Improving the Health of Older Prisoners: Nutrition and Exercise in Correctional Institutions

This qualitative article presents and compares the views of older prisoners and expert stakeholders on the topic of nutrition and exercise. The study highlights measures for improving the health of older prisoners. Older prisoners report the need to improve quality of meals provided in prison. They note that prison food is of poor quality and not adapted to their needs. With regard to exercise, they point out the lack of proper opportunities to engage in exercise and sports, and describe several factors that make physical activities either unsuitable or unfeasible. Expert stakeholders see prison as an opportunity to improve the health of those convicted of crimes. In light of the increasing number of older prisoners, age-appropriate nutritional and exercise interventions should take priority in prisons

Polypharmacy and drug-drug interactions among older and younger male prisoners in Switzerland

The purpose of this paper is to determine the prevalence of polypharmacy and drug-drug interactions (DDIs) in older and younger prisoners, and compared if age group is associated with risks of polypharmacy and DDIs.; For 380 prisoners from Switzerland (190 were 49 years and younger; 190 were 50 years and older), data concerning their medication use were gathered. MediQ identified if interactions of two or more substances could lead to potentially adverse DDI. Data were analysed using descriptive statistics and generalised linear mixed models.; On average, older prisoners took 3.8 medications, while younger prisoners took 2.1 medications. Number of medications taken on one reference day was higher by a factor of 2.4 for older prisoners when compared to younger prisoners (; p; = 0.002). The odds of polypharmacy was significantly higher for older than for younger prisoners (>=5 medications: odds ratio = 5.52,; p; = 0.035). Age group analysis indicated that for potentially adverse DDI there was no significant difference (odds ratio = 0.94;; p; = 0.879). However, when controlling for the number of medication, the risk of adverse DDI was higher in younger than older prisoners, but the result was not significant.; Older prisoners are at a higher risk of polypharmacy but their risk for potentially adverse DDI is not significantly different from that of younger prisoners. Special clinical attention must be given to older prisoners who are at risk for polypharmacy. Careful medication management is also important for younger prisoners who are at risk of very complex drug therapies

Ageing prisoners and ethics behind bars : law, human rights and health care - old (age) problems and new challenges

The structure of penal institutions and their impact on inmates raises complex ethical and human rights issues. The circumstance that the number of prisoners who are older and/or suffer from mental disorders is steadily growing in Switzerland and worldwide in general, creates additional problems. Therefore, the aims of this thesis are to provide information on the current health care situation of ageing prisoners in Switzerland, to better understand the legal and practical settings of health care provision for ageing prisoners and to analyse the ethical issues that arise from the need to provide adequate health care to inmates in the context of an increasingly ageing prison population. This thesis is divided in a general introduction, seven chapters and a general discussion. The introduction provides general information on institutions and their characteristics, the role of punishment in institutions and the numerical changes of the prison population in the correctional system. Furthermore, an overview of possible reasons for the tremendous growth of the prison population is given. Special focus is put on the sub-group of ageing prisoners and their features. Their needs in accommodation and health care are presented in detail. The introduction then proceeds with a brief description of the ethical issues in relation to the health care for ageing prisoners and continues with an overview about project details of the “Agequake in Prisons” project. A first theoretical overview about the challenges that the prison system has to face with the growing number of ageing prisoners and their special needs is given in Chapter 1. Special emphasis is put on the accommodation of older prisoners and the end-of-life care and death in prison. The principle of equivalence of care is used as a framework. Chapter 2 contains a review of national and international guidelines, legal frameworks and other documents relating to the health care needs of ageing prisoners. The results on the existence or non-existence of regulations that address the health care of ageing prisoners are critically examined. In this analysis focus is particularly put on Europe and the United States of America (USA). Chapter 3 explores current expert perspectives on Western European prison health care services and investigates if ageing prisoners receive equivalent care. Here, the difficulties of providing equivalent health care to ageing prisoners are described in detail. The factors that contribute to these difficulties are looked at. Possible solutions for the described problems are provided which shall give guidance to people working in correctional facilities. Chapter 4 reflects on the disease burden of ageing prisoners and the different impact that age and length of imprisonment have on their health. The topic of end-of-life in prison is covered in Chapter 5. More and more prisoners grow old in prison and are likely to die there. Non-physician assisted suicide is under certain conditions available to the public in Switzerland. In this chapter it is argued that it should be made available for prisoners, too. Chapter 6 and Chapter 7 give an insight into the topic of restraint measures. While Chapter 6 addresses restraint measures in hospitals in Germany, Chapter 7 explores the new legal regulation of restraint measures in Switzerland. The last part of this thesis contains a general discussion of the presented work and summarises its findings. Furthermore, the implications of this study for research and practice in correctional facilities are described. It should be noted that Chapters 1, 2, 3, 4, 5, 6 and 7 have been published in different European and American journals; therefore it is possible that there is an overlap between the description of the background, ethical issues and methods used. Although, the delivery of health care for ageing prisoners does meet the standard of equivalent health care in certain prisons, it is of great concern that it is not achieved in every Swiss prison according to the Stakeholders that were interviewed. This thesis provides an insight into some of the most challenging aspects of old age inside prisons such as the provision of equivalent health care and contributes to the understanding of how the health care provision for ageing prisoners could be made more effective

Die neue Schweizer Gesetzgebung zu bewegungseinschränkenden Maßnahmen auf dem medizinethischen Prüfstand

Zusammenfassung: Bewegungseinschränkende Maßnahmen werden in verschiedenen medizinischen Institutionen angewendet, um das Verhalten von Patienten durch physische bzw. mechanische oder chemische Eingriffe zu beeinflussen. Solche Maßnahmen stellen eine Art Freiheitsentziehung dar und bedürfen daher immer einer Rechtfertigung. Die Frage nach der Indikation für bewegungseinschränkende Maßnahmen ist abzuklären, da ein standardmäßiger Gebrauch nicht Ziel einer Behandlung sein sollte. Gesetze können als Richtschnur für behandelnde Ärzte und Pflegepersonal dienen. In der Schweiz ist am 1. Januar 2013 erstmals eine gesetzliche Regelung zu bewegungseinschränkenden Maßnahmen eingeführt worden. Hauptziel dieser neuen Artikel im Schweizerischen Zivilgesetzbuch (Artikel 383ff. ZGB) ist die Stärkung von Autonomie und persönlicher Freiheit von Patienten. Es ist wichtig, Vorschriften zu hinterfragen bzw. deren Auswirkungen für die betroffenen Personen zu analysieren und einen kritischen Dialog zu führen. Die vorliegende Publikation betrachtet bewegungseinschränkende Maßnahmen aus zwei verschiedenen Perspektiven: einerseits anhand einer medizinethischen Debatte, andererseits anhand einer Analyse der gesetzlichen Regelung in der Schweiz. Die neuen Artikel umfassen eine detaillierte Regelung zur "Einschränkung der Bewegungsfreiheit". Dennoch schließen sie nicht alle bestehenden Regelungslücken. Die neue Schweizer Gesetzgebung kann daher nur als ein erster Schritt in die richtige Richtung betrachtet werden. Ausführungen zur praktischen Anwendung sind dringend nötig und sollten so schnell wie möglich ausgearbeitet werden

Fixierungsmaßnahmen in Krankenhäusern - Ein wunder Punkt

Fixierungsmaßnahmen werden in den unterschiedlichsten medizinischen Versorgungssituationen angewendet. Ihr Einsatz wurde bisher vor allem in der Psychiatrie und in Pflegeheimen problematisiert, wohingegen die Anwendungen in Krankenhäusern kaum diskutiert wird. Dies ist besonders beunruhigend, da Fixierungen in Krankenhäusern unter den verschiedensten Umständen angeordnet werden, jedoch als freiheitsentziehende Maßnahme einen ambivalenten Charakter haben. Ziel dieses Artikels ist es, die zivilrechtliche Gesetzgebung für Fixierungen und die medizinischen Gründe für die Vornahme von Fixierungen in deutschen Krankenhäusern zu analysieren. Ich werde zeigen, dass die Vornahmen von Fixierungen erst nach einer eingehenden Beurteilung des Patienten und seiner Wünsche vorgenommen werden sollten. Als vulnerable Gruppe sind Patienten von den Mitgliedern des medizinischen Personals abhängig, die unter allen Umständen ihr Bestes tun müssen, um die Autonomie und Rechte ihrer Patienten zu respektieren. Das Bewusstsein des Gesundheitspersonals in Bezug auf Fixierungen muss geschärft werden und die interdisziplinäre Zusammenarbeit von Betreuungsrichtern, Ärzteschaft und Pflegepersonal verbessert werden, um den Informationsfluss und -austausch zu dieser ethischen und moralischen Frage zu verbessern

Die neue Schweizer Gesetzgebung zu bewegungseinschränkenden Maßnahmen auf dem (ethischen) Prüfstand

Definition of the problem Restraint measures are still used in different medical institutions to change or influence patients’ behaviour. Arguments Mobility restrictions can constitute a deprivation of liberty and justification is always needed. Also, indications for these measures have to be clarified as the aim of treatment in patients’ health care should not be their standard application. Regarding this issue, legal regulations can be guidance for physicians in charge, the nursing staff and a supportive tool in times of uncertainty. For the first time, on 1 January 2013, a law addressing restraint measures came into force in Switzerland. The main aim of this new regulation (article 383 et seqq. ZGB) is to strengthen autonomy and personal freedom of patients. Nevertheless, it is highly important to engage in a dialogue and to question rules like this. Not only is awareness important, but the consequences for all involved persons need to be examined. The objectives of this paper are to illuminate restraining measures from two different perspectives. This will be done by a medico-ethical debate as well as by analysing the new legal regulation in Switzerland. Conclusion Even though the introduced articles provide a detailed regulation about “Restrictions of freedom of movement”, not all existing regulatory gaps are filled. The new Swiss legislation can only be called a first step in the right direction. More information on the practical application is urgently needed and should be developed as soon as possible

Ageing Prisoners’ Health Care: Analysing the Legal Settings in Europe and the United States

Background: Relatively little is known about the current health care situation and the legal rights of ageing prisoners worldwide. To date, only a few studies have investigated their rights to health care. However, elderly prisoners need special attention. Objective: The aim of this article is to critically review the health care situation of older prisoners by analysing the relevant national and international legal frameworks with a particular focus on Switzerland, England and Wales, and the United States (US). Methods: Publications on legal frameworks were searched using Web of Science, PubMed, MEDLINE, HeinOnline, and the National Criminal Justice Reference Service. Searches utilizing combinations of keywords relating to ageing prisoners were performed. Relevant reports and policy documents were obtained in order to understand the legal settings in Switzerland, England and Wales, and the US. All articles, reports, and policy documents published in English and German between 1774 to June 2012 were included for analysis. Using a comparative approach, an outline was completed to distinguish positive policies in this area. Regulatory approaches were investigated through evaluations of soft laws applicable in Europe and US Supreme Court judgements. Results: Even though several documents could be interpreted as guaranteeing adequate health care for ageing prisoners, there is no specific regulation that addresses this issue completely. The Vienna International Plan of Action on Ageing contributes the most by providing an in-depth analysis of the health care needs of older persons. Still, critical analysis of retrieved documents reveals the lack of specific legislation regarding the health care for ageing prisoners. Conclusion: No consistent regulation delineates the provision of health care for ageing prisoners. Neither national nor international institutions have enforceable laws that secure the precarious situation of older adults in prisons. To initiate a chan this work presents critical issues that must be addressed to protect the right to health care and well-being of ageing prisoners. Additionally, it is important to design legal structures and guidelines which acknowledge and accommodate the needs of ageing prisoners

Will I stay or can I go? Assisted suicide in prison

Assisted suicide (AS) is a controversial practice with which physicians and nurses are confronted more and more often. In Switzerland, it is available for Swiss residents and in certain cases for foreigners. Prisoners meet the same prerequisites for AS as the general population and should therefore be eligible for it. Ethical issues, such as informed choice and the autonomy of prisoners, and organizational questions need to be addressed. They must not lead to a denial of this practice. Even though prisons constitute a special area of work for medical staff, it is important to address the possibility of AS in prison openly. This can raise awareness of the difficulties health-care professionals face working in closed institutions