Anxiety and Physical Health Among Older Adults Incarcerated in Prison

Background and Purpose

Older adults are the fastest growing age demographic among persons incarcerated in United States prisons due to aging of the general population, sentencing structure revisions, and the criminalization of mental illness. While much is known regarding the physical health of these older adults, less is known of their mental health despite the role of prisons in mental health care. Examining the association between anxiety and physical health among this population is likewise warranted as these older adults endure an earlier onset and heavier burden of life-limiting disease. We explored these relationships and sought to answer the following: 1) How does anxiety relate to physical health?, 2) How do anxiety and physical health differ between older adults with and without self-reported anxiety?, and 3) How does anxiety contribute to physical health? We hypothesized that increased anxiety would relate to worse physical health and that these measures would be worse among older adults with self-reported anxiety. We further anticipated that anxiety would contribute to impairment in activities of daily living (ADL), chronic disease multimorbidity, physical health life quality, and physical functioning.

Methods

Secondary data were used. Data were collected between 2018 and 2019 from persons aged 45 or older incarcerated in five Kentucky prisons (N = 499). Sociodemographic measures included gender, race, age, and length of current incarceration. Anxiety measures included items drawn the World Health Organization Quality of Life BREF (WHOQOL-BREF), the eight-item Patient Health Questionnaire (PHQ-8), and the 20-item short form of the Medical Outcome Study measure (SF-20). Physical health measures included ADL impairment (Duke Older Americans Resources and Services [OARS] measure), multimorbidity, physical health life quality (WHOQOL-BREF), and physical functioning (SF-20). Bivariate statistics (r) were used to examine associations among anxiety and physical health measures. Mean differences were examined using independent sample t-tests and Cohens d and the contribution of anxiety to variation in physical health was explored using hierarchical multiple linear regression.

Results

The sample was predominantly white men aged 55 years with an average length of current incarceration of 12 years. Roughly one-quarter (24%) reported anxiety or related conditions. Statistically significant relationships emerged between all anxiety and physical health measures (r range: -.46 - .53, p<.000) and significant differences were found between older adults with and without self-reported anxiety (d range: -.76 - .83). Anxiety measures accounted for variation in physical health with the strongest effect emerging for 'being a very nervous person' during the past month (β range: -.31 - .33, p<.000).

Conclusions and Implications

Anxiety accounted for variation in physical health in this sample. Social workers in allied fields possess a tailored acumen to decrease anxiety and increase physical health among older adults incarcerated in prison through the development and deployment of programs that build social capital. Too, social workers are well-suited to advocate for policy revision to improve the well-being of older adults in these settings. Inclusion of standardized anxiety measures and the supplement of biometrics and disability indexes is recommended for future studies.