Prisons ill-equipped to manage the growing challenge of older inmates with dementia

18 February 2013
  • Dementia is a growing problem for prisons with the increasing population of older people serving sentences

  • Most prisons are unprepared for a rising sub-population of prisoners with dementia

  • The issue is largely overlooked at policy level

Policy makers and others working in the field of criminal justice including prison staff will be able to find out more about managing male offenders with dementia thanks to the new report Losing Track of Time, Dementia and the Ageing Prison Population, Treatment Challenges and Examples of Good Practice published by the Mental Health Foundation today.

In recent years, the number of older men serving prison sentences has risen to unprecedented levels. This growing population brings with it an abundance of healthcare needs, unfamiliar to many prisons more used to managing younger people. Dementia is acknowledged as one of the most pressing problems facing health and social care systems yet very little has been done to tackle the management and treatment of inmates with dementia. As a result, an independent research programme, funded by Robert A. Fox Leadership Program at the University of Pennsylvania, was conducted by Adam Moll, supported by the Mental Health Foundation.

The report gathered existing research on managing and treating male offenders with cognitive impairment and goes on to identify  and share examples of good practice employed by 14 prisons worldwide. The establishments were invited to complete a comprehensive survey detailing their current policies and provisions for older prisoners and any desired additional resources to better manage prisoners with dementia.

Adam Moll says:

“Dementia is an issue slipping under the radar of criminal justice systems. Prisons are designed to accommodate a younger population yet, as the effects of decades of punitive sentencing policy continue to be felt, officers and healthcare teams are increasingly confronted with issues associated with later life that most are ill-equipped to manage. Diagnosing dementia in such a regulated environment is extremely challenging, particularly as most staff lack the requisite training or experience, so it is difficult to gauge levels among the current prison population. However, it is almost inevitable that rates will rise significantly as the age demographic behind bars continues to shift, presenting a major threat to existing resources. The establishments participating in this research offer a range of innovative examples of good working practice with offenders with dementia that should be considered by policymakers and practitioners alike.”

Toby Williamson, Head of Development & Later Life says:

“The ageing prison population is generating new challenges, including a rising number of male inmates with dementia. Like other medical conditions associated with later life this affects prisoners at an earlier age than the rest of the population. Not only is this potentially very distressing for prisoners with dementia but it also presents most prison regimes with difficult and unfamiliar problems to deal with. Being in prison and constantly confused and forgetful is undoubtedly very unsettling while on the other hand managing this behaviour as a prison officer while trying to ensure security and good behaviour among inmates must be challenging. This ground-breaking report not only identifies some of these challenges but provides examples of good practice and makes recommendations to address these issues.”

RECOOP (Resettlement and Care for Older ex-Offenders and Prisoners) says:

“We welcome this report and insight in to how differing prisons across the world are tackling the challenges of dementia amongst prisoners within their care. We hope this will encourage more prisons in the UK to review their own procedures and practices relating to dementia care and offsetting dementia activities. There is building momentum across the Criminal Justice arena to increase these services and those offered to older prisoners. There are local organisations across all regions that can offer the support, staff, training and expertise to prisons looking to work in collaboration to increase dementia awareness and services. RECOOP has proven how innovative joint working can really work and hope that we can support other organisations to develop services with prisons through our capacity building project, grant funded by the National Offender Management Service (NOMS).”

  • The report highlights a number of key findings and goes on to make a series of recommendations to tackle the issues
  • The older offender population presents a wide range of challenges to prisons in the delivery of health and social care
  • Inmates with dementia bring added issues as the early symptoms are often difficult to identify
  • With a few exceptions, prisons lack the resources to meet these challenges without support
  • While the number of older inmates continues to rise, prisons around the globe are suffering from the impact of government cuts
  • The impact of these cuts on personnel, regimes and staff morale means correctional systems are increasingly less able to prepare for a growing problem
  • There are some signs that dementia is beginning to gain recognition as a growing issue for prison health care.


Routine screenings for older prisoners

Dementia screening tools, , should be adopted by prisons as a low-cost method of signalling when prisoners require further support.

Staff training

Staff must be equipped with the knowledge and confidence to manage prisoners with dementia. Dementia awareness training should be provided to security officers and a designated lead for older prisoners in the health care team should be appointed.

External agencies

Our survey highlighted the crucial value of using outside agencies. Growing prison populations, together with the pressure to be financially efficient, will make many criminal justice systems increasingly dependent on external agencies and the voluntary sector in order to cope with the additional strain and deliver education, training and other purposeful activities to prisoners.

Promote information sharing and adopt clear procedures

The surveys revealed communication deficiencies in some establishments, with coordination between security and health care staff insufficient or absent. A clear referral process, particularly if combined with the staff training recommended, could considerably improve a prison's ability to diagnose dementia and intervene early.

Modifications to living environment

People with dementia are highly sensitive to their surroundings. Adaptations to their physical environment are needed to reduce anxiety and help them to maintain their independence.

Download the Losing Track of Time report for free.