Older adults in jail: high rates and early onset of geriatric conditions

Abstract

Background: The number of older adults in the criminal justice system is rapidly increasing. While this population is thought to experience an early onset of aging-related health conditions ("accelerated aging"), studies have not directly compared rates of geriatric conditions in this population to those found in the general population. The aims of this study were to compare the burden of geriatric conditions among older adults in jail to rates found in an age-matched nationally representative sample of community dwelling older adults.

Methods: This cross sectional study compared 238 older jail inmates age 55 or older to 6871 older adults in the national Health and Retirement Study (HRS). We used an age-adjusted analysis, accounting for the difference in age distributions between the two groups, to compare sociodemographics, chronic conditions, and geriatric conditions (functional, sensory, and mobility impairment). A second age-adjusted analysis compared those in jail to HRS participants in the lowest quintile of wealth.

Results: All geriatric conditions were significantly more common in jail-based participants than in HRS participants overall and HRS participants in the lowest quintile of net worth. Jail-based participants (average age of 59) experienced four out of six geriatric conditions at rates similar to those found in HRS participants age 75 or older.

Conclusions: Geriatric conditions are prevalent in older adults in jail at significantly younger ages than non-incarcerated older adults suggesting that geriatric assessment and geriatric-focused care are needed for older adults cycling through jail in their 50s and that correctional clinicians require knowledge about geriatric assessment and care.

Keywords: Criminal justice; Geriatric conditions; Jail.

Fig. 1

Geriatric conditions in jail cohort vs. HRS population vs lowest net worth quintile HRS population. Older jail-based participants have higher rates of each of six geriatric conditions when compared to age-adjusted community-dwelling populations of older adults in the Health and Retirement Study (HRS) overall and to the subpopulation in the HRS sample in the lowest net worth quintile (p-value for all comparisons < 0.001). Falls was defined as a fall within the last 2 years (HRS) or in the last 3 months (jail-based population); incontinence defined as a response of “yes” to “have you lost any amount of urine beyond your control?” in the last 2 years (HRS) or the last 3 months (jail-based population); Functional impairment was defined as difficulty in one or more of the five Activities of Daily Living; mobility impairment defined as difficulty walking several blocks; hearing impairment defined as a response of “poor” or “fair” to “Is your hearing excellent, very good, good, fair or poor?”; multimorbidity defined as two or more medical conditions (hypertension, diabetes, cancer, lung disease, heart disease, stroke, arthritis), including HIV and Hepatitis C for jail inmates