Going grey behind bars: meeting the care needs of older people in prisons

The population is ageing. People are living longer, and are in need of greater levels of care than ever before. But how is this increase in life expectancy and demand for care being met in prisons? Our prison population is also ageing, at a time when the sector is under increasing pressure, low staff numbers, higher levels of prison violence and disorder, and poor, crowded living conditions. In an environment which is largely designed to support young, able bodied men, how are prison staff and care teams liaising to help meet the needs of older prisoners?

A care plan for ageing prisoners

A report published in 2017 by the Scottish Prison Service called for a specific care plan for ageing prisoners to react to and provide planning to reflect the change in demographic of the prison population. The report found that between 2010 and 2016, the number of men aged over 50 in Scotland’s prison population rose by more than 60%, from 603 to 988. According to a Ministry of Justice report on prison population, the number of inmates aged over 50 is projected to grow from 12,700 to 13,900 by the end of June 2020, a rise of 9.5%, while the number of over-60s behind bars will grow by 20% from 4,500 to 5,400 over the same period.

In July 2017 Prisons and Probation Ombudsman produced the Thematic Review: Older Prisoners, which stated that HM Prison and Probation Service needs a national strategy to address the needs of the increasing numbers of elderly prisoners. It highlighted six areas where lessons still needed to be learned: healthcare and diagnosis, restraints, end-of-life care, family involvement, early release and dementia, and complex needs.

The difficulties older prisoners face on prison estates are far reaching. Not only are there physical barriers to moving around and living within a prison environment, but the increased mental health and social care burden is significant, as well as the potential need to begin end-of-life care. Many prison inmates suffer from multiple, longstanding and complex conditions, including addiction, and these conditions are exacerbated by a phenomenon known as “accelerated ageing”, which suggests that prisoners age on average 10 years faster than people of the same age in the wider community.

While some prisons have effective care plans which allow older prisoners to live with dignity, often older prisoners rely on the goodwill of officers and fellow inmates to meet the gaps in their care needs. And while in England and Wales the Care Act means that, a statutory requirement to provide care lies with the local authority within which the prison is located, this is not a guarantee. Calls have been made for care planning in prisons to become more robust, with minimum standards of care and a clear pathway of delivery, with accountability and responsibility of specific bodies being made explicit.

 

Prison staff, care teams and the NHS in partnership

Any care planning for older people needs input from a number of different sources, and care planning for older people in prison is no different. It will require input from professionals across health, social care, and housing and the criminal justice system as well as wider coordination support and legislative and financial backing from central and local government.

Prisoners with physical disabilities or diseases such as dementia need specialist care at a level that standard prison officers cannot give. Research has suggested that prison staff are being expected to shoulder this extra burden, often having to perform beyond their duty to care for and look for signs of degeneration in prisoners, particularly those who show signs of Alzheimer’s and dementia.

A number of research studies have looked at the provision of training and the use of additional, multi-agency staff to try to bridge the gap in care for elderly prisoners. In 2013 a review was conducted of multiple prisons, including some in England, the USA and Japan, which examined the training available on each estate for prisoners with dementia and similar conditions.

A number of schemes have been trialled, including extra training for staff, the allocation of specific wings or cells adapted to cater to the specific needs of older and vulnerable prisoners, and the use of peer to peer buddying or befriending services to help with care and support. Some prisons have also trialled the introduction of “dementia champions” to identify and support those with early signs of dementia or Alzheimer’s.

Extra challenges on release

As well as social care needs inside prison, specific rehabilitative needs of older prisoners being released from prison is also something that prison charities and reform bodies are keen to raise onto the agenda. A report from the Prison Reform Trust in 2016 highlighted the challenges of rehabilitative and parole needs of older prisoners, commenting that older people released from prison are being “set up to fail” by a lack of adequate provision to meet their health and social care needs on release. It highlights the limited and inconsistent housing, employment, debt and substance abuse advice available specifically for older offenders and suggest that their particularly vulnerable position puts them at risk of serious harm or reoffending.

Final thoughts

The population of older prisoners in our prisons is growing, and it is clear that a comprehensive strategy is needed to ensure that the specific, and at times unique care needs of these prisoners are met. This will mean greater cooperation from social care, health and criminal justice agencies, but will also mean reassessing how we think about social care, how it should be delivered and funded. The needs of older prisoners go beyond physical adaptations, to mental health, dealing with social isolation, the onset of chronic illnesses and at times the provision and planning of end of life care.

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If you enjoyed this blog, you may also be interested in our other articles:

Helping people with dementia to live well through good urban design

Planning for an ageing population: some key considerations

Co-production in the criminal justice system

Planning for an ageing population: designing age-friendly environments

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In the UK, increased life expectancy means that people can expect to live longer than ever before.  While this is clearly good news – and has a number of potential economic benefits – the shift in demographic structure towards an increasingly elderly population has a number of significant implications.

Following Wednesday’s blog post on the implications for planning of the ageing society, today we highlight some of the ways in which planners can help support the creation of age-friendly environments by influencing the design of the urban environment, transport, housing and the wider community and neighbourhood.

The importance of an age-friendly environment

Age-friendly environments are underpinned by three key factors:

  • Safety
  • Accessibility
  • Mobility

Such environments impact positively upon the quality of life of older people by enabling and encouraging physical activity and social connection.  This in turn has a beneficial impact upon their physical and mental health, and helps to tackle social exclusion – which can be a particular problem among older people.

Conversely, as the World Health Organisation (WHO) notes, poor design can have a negative impact:

“older people who live in an unsafe environment or areas with multiple physical barriers are less likely to get out and therefore more prone to isolation, depression, reduced fitness and increased mobility problems”

Creating an age-friendly environment

There are a number of areas in which planners may have an influence on the provision of age friendly environments:

  • the design of the urban environment
  • supporting appropriate transport options
  • the provision of age-appropriate housing
  • adequate neighbourhood and community facilities

Urban environment

In terms of the urban environment, green spaces are an integral aspect of age friendly environments.  Access to green spaces supports the physical activity of older people, makes a positive contribution to their health and wellbeing, and provides opportunities for social interaction.

Research has found that green spaces that are poorly maintained, perceived as unsafe, or contain potential hazards resulting from the shared use of parks and walkways are less likely to be used by older people.  Suggestions for improvement include the creation of small, quieter, contained green spaces and improved park maintenance.

Paths, streets and pedestrian areas are also a key planning consideration. Older people have greater reliance on pedestrian travel and are more likely to be physically active in areas that are pedestrian friendly.  The perception of safety also influences use – therefore, lighting and road safety measures can help to enhance this.

Adequate public toilet provision will also become an increasingly important issue.  Recent cutbacks have resulted in many public toilets being closed – in their review of public toilet provision in the UK Help the Aged noted that provision was sporadic. They found that the majority of older people had experienced difficulties in finding a public toilet, and even when toilets were found, they were often closed.

Transport needs

Responding to the transport needs of different groups will also present a key challenge. For example, an analysis of major European cities  by the Arup engineering consultancy found that older people typically make fewer journeys, use private cars less, public transport more (trams and buses in particular) and walk more.  In addition to this, older people’s typical walking speed – as well as the average length of walking trips – were lower than younger people’s patterns.  These differences must be considered when designing age-friendly environments.

The growing population of older people in rural and semi-rural areas, and the reliance on cars in areas with limited public transport options were also identified by Arup as important issues.

Age-appropriate housing

There will be increased demand for age-appropriate housing that meets the needs of older people as the population ages. People are likely to have longer periods of retirement and possibly longer periods of ill-health. As noted by the Future of an Ageing Population Project, unsuitable housing can damage individual wellbeing and increase costs for the NHS.

In order to meet demand, it will be necessary to both adapt existing housing stock, as well as ensure that new housing can adapt to people’s changing needs as they age.  Age-appropriate housing that supports independent living can reduce demand on health and care services, and positively enhance the lives of older people.

Thinking ‘beyond the building’

There is also a need to think ‘beyond the building’. It is thought that interventions that improve homes are likely to be less effective without similar improvements in the neighbourhood.  The ability to socialise and to access services is considered to be particularly important.

Therefore, planning for the provision of local shops and other community facilities such as GP surgeries, post offices and libraries, in tandem with an increased focus on walkable neighbourhoods and public transport provision, will help older people to be physically active and more independent.

Raising awareness

Despite a pressing need for action, the provision of age friendly infrastructure in the UK has been constrained by a lack of resources, and assigned a relatively low priority.  However, there is growing recognition of the need to raise awareness of the potential effects of the ageing population and its implications for the design of cities, towns and villages across the UK.

Planning departments cannot address these implications in isolation.  However, for their part, knowing and understanding the potential implications of the UK’s ageing population is a positive step towards the creation of a successful age-friendly built environment.


For further information, you may be interested in our other blog posts on the creation of age-friendly towns and cities and the economic opportunities presented by an ageing society.

We have also published two members-only briefings on Ageing, transport and mobility and Meeting the housing needs of older people.

 (Older) people power: the economic opportunities of an ageing society

By James Carson

Responding to a recent Ask-a-Researcher request for information about Britain’s ageing population, I found that an online search generated a discouraging set of headlines:

“Ageing UK population will increase strain on public spending”

“UK faces ‘debt timebomb’ from ageing population”

“UK woefully underprepared for ageing society”

Further down the list was something more positive:

“Britain’s retiring workers have never had it so good. As well as being among the last workers to benefit from generous final salary pensions, many older people have housing wealth, having got on to the property ladder long before the boom that has priced out many younger buyers. And thanks to new pension freedoms, which came into force in April, the over-55s can now withdraw money from their pension funds.”

If anything, this article from The Guardian was a little too upbeat – there was no mention of the tens of thousands of older people enduring fuel poverty.

But the story does highlight the growing market which older consumers represent for products and services.

The demographic trends

In many developed countries, ageing populations are being driven by two demographic trends: a declining birth rate due to women having fewer children than in previous generations; and increasing numbers of people living longer, thanks to improvements in diet and medicine.

The global population aged 60 or over is projected to more than triple by 2050, reaching approximately 2 billion people. In the UK, the number of people aged 65 and over is expected to increase from 10.3 million in 2010 to 16.9 million by 2035.

Harnessing the economic opportunities from an ageing population

Surveys of household income and expenditure have reported that older people devote a greater proportion of their total expenditure to necessities, such as food and drink, housing, fuel and power. Luxury items related to recreation and culture are also areas of significant expenditure for older households.

With the abolition of the default retirement age, many older people are continuing to lead productive working lives, and have financial security. The STUC recently published a report highlighting the potential economic contribution of women over 50 to the economy, although noting that they are often ignored in labour market and economic policy.

In 2011, a report for the Centre for Local Economic Strategies (CLES) suggested that harnessing the spend of older people will be increasingly important for both the private and public sectors.

The research pointed to ways in which an ageing society might affect the economy:

  • Changes in housing needs may provide opportunities for developers and the construction industry to explore new types of housing provision to support older people.
  • Retired people, such as former business managers, may be interested in setting up their own business, or investing in local enterprises.
  • More retired people may become interested in playing a wider role in the community through voluntary work, something that may become even more important as public services are cut back.
  • Older people will also be increasingly important to the labour market, and there are opportunities to explore how their experience and skills can be best used.

Earlier this year, a report from the International Longevity Centre-UK also highlighted the importance of design and technology in responding to the needs of older people, and outlined what needs to happen in order for new technologies to live up to their full potential. Among the recommendations:

  • Ensuring homes meet lifetime homes standards and neighbourhoods adopt age friendly guidelines.
  • Tackling digital exclusion to ensure older people maximise the benefits of new technology.
  • Providing more evidence on what works to help designers, marketers and retailers understand the potential economic return of targeting older consumers.

The report provided some examples of innovative technologies that could make a significant difference to the lives of older people, including:

  • a kettle which monitors blood pressure;
  • lights which adapt to the level of daylight in a room;
  • driverless cars;
  • a secure platform enabling the management of bank accounts, bills and pensions through one simple portal.

The ageing population presents challenges for government, business and society in general. However, growth in this section of the population also brings with it emerging economic opportunities. That’s something worth remembering on this International Day of Older Persons.


 

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Enjoy this article? Read our other recent blogs on policy relating to older people:

Shedding light on a serious issue: how Men’s Sheds are tackling social exclusion

by Stacey Dingwall

Promoting awareness of health and social issues among men, and particularly older men, has always been a tricky challenge. According to research, the longstanding stereotype of men who actively avoid visiting the doctor is true: significant numbers of older men may be experiencing loneliness and isolation due to their reluctance to join clubs for older people, a fact which may explain why suicide rates are higher among middle-aged and older (white) men.

One initiative that has tried to tackle this issue is the Men’s Sheds movement, which originated in Australia in the 1990s after concerns were raised over the lack of opportunities for older men to socialise and discuss any issues they were having with their peers. This led to the emergence of numerous Men’s Sheds across the country, in the form of workshops where men could come together to engage in traditional shed-orientated activities such as woodwork, as well as form new social connections and access health information.

The benefits of Men’s Sheds

Evaluations of Men’s Sheds have identified a range of benefits for the men who participate in them, as well as for the wider community. Older men and social activity: a scoping review of Men’s Sheds and other gendered interventions published in Ageing and Society in April 2015 identified a range of positive effects of the initiative on older men, particularly in terms of improvements in their mental health and wellbeing status. While limited evidence was found of a positive impact on the men’s physical health, the review did find that belonging to a Men’s Shed provided participants with both a personal and social sense of accomplishment – through learning and sharing skills and contributing to their local community – as well as a sense of purpose, through social engagement with their peers which enabled opportunities for fun and camaraderie.

Men’s Sheds in the UK

Between 2010 and 2012, Age UK ran a ‘Men in Sheds’ pilot project, initially limited to Kendal, Bildworth and South London. The popularity of the pilot saw it covered in the national press and other ‘Men in Sheds’ projects soon opened in other areas, with one participant expressing his regret that the initiative had not been established in his area years ago.

In 2013, the UK Men’s Sheds Association was launched. They provide information on how to start a new Men’s Shed, or develop an existing organisation, and have helped form regional networks of Sheds.

One of these networks is in Glasgow, which is now home to the Glasgow Area Men’s Sheds (GAMS) group. We spoke to current GAMS secretary Charlie, who became involved in Men’s Sheds after illness led to him experiencing unemployment and social isolation. After coming across the UK Men’s Sheds Association website, he met up with six other men who were also interested in starting a Shed in Glasgow. Fast forward a year, and there are now at least six separate Sheds in the Glasgow area, at which Charlie estimates there are around 80 regular attendees. For Charlie personally, involvement with Men’s Sheds has allowed him to “build a portfolio of work experience, gain possible references, meet new people, go to new places and do new things”.

Charlie also pointed to research published by the Joint Improvement Team (JIT) in February 2015 which highlights the rapid spread of Men’s Sheds throughout Scotland over the last two years, with Sheds now in 18 of the country’s 32 local authority areas. The report also looks at the development paths of Men’s Sheds, as well as drawing out lessons for other community capacity building initiatives and outlining the local and community support needed to develop a Shed.

What about the women!

According to GAMS, the question of why the Sheds are men-only affairs is a common one. Their response is that “Men’s Sheds address specifically male issues involving male social isolation, men’s health both physical and psychological, re-defining of masculinity in modern society […] women have much more and highly developed socialising group opportunities”.

As well as highlighting a tendency towards loneliness among older men, research has also indicated another trend – the decline of men’s social networks as they age, particularly after the death of a partner. Thus, the importance of Men’s Sheds in “promoting social engagement and healthy, active ageing among older men” is perfectly demonstrated.


The Idox Information Service can give you access to a wealth of further information on active and healthy ageing. To find out more on how to become a member, contact us.

Further reading:

The experiences of older male adults throughout their involvement in a community programme for men, IN Ageing and Society, Vol 35 No 3 Mar 2015, pp531-551

Tackling men’s health: implementation of a male health service in a rugby stadium setting, IN Community Practitioner, Vol 84 No 4 Apr 2011, pp29-32

One hundred not out: resilience and active ageing

Active ageing: live longer and prosper – realising the benefits of extended healthy life expectancy and ‘disability compression’ in Europe

Ageing, health and innovation: policy reforms to facilitate health and active ageing in OECD countries