Do we care about old people behind bars, and should we?

I was interviewed on radio after conducting a literature review on services to the aged in prison in Australia and overseas. The mild shock jock host asked, “Why should we care about old prisoners? They are there for good reason. Why be soft on them?”

I could understand his listeners might not want to “waste” any compassion on aged sex offenders or murderers serving life in prison.

But what kind of society do we want to live in?

I made the point that an important indication of a humane society is how we treat our vulnerable. It is hard to think of anyone more vulnerable than an aged person in jail. Even he agreed.

A growing problem

The aged are the fastest growing segment of the prison population. Some contributing factors are mandatory minimum sentences, longer sentences for serious crimes and the reluctance to release some offenders back into society.

But how do we define being old? Generally this is defined as 50 years or older (45 years for indigenous). The reason is obvious if you think about the way most prisoners abuse alcohol and/or drugs, smoke, have poor diets 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 prisoners are diverse, including first time offenders, aged recidivists, those serving long or life sentences, and those incarcerated for short periods late in life.

It’s not easy to know where to start when trying to solve this problem. The aged in prison face many challenges, including the unsuitability of facilities for aged prisoners. Many prisons were built in the 19th century with younger offenders in mind. Problems include wheelchair accessibility to outdoor courtyards (often their only chance to be outside) and being disallowed walking sticks or frames because they might be considered weapons.

Other issues include who should change sheets for incontinent prisoners, and problems with frailty and mobility. One very serious issue for aged prisoners is the pervasive anxiety and fear they feel for their safety. This is accentuated if they are disgraced prisoners such as convicted child sex offenders.

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, such as education programs and exercise programs that target a higher level of fitness. In some prisons there is gym equipment but older prisoners may be given lower priority for access or pushed off.

There is also the potential for victimisation. This is especially the case with sex offenders, who tend to be older when convicted and are among the most stigmatised in our society. There have been reports of prisoners expecting payment to provide basic assistance to aged offenders.

What needs to be done

The picture isn’t completely bleak. The NSW justice report in 2015 talked about prisoners who had responsibility for common areas, called “sweepers”, generously supporting older prisoners.

In our review we identified examples of good practice. 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. There are also specialists who assist the incarcerated including optometry, podiatry, psychology, forensic psychiatry and geriatric physicians – but generally demand outstrips supply of services.

There are encouraging signs from international services. In the United Kingdom there are examples of specialised units in prisons. In the USA 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.

Overall there is a need for more research to inform policy. However, we experienced considerable difficulties in getting ethical approval to conduct research with the incarcerated.

There is an urgent need to resource research, initiate pilot programs, evaluate and change practice in line with evidence based research. However, the real barrier is: who cares? Arguably we don’t.

The literature review mentioned was sponsored by Aged Care Plus (Salvation Army).