Preparing the Interdisciplinary Health Care Team to Meet the Needs of Older Adults In Prison

Background and Purpose: America's overcrowded prison system is rapidly graying. Official statistics show that prisoners aged 50 and older have serious physical and mental health problems and trauma histories (Maschi et al, 2011). The correctional system is ill-prepared to address their complex needs while in prison and community reentry needs (Loeb et al., 2008). Whereas there is a general understanding of health issues among older adults in prison, there is a dearth of literature that describes older prisoners' patterns and perceptions of service use and contact with allied health professionals, such as doctors, nurses, psychologists, psychiatrists, and social workers. The current study examines prisoners' (aged 55+) physical and mental health status service use and professional contact patterns while in prison. These findings can inform the preparation of interdisciplinary health care team professionals for effective interprofessional practice with older adults in prison.

Methods: The study was a cross-sectional correlation design and was conducted in the New Jersey Department of Corrections in 2010. A survey-questionnaire was sent to all older adult prisoners using the Dillman et al. (2004) four step mail methods strategy. A total of 335 older prisoners returned the survey resulting in a 50% response rate. Participants completed a battery of instruments including the Center for Disease Control and Prevention Health-Related Quality-of-Life (CDC-HRQOL-14) Survey. The Personal and Professional Contact Inventory (PPCI; Maschi, 2010) gathered information on service use and personal and professional contact patterns over a three month period.

Results: The results showed that one third of older prisoners reported physical and mental problems that suggest multiple services were needed. Older prisoners reported limitations in activities (48%) due to physical or mental health limitations. About two out of five prisoners reported physical health (i.e., arthritis, vision, and neck/back) and mental health problems. Ten percent reported needing assistance with activities of daily living. As for service use and professional contact, older prisoners were most likely to report using medical services (87%) followed by recreational (70%) and religious services (63%) in the past three months. Only25% reported using mental health or substance use treatment. Professional services (30%) were viewed less helpful than religious or recreational services (70%). Older prisoners had the most contact with professionals, such as doctors or nurses (70%), followed by religious volunteers (38%), social workers (34%), psychologists (30%) and psychiatrists (23%). Older prisoners were about three times more likely to have contact with professionals with family members (13%).

Conclusions and Implications: Educating interdisciplinary health care teams for interprofessional practice with older adults in prison settings is critical. By far, medical professionals are the central hub of contact with older prisoners. Educating interdisciplinary health care teams includes the use of service coordination and triaging with medical services as a central hub for referral and service linkages. Strategies that include the aging related health and mental health issues, use of rapid assessment strategies including geriatric depression, care coordination skills for in-prison service referrals, and discharge planning skills to ensure a continuum of care from prison to the community are reviewed.