Dementia in the incarcerated population: a retrospective study using the South Carolina Alzheimer’s disease registry, USA

• DOI: https://doi.org/10.1108/IJPH-08-2021-0071
• Published date: 27 February 2023
• Date: 27 February 2023
• Pages: 109-124
• Subject Matter: Health & social care,Criminology & forensic psychology,Prisoner health,Sociology,Sociology of crime & law,Public policy & environmental management,Policing,Criminal justice
• Author: Margaret Chandlee Miller,Glaucia Salgado,Nicole Nasrallah,Jennifer Bronson,Charles P. Sabatino,Jacobo Mintzer

Dementia in the incarcerated population:

a retrospective study using the South

Carolina Alzheimer’s disease

registry, USA

Margaret Chandlee Miller, Glaucia Salgado, Nicole Nasrallah, Jennifer Bronson,

Charles P. Sabatino and Jacobo Mintzer

Abstract

Purpose –Research about the prevalence of dementia among older adults in the incarceration system i s

currently lacking, and further investigation is warranted. Considering the high leve l of healthcare needs, unique

behavioural issues and difficulty to rehabilitate within the system due to its punitive approach and lack of

effective rehabilitation programs, further investigation is warranted to characterize and determine the number of

incarcerated older adults with dementia. The purpose of this study is to estimate the prevalence of individuals

with dementia in the prison system while also describing the incarceration, demograp hic and offence-related

characteristics of this unique population.

Design/methodology/approach –South Carolina (SC) Alzheimer’sDisease and Related Dementias Registry

(1992–2016) and South Carolina Department of Corrections (SCDC) data (Fiscal years 1992–2019) were cross-

referenced. The prevalence of Alzheimer’s disease and related dementias (ADRD) cases in the corrections

system was calculated using South Carolina Alzheimer’s Disease (SC AD) SC ADRD Registry and SCDC data.

Pearson’s correlation coefficients were calculated to determine strength and direction of relationships between

year of incarceration and frequencyof ADRD cases both prior to and after incarcerations, respectively. Significant

differences by age group, race, gender and dementia type were determinedusing a two-tailed pooled t-test and

Bonferroni approach where appropriate.Count data for types of crimes committed are also presented.

Findings –The linkage showed that there were 2,171 individuals within the SC AD Registry who have been in

the corrections system, about 1% of those in the Registry. Of these individuals, 1,930 cases were diagnosed with

ADRD after incarceration and 241 prior to incarceration. In 2016, 317 individuals wit h ADRD were incarcerated.

For ages 55 and above in South Carolina, the prevalence of ADRD is 6 .7% in the general, non-incarcerated

population compared to 14.4% in the incarcerated population. Additional result ssh owed that those diagnosed

with ADRD between 55 and 65 years of age had a significantly lower mean age a t first incarceration (34.6 years

of age) than those diagnosed between 66 and 74 years of age (55.9 years of age), indicating that those

incarcerated earlier in life had an earlier dementia diagnosis. Addit ionally, African Americans had a significantly

lower mean age at first incarceration (43.4 years of age) than Whites (46.2 years of age) and femal es had

significantly lower mean age at first incarceration (42.9 years of age) t han males (45 years of age). When

investigating trends, results showed a significant positive linear associat ion between year and frequency of

ADRD diagnoses (p-value <0.05) for those with ADRD diagnosis prior to incarceration and a significant

decreasing linear association (p-value <0.0001) in the number of individuals with an ADRD diagno sis after

corrections. Findings also showed that a large percentage of older adults with ADRD in prison did not commit a

violence offence.

Originality/value –This study links a population-based Alzheimer’s disease registry and state-wide

correctionsdata to estimate the prevalenceof individuals with dementia in the prisonsystem. This linkage

presents an opportunity to fill in significant gaps and contribute to the body of literature on dementia

among peoplein prison in the USA.

Keywords Elderly prisoners, Dementia, Incarceration, Alzheimer’sdisease, Prisoners with dementia, Registry

Paper type Research paper

(Informationabout the

authorscan be found at the

end of this article.)

Received 1 August 2021

Revised 11 March 2022

27 April 2022

5 August 2022

6 December 2022

Accepted 9 December 2022

DOI 10.1108/IJPH-08-2021-0071 VOL. 19 NO. 1 2023, pp. 109-124, ©Emerald Publishing Limited, ISSN 1744-9200 jINTERNATIONAL JOURNAL OF PRISONER HEALTH jPAGE 109

Introduction

Dementia has been understood as a biomedical phenomenon strongly influenced by

personal histories, social interactions and contexts. Although not considered a normal part

of aging, individuals become at higher risk of developing dementia as they age (Corrada

et al., 2010;Doyle and Rubinstein, 2014). Dementia is most commonly diagnosed in

individuals over the age of 65, but earlier onset is possible in individuals as early as their

mid-20s (Vieira et al., 2013). Research about the prevalence of dementia among older

adults incarcerated in state prison is currently lacking. Due to unique incarceration trends

such as mass incarceration comprised by racial disparities, a rise in both men and women

in prison, and a growing number of aging incarcerated individuals, the US prison system

faces challenges to provide services to its aging population, particularly among those with

symptoms of dementia. Consideringthe high level of health care needs, unique behavioural

issues and difficulty to rehabilitatewithin the system due to its punitive approach and lack of

effective rehabilitation programs, further investigation is warranted to characterize and

determine the number of incarcerated older adults with dementia. This study seeks to use a

state-wide Alzheimer’s and related dementias registry and existing incarceration data

sources to calculate the prevalence of dementia among older adults in the state prison

system.

Incarceration trends in the US population

The USA is the largest incarcerator globally, holding almost 20% of the entire incarcerated

population in the world. Criminal justice policies based on narratives of criminal behaviour

and disproportionate imprisonmentof minorities are critical factors that influenced the mass

incarceration phenomenon observed in the USA (Cahalan, 1979). Nowadays, such

disproportion still exists. In many Americancities, rates of incarceration are particularly high

among Black people and Native American (Reisner et al.,2014). The rate of incarceration

among Black Americans is five times higher than among White Americans. Similarly, Latinx

individuals are 1.3 more likely to be incarcerated than non-Latinx White (The Sentencing

Project, 2021). When considering gender, men compromise the highest percentage of

individuals in prison compared to women, 93% and 6.3%, respectively (The Sentencing

Project, 2022). Among Black malewho go to prison, sentences are about 20.4% longer than

similarly situated White incarcerated persons while females from all races tend to receive

shorter sentences (United States Sentencing Commission, 2017). Adding the number of

men and women from different ages and races, the USA currently has 1.8 million people

living in the US prison system (Kang-Brownet al., 2021).

Older adults in prison

Older incarcerated people make up the fastest-growing demographic in the US prison

system. Between 1993 and2013, the number of people 55 or older in state prison increased

from 26,300 to 131,500, an increase of 400%. Consequently, the incarcerated older adults

went from 3% to 10% of the totalstate prison population (Carson and Sabol, 2016).

In contrast, the incarceration rate for young adults ages 18 to 24 decreased by 25%,

changing from 752 to 563 between 1993 and 2013 (Carson and Sabol, 2016). According to

Widra (2020), individuals aged 55 or older presently comprise 7% to 16% of incarcerated

persons, depending on the state.It is estimated that older people in prison (age 55 or older)

will represent a third of the incarcerated population in the US prison system by 2030 (The

Osborne Association, 2018). The aging population living in prisons has been categorized

into two main profiles: individuals who have been incarcerated as a young adult and are

aging in prison as a result of a lengthy prison sentence, and those who are first-time

incarcerated persons admitted as older adults (Blowers and Blevins, 2015;Cipriani et al.,

2017). Alongside with the increase in the number of older adults in prison, incarcerated

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