Session Spotlight: Incarcerated Older Adults Face Unmet Needs, Barriers to Care

Older adults in carceral settings have higher rates of depression, posttraumatic stress disorder, cognitive decline, chronic diseases, and disability compared with their peers who live in the community. Addressing these challenges will take a multifaceted approach, according to experts who spoke at the Annual Meeting.

“Incarceration is fundamentally incompatible with good health, but at the same time, incarcerated people have a remarkable ability to survive and find joy and purpose in their lives,” said Madeleine Lipshie-Williams, M.D., an assistant professor of psychiatry at the University of Pittsburgh School of Medicine. “I think we can consider both of those things together.”

Karen Dionesotes, M.D., M.P.H., an assistant professor of psychiatry at Icahn School of Medicine at Mount Sinai, noted that adults ages 55 and older are the fastest-growing segment in U.S. prisons, and they will make up more than a third of the prison population by 2030. She framed the needs of this population in terms of both physical challenges in the prison environment, such as having to climb up into bunk beds, and mental and social challenges, such as loneliness or a dearth of education and work programs geared toward older adults.

“There is a really heavy burden carried by older [incarcerated] adults due to accelerated aging and weathering, which is attributable to … prolonged coping demands and other physiological wear and tear on bodily systems,” Dionesotes said. “People who are confined to prison have the biopsychosocial profiles similar to non-incarcerated persons 10 years older.”

Dhruv Gupta, M.D., M.S., a forensic psychiatrist at NYC Health + Hospitals, discussed barriers to health and social well-being in older incarcerated adults. “One of the biggest barriers is a lack of geriatricians and specialists to address age-specific health issues,” Gupta said. “There’s inadequate preventive [care] for cardiovascular disease and [inadequate] cancer screenings. Conditions like diabetes, arthritis, and dementia are just not sufficiently prioritized.”

He cited the need for geriatric training for not only clinicians but also other staff members who frequently interact with the incarcerated population, such as correctional officers. Other recommendations to promote social well-being include environmental modifications, peer support programs, and age-appropriate educational or recreational programs.

Psychiatrists who wish to work in the correctional system will have to contend with bureaucracy and the requirements of the facility’s security staff, according to Michelle Joy, M.D., an assistant professor of psychiatry at Perelman School of Medicine at the University of Pennsylvania. “We have to be realistic about who’s in charge at the end of the day, because there are [multiple] committees and guidelines,” Joy said.

She also noted the landmark case Estelle v. Gamble, which asserts that the correctional system cannot have deliberate indifference to a serious medical condition, because it would be a violation of the Eighth Amendment as “cruel and unusual punishment.” ■

(Image: Getty Images/iStock/EvgeniyShkolenko)