The older prisoner and complex chronic medical care

Key points • Prisoners are often considered geriatric at the age of 50 or 55 years. • Plans should be made for the increasing use of health care services and medical care costs in the light of the growing number of older prisoners. • Consideration should be given to developing a geriatric, team-based model of care for older prisoners, particularly those with multimorbidity. • The medication lists of older adults should be regularly reviewed to avoid specific medications and to limit polypharmacy. • The physical and mental health status of older prisoners should be assessed by focusing on geriatric syndromes, such as sensory impairment, functional impairment, incontinence and cognitive impairment, which are common and may pose unique risks in prison. • Specific housing and prison environments should be evaluated and adapted as needed to ensure that older prisoners with limited function or mobility are not at risk for falls or social isolation. • The risks and benefits of screening tests or medical treatment plans should be discussed with older prisoners, taking into account life expectancy and the individual’s goals for care. • Approaches should be developed to address behavioural infractions among older prisoners with sensory, functional or cognitive impairment, and prison officers and staff educated as needed. • People who are independent in the community might be functionally impaired in prison. Older prisoners should be assessed for their ability to perform physical prison tasks such as standing to be counted, getting in and out of a top bunk or responding to alarms, and adaptations made as needed. • Prior to release from prison, an inmate should receive personalized discharge planning, including a bridging supply of medications, post-discharge medical appointments, summarized health records, a social support plan and age-specific community agency referrals. • Resources should be developed, either prison-based or community-based working in the prison, to provide seriously ill and dying prisoners with palliative and/or hospice care according to individual need.