End-of-life care for older prisoners

The number of older prisoners in the UK has grown considerably over the last two decades. The rise can be largely attributed to convictions for ‘historical’ sexual offences, resulting in lengthy custodial sentences. Entry into prison is a catastrophic event at any age, but entry later in life can be particularly challenging. Many older prisoners will present with greater levels of chronic diseases, disability, decreased mobility and sensory impairment than younger prisoners. An individual convicted of a sexual offence may continue to be a significant risk to the public and so this, coupled with a lengthy sentence and age-related health problems, may mean that they are likely to die behind bars.

Over the last few years, prisons have been subject to increased scrutiny in relation to their management of the older population. In July 2020, the Justice Select Committee published its fifth report into the ageing prisoner population and recommended that a national strategy be developed to ensure prisons can properly respond to the needs of this population. The committee did recognise that reforming the management and care of this group is challenging. For example, the built environment may not be readily adaptable for those who have mobility problems, and access to health and social care provision from local authorities is inconsistent. To assist in the development and implementation of the strategy, I am fortunate to have been appointed by the Ministry of Justice as the first Specialist Advisor for Older Prisoners. As such, this enables me to put the learning from my 2018 Fellowship research to good use.

My Fellowship provided me with a unique opportunity to visit the USA and learn more about how they sought to manage older prisoners in their custodial system. The USA were the first to recognise the rise in older prisoners and have had to adapt to meet the needs of this cohort.

To reform the management and care of older prisoners in the UK, we will need to overcome a number of challenges – such as making accessibility modifications to buildings that are largely Victorian in design, and engaging health providers and local authorities to provide equitable standards of care, consistent with those in the general population.

Some key areas to focus attention on, over the next couple of years, should include:

1. Design activities that stimulate and engage older prisoners, provide them with social interaction and build a sense of community. Not all prisoners can engage in work, so they need activities that can help them to occupy their time, remain physically active and prevent cognitive decline.
2. Implement age-appropriate screening and assessment that will help staff to identify health and social care needs at an early stage (such as mobility issues and the potential for falls, and whether an individual can manage the activities of daily living). Early identification will assist in planning and providing care, as well as providing a baseline for ongoing monitoring and management decisions.
3. Develop peer assistance programmes that will support inclusion and build intergenerational understanding amongst the prison population. These programmes could also provide training and qualifications that would equip prisoners with skills that could improve their employment chances on release.
4. Develop staff knowledge and skills so they can understand how increasing age can affect an individual and what needs they may have (such as in the onset of dementia). Staff also need to know more about how to engage with charities, including how to contact them and what services they can provide.
5. For prisoners who are approaching end of life in prison, ensure that there is support for individuals to make wills and put their affairs in order, as well as make decisions about their care, including family involvement, aligned to the Dying Well in Custody Charter published in 2018.

I believe that it is possible for an individual to serve the sentence tariff and age well in prison. I would welcome contact with Fellows who would like to share their findings and assist in developing the evidence base of what works for older people in prison.