We urgently need to resource research and change practice in line with the evidence, writes Dr Bruce Stevens.
Older people are the fastest growing segment of the prison population.
There are many reasons for this including our ageing population and contributing factors such as mandatory minimum sentences (note the incarcerate rate in Northern Territory), longer sentences for serious crimes and the reluctance to release some offenders.
But how do we define being old? Generally this is defined 50 years or older (with 45 years for indigenous). This is not surprising since most in prison abuse alcohol and/or drugs, smoke, have poor diet and do not seek medical treatment. The result is bodies older than their years and an early onset of frailty, dementia and chronic conditions.
Older people in prison face many challenges. This includes the unsuitability of facilities for aged prisoners. Many prisons were built in the 19th century to ‘house’ younger offenders.
How does a person in a wheelchair get down stairs to enter the courtyard? How can he or she use a walking stick or frame when such objects might be considered potential weapons?
The issues continue with medical and mental health needs – naturally both are more prevalent inside. There is a need for age appropriate activities, when almost all programs target young offenders. Indeed, activity directors are often a soft target for staff cut backs. And there are difficulties associated with release and re-integration into society, especially with sex offenders (36 per cent of males over 50).
Victimisation is a problem. This is especially the case with sex offenders, who tend to be older when convicted and are among the most stigmatised people in our society. There have been reports of prisoners expecting payment to provide basic assistance to older offenders.
The picture, however, is not completely bleak. The 2015 report by NSW Justice, Old and inside: Managing offenders in custody talked about prisoners who had responsibility for common areas, called “sweepers”, generously supporting older prisoners.
In my literature review, which was sponsored by Aged Care Plus (Salvation Army) and assisted by Rebecca Alexander, examples of good practice were identified.
Modifications were made for the aged at Silverwater Women’s Correctional Centre including ramps and wider corridors.
The Kevin Waller Unit at Long Bay is an example of an integrated aged care unit. There is the Marlborough Unit at Port Philip Prison for intellectual disability.
And there are specialists who assist the incarcerated including optometry, podiatry, psychology, forensic psychiatry and geriatric physicians. However, demand generally outstrips supply of services. I have heard that New Zealand has programs for the aged in prison but unfortunately this has not been reported in journals.
There are encouraging signs from international services. In the UK there are examples of specialised units in prisons. In the US and Germany there are moves towards ‘nursing homes behind bars’ and palliative care. The True Grit program in Northern Nevada is a structured living program for the aged with healthy activities.
There is an urgent need to resource research, initiate pilot programs and evaluate and change practice in line with evidence-based research.
However, the real barrier is: who cares?
Dr Bruce Stevens is a clinical psychologist and Wicking Chair of Ageing and Practical Theology at Charles Sturt University.
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