The ageing prisoner population: demographic shifts in Australia and implications for the economic and social costs of health care

Purpose: The Australian prisoner population has experienced a dramatic increase in the number of older inmates over the past decade, consistent with the greying of the prisoner population that is being observed worldwide. Reviews suggest the need for further evidence and practice outside of the USA. This paper aims to review and discuss the cost and social implications of the rising health-care needs of this population in Australia. Design/methodology/approach: A review of international research and policies is presented, as well as the results of basic economic modelling relating to the expected rise in health-care costs of the ageing prisoner population in Australia. Findings: Taking into consideration the continued rise in incarceration rates, the calculations show that the health costs of prisoners could increase by anywhere between 17% and 90% depending on whether the increase of older prisoners continues as it has in the past decade. These trends are likely to continue over the next decade and will result in higher health costs of prisons under a number of different imprisonment scenarios. Policy responses in Australia have been slow so far, with most initiatives being undertaken in the USA with promising results. Practical implications: The authors suggest that in the absence of a coordinated policy response, covering a range of interventions, costs will continue to increase, particularly as this population continues to age more rapidly than the general population due to an accumulation of risk factors. Well-conceived interventions would be a worthwhile investment from both financial and social perspectives. Originality/value: To the best of the authors’ knowledge, this is the first commentary to acknowledge this rising public health issue and to both review and model its implications for the future

COVID-19 and incarcerated older adults: a commentary on risk, care and early release in Australia

Purpose: The purpose of this commentary is to draw upon available literature and practices related to COVID-19 and management of older incarcerated adults in Australia to highlight key matters for better risk management and care of this population during this and future infectious disease pan/epidemics. Design/methodology/approach: The present commentary draws on current policies, practices and literature regarding the health, needs and management of older incarcerated adults in Australia to discuss risk, care and early release for this population during the COVID-19 pandemic. Findings: Incarcerated persons experience poorer health and accelerated age-related decline compared to those in the general community. The present situation offers the opportunity to fill knowledge and practice gaps, including policies for staff training, identification of dementia and cognitive decline, assessment of mobility issues, addressing barriers to health-seeking, possibilities of medical or compassionate release, risk assessment and release protocols and post-release needs. Practical implications: While Australian prisons have acknowledged the vulnerability of older persons, more focused adaptation of COVID-19-related policies to consider adults as young as 45 years are needed. Appropriate ethical identification and management of cases in this population is needed, as is discussion on issues of decarceration and medical release. Re-conceptualisation of incarcerated adults as “citizens in need of care”, rather than as “offenders to be secured”, will be beneficial. Robust, local evidence is needed to assist decision-making. Originality/value: This is a comprehensive, focused review of relevant evidence, policies and practices for a growing subpopulation of prisoners worldwide with complex needs and particular vulnerability to the COVID-19