lives, including old age, in prison," she observes. "In addition to the economic burden, the incarceration of the elderly poses fundamental questions of how we as a society treat our elders. What do we, as a society, want to do with a prisoner who is so demented he doesn't remember his name, or who has had a stroke and is completely paralyzed? As a physician and as a citizen, I think we need to ask how we can make society safe but also have a reasonable system of incarceration."

Currently, Williams is working with a consulting team for the California Department of Corrections and Rehabilitation on assessing the needs of older prisoners and suggesting ways to make the California prison system safer for geriatric inmates.
Co-authors of the paper are Karla Lindquist, MS, of UCSF; Rebecca L. Sudore, MD, of SFVAMC and UCSF; Heidi M. Strupp and Donna J. Willmott, MPH, of Legal Services for Prisoners with Children; and Louise C. Walter, MD, of SFVAMC and UCSF.

The research was supported by funding from the Department of Veterans Affairs and a grant from the National Institute on Aging that was administered by the Northern California Institute for Research and Education. Design of the health survey and recruitment of subjects were sponsored by Legal Services for Prisoners with Children.

UCSF is a leading university that consistently defines health care worldwide by conducting advanced biomedical research, educating graduate students in the life sciences, and providing complex patient care.

The mission of NCIRE is to improve the health and well-being of veterans and the general public by supporting a world-class biomedical research program conducted by the UCSF faculty at SFVAMC.

University of California - San Francisco

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