Older persons with dementia in prison: an integrative review

• Date: 07 August 2019
• Published date: 07 August 2019
• Pages: 1-16
• DOI: https://doi.org/10.1108/IJPH-01-2019-0007
• Author: Shelley Peacock,Meridith Burles,Alexandra Hodson,Maha Kumaran,Rhoda MacRae,Cindy Peternelj-Taylor,Lorraine Holtslander
• Subject Matter: Health & social care,Criminology & forensic psychology,Prisoner health,Sociology,Sociology of crime & law,Public policy & environmental management,Policing,Criminal justice

Older persons with dementia in prison: an

integrative review

Shelley Peacock, Meridith Burles, Alexandra Hodson, Maha Kumaran, Rhoda MacRae,

Cindy Peternelj-Taylor and Lorraine Holtslander

Abstract

Purpose –The number of prisoners over 55 years is increasing and many are at risk of developing dementia.

This has generated new responsibilities for prisons to provide health and social care for older persons.

The purpose of this paper is to synthesize the existing research literature regarding the phenomenon of the

health and social care needs of older persons living with dementia in correctional settings.

Design/methodology/approach –Using an integrative review method based on Whittemore and Knafl, the

inclusion criteria for the review are: articles written in English; a focus on some form of dementia and/or older

persons with discussion of dementia; to be set in a correctional context (correctional facility, prison and jail);

be derived from a published peer-reviewed journal or unpublished dissertation/thesis; and be a qualitative,

quantitative or mixed methods study. Based on those criteria, a search strategy was developed and

executed by a health sciences librarian in the following databases: Medline, CINAHL, Embase, PsychINFO,

Proquest Nursing and Allied Health and Web of Science; searches were completed up to April 2019.

After data were extracted from included studies, synthesis of findings involved an iterative process where

thematic analysis was facilitated by Braun and Clarke’s approach.

Findings –Eight studies met the inclusion criteria. Key findings of the eight studies include recognition of

dementia as a concern for correctional populations, dementia-related screening and programming for older

persons and recommendations for improved screening and care practices. Most significant is the paucity of

research available on this topic. Implications for research are discussed.

Originality/value –This paper identified and synthesizes the limited existing international research on the

health and social care needs of older persons with dementia living in correctional settings. Although existing

research is scant, this review highlights the need for increased awareness of dementia as a concern

among older persons living in correctional settings. As well, the review findings emphasize that enhanced

screening and interventions, particularly tailored approaches, are imperative to support those living with

dementia in correctional settings.

Keywords Social care, Prison, Dementia, Health care, Older adults, Integrative review

Paper type Literature review

Introduction

Internationally, the number of prisoners over 55 years is increasing disproportionately among

correctional populations (Moll, 2013). Reasons are multifactorial and include population ageing,

longer sentences and recent sexual abuse convictions for historical offenses (Moll, 2013). Many

of these older persons may be at risk of developing dementia while incarcerated (Christodoulou,

2012; Gaston, 2018) due to factors such as unhealthy diets, inactivity, smoking, social isolation,

depression, substance abuse, head injury and lower educational attainment (Maschi, Kwak, Ko

and Morrissey, 2012). Increasing numbers of incarcerated persons with dementia have

generated new responsibilities for correctional services to provide care for the aging population.

For prison staff, the invisibility of challenges for persons with dementia-related challenges (such

as changes in mood, depressive symptoms, confusion and disorderly behavior) presumed levels

of prisoner distress have been highlighted within prison inspection reports (HM Inspectorate of

Prisons for Scotland, 2017). The consequences of not properly diagnosing dementia for the

Received 30 January 2019

Revised 10 May 2019

21 June 2019

26 June 2019

Accepted 27 June 2019

Shelley Peacock is Associate

Professor and Meridith Burles

is Post-doctoral Fellow, both at

the College of Nursing,

University of Saskatchewan,

Saskatoon, Canada.

Alexandra Hodson is Instructor

at the College of Nursing,

University of Regina,

Regina, Canada.

Maha Kumaran is Head at the

Education and Music Library,

University of Saskatchewan,

Saskatoon, Canada.

Rhoda MacRae is Lecturer at

the School of Health and Life

Sciences, University of the

West of Scotland,

Dumfries, UK.

Cindy Peternelj-Taylor and

Lorraine Holtslander are

Professors, both at the College

of Nursing, University of

Saskatchewan, Saskatoon,

Canada.

DOI 10.1108/IJPH-01-2019-0007 VOL. 16 NO. 1 2020, pp. 1-16, © Emerald Publishing Limited, ISSN 1744-9200

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person include heightened fear and distress, denial of access to appropriate health care and

potential violation of human rights. For staff, lack of understanding has led to conflict,

inappropriate restraint and segregation, therefore escalating dementia-related distress

(Newcomen, 2016).

Dementia describes a collection of diseases that affect the brain and that are usually chronic or

progressive in nature (Alzheimer Society of Canada, 2017). Its prevalence shows a striking

association with age, but dementia is not a normal part of ageing. Disease progression causes

disturbance of memory and orientation uniquely in each person, shaped by underlying physical

and psychological health, personality, biography and social context. People with dementia can

experience greater difficulties than the level of impairment warrants because of disabling

environments and relationships (Spector and Orrell, 2010), with negative social experiences

prompting deterioration (Macaulay, 2018). Functional improvements can be achieved if people

with dementia are supported by enabling environments, interventions and care practices

(Laver et al., 2016; Vreugdenhil et al., 2012). As brain health deteriorates and the damage

progresses, people with dementia require increasing levels of support. Health care needs must

be addressed in tandem with psychosocial and spiritual needs, and careful attention paid to the

living environment and level of family caring where possible (Hanson et al., 2016; Tolson et al.,

2016). Thus, emphasis must be placed on interventions, environments and approaches that

enable and enhance quality of life. However, adopting a biopsychosocial-spiritual model of

dementia care that places the person and caring relationships at the center of health care practice

during advanced stages of the condition remains a challenge in many community care settings

across the globe (World Health Organization, 2017). This challenge may be even greater for those

working in secure environments. Nevertheless, there is potential in all settings, including prisons,

for staff to adopt approaches that enable and enhance quality of life.

Prisons and correctional facilities are among the most extreme, stressful environments known to

society and have not been built with an aging population in mind. The intensity of the physical and

interpersonal environments, including the emphasis on authority, overcrowding, lack of privacy,

architectural impediments and threats of violence and exploitation, make prisons particularly

challenging places for older persons (HRW, 2012). Structurally, the design and layout of most

prisons are also challenging for older persons, frequently requiring them to walk long distances

for meals, medication and health care services, while trying to keep pace with younger able-

bodied peers. Many aging incarcerated persons are unable to readily climb stairs, navigate dimly

lit corridors and uneven floors, pull themselves onto a top bunk or easily complete toileting

activities (Bedard et al., 2016; HRW, 2012). HRW (2012) concluded that accommodating older

persons in prison is a “daily game of musical chairs that can shortchange individual elderly

persons while it bedevils corrections officials”(p. 51).

For those with dementia, coping with these physical and structural challenges may exacerbate

stress, disability and disruptive behaviors. Changes in behavior, like shouting and repetitive

behavior, usually happen when a person with dementia feels confused or distressed and cannot

make sense of their surroundings (Alzheimer Society of Canada, 2017; Bedard et al., 2016).

Such behaviors are poorly understood by those around them, leaving persons vulnerable to

disciplinary responses from correctional staff or victimization from peers. Accommodating

persons with dementia therefore require adaptations and approaches based on understanding of

the condition, the person and how distressed behavior can present, enabling treatment that

extends beyond a custodial response (Williams et al., 2014).

Previous literature reviews

Several literature reviews have been completed that are relevant in some way to the phenomenon

of older persons in correctional settings. These reviews adopt diverse foci related to mental and

cognitive health in the prison population, and older persons who are incarcerated. For example,

some authors examine the prevalence of mental health disorders and cognitive impairment

across general prison populations (Brooke et al., 2018; Di Lorito et al., 2018; Kakoulis et al.,

2010), establishing dementia as one mental or cognitive health concern. Others identify

challenges facing older persons in general and specific to dementia across all phases of

corrections (Cipriani et al., 2017; Maschi, Sutfin and O’Connell, 2012; Stojkovic, 2007),

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