Photo by Ackerman + Gruber

An elderly prisoner in hospice care. Photo by Ackerman + Gruber

Inmates 54 or older are the fastest growing age demographic in U.S. prisons. According to the U.S. Bureau of Justice Statistics, the percentage of inmates who are 54 or older jumped from 3% to 8% in two decades (1991–2011). Criminal justice experts say the increase is probably an effect of the longer sentences of 1980s antidrug laws.

A 2014 report by the Vera Institute of Justice asserts that “prisons and jails are generally ill-equipped to meet the needs of elderly patients who may require intensive services” for their medical conditions. Correctional staff often lack training for treating age-related illnesses and prisons typically don’t have the ability to monitor chronic health issues or employ preventative measures. Inmates are often sent off-site for medical treatment beyond what prisons can provide.

Older adults with physical disabilities or cognitive impairments are also more vulnerable to injury, abuse, and psychological decompensation in the prison setting. “[T]he prison environment is, by design, an extremely poor place to house and care for people as they age or become increasingly ill or disabled,” said a 2013 American Civil Liberties Union report. Even reliance on devices like wheelchairs, walkers, or breathing aids can present logistical hardships for inmates in facilities that were designed to accommodate a younger population.

This month’s CE feature, “End-of-Life Care Behind Bars: A Systematic Review,” takes a close look at end-of-life (EOL) care in U.S. prisons, reporting on its quality, key issues that facilitate or impede its delivery, and the ways prisoners function as caregivers to their dying peers. Here’s how the authors summarize the nursing implications of their review findings:

“EOL care for inmates is not solely a concern of nurses working within the prison setting. Nurses in many different settings may have the opportunity to provide care to dying inmates….By being aware of the issues dying inmates face within the walls of prison and advocating for best practices, nurses can help inmates at the end of life to have a dignified death.”

Though the government has taken recent strides to help relieve the U.S. prison system of the consequences of harsh drug sentencing laws—including a late 2015 release of approximately 6,000 federal prisoners, with more to come this year—the issue of providing adequate health and hospice care for older prisoners will persist. Read the full article for more on this topic.—Diane Szulecki, associate editor