Elderly life sentence prisoners : physical and psychiatric morbidity, prison experiences and access to appropriate healthcare

Abstract

This thesis examines the psychiatric and physical morbidity of elderly life and indeterminate sentence prisoners. It explores contributory factors to their ill health, their prison experiences and access to the provision of current primary and secondary healthcare. A total of 181 prisoners aged 55 years and above were interviewed at two Category B prisons, HMP Kingston and HMP Albany. Prisoners' physical health was assessed by self-report and from the prison medical record. Three reliable and validated screening instruments were used to assess their cognitive status and functional ability, and in a small subset, (N=121) depressive symptoms were recorded. Current healthcare delivery is assessed using the principles and standards as defined in the National Service Framework for Older People, together with the efficacy of Clinical Governance. Qualitative data gathered at interview details prisoners' views on their overall experiences of health at different stages of sentencing, including access to and the provision of healthcare. Changes in criminal justice policy over the last decade have resulted in a significant increase in the number of elderly life/indeterminate sentence prisoners in England and Wales whilst the proposed partnership between the Prison Service and National Health Service (NHS) was to be fully operational from April 2006. Contemporary studies of elderly prisoners and their health care needs are limited in number and since psychiatric and physical morbidity regardless of type or origin is usually more common with increasing age, an ageing prison population should demonstrate a high incidence of multiple-pathology and morbidity. The results clearly indicate that elderly lifers demonstrate high levels of multiple physical health pathology and high rates of depressive illness although cognitive function is similar to age matched controls. Length of prison sentence, as a proxy for exposure to the prison environment, does not appear to relate to the burden of ill health. Ill health appears to be a characteristic of this population's demographics. As the Prison Service now embarks upon un-chartered territory having reached maximum population capacity policymakers will have to address the specific needs of those prisoners who will spend the remainder of their lives in prison as well as those who will be released in old age.

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