Addressing the aging crisis in U.S. criminal justice health care

Abstract

The U.S. criminal justice population is aging at a significantly more rapid rate than the overall U.S. population, with the population of older adults in prison having more than tripled since 1990. This increase is at the root of a prison healthcare crisis that is spilling into communities and public healthcare systems because nearly 95% of prisoners are eventually released. The graying prison population is also straining state and local budgets. In prison, older prisoners cost approximately three times as much as younger prisoners to incarcerate, largely because of healthcare costs. In the community, older former prisoners present the least risk of recidivism yet are vulnerable to serious and costly social and medical challenges such as housing instability, poor employability, multiple chronic health conditions, and health-related mortality; however older current and former prisoners are largely ignored in the current geriatrics evidence base. Knowledge about the health, functional, and cognitive status of older prisoners is limited, with even less known about risk factors for long-term poor health outcomes during and after incarceration. This article provides an overview of aging in the criminal justice system. It then describes how geriatric models of care could be adapted to address the mounting older prisoner healthcare crisis and identifies areas where additional research is needed to explore prison-specific models of care for older adults.

Figure 1. The Older Prisoner Population Has Grown Faster than the Total Prison Population and the Population of Non-Incarcerated Older Americans^,

While the population of older adults in the U.S. grew by more than half from 1990 to 2009 and the overall prison population doubled, the population of older adults in prison more than tripled, Figure 1

Figure 2. Increasing Number of U.S. State Prisoners Age 55 or Older, 1990–2009^,

For many state prison systems, the demographic shift towards significant populations of older prisoners has been dramatic. There are now 28 states that hold over 1,000 older prisoners, compared to just 2 in 1990.