Tina Maschi, PhD, LCSW, ACSW, Associate Professor at Fordham University and President of the National Organization of Forensic Social Work talks about dementia in the prison population in this episode of Correctional Nursing Today. She recently published, along with several colleagues, an article in The Gerontologist entitled Forget me Not: Dementia in Prison.

Dementia is a significant concern for the correctional population. In fact, Maschi considers this the largest human-made disaster of the modern day. Dementia in the inmate population is projected to be triple that of the general population by the year 2050. The compound issues of aging prisoner growth rates and increasing mental health issues are significant factors. Although inmate aging is an international crisis, the US has the largest incarceration rate in the world and therefore the largest aging inmate population.  Punitive sentencing policy of the 1980’s such as mandatory sentencing and 3-strikes laws have added to incarceration rates. Poor health practices prior to incarceration such as drug use, family violence, homelessness and exposure to violence are known to accelerate aging. The inmate population can be 10-15 years biologically older than their counterparts in the general population.

A prison culture of punishment, incapacitation, violence, stress and abuse also escalates dementia initiation and progression. Prison foods high in salt and carbohydrate, along with smoking and sedentary lifestyle also contribute to this condition. Therefore, inmates have increased the likelihood of developing dementia due to being behind bars.

Preventive interventions that focus on improving healthy lifestyles can slow the progression of dementia. The following best practices have been found to improve cognitive functioning:

• Smoke cessation programs
• Increased physical activity
• Increased social activities
• Chronic care clinics that focus on patient teaching for lifestyle changes
• Stress management
• Health/psychosocial management
• Use of yoga and art therapy
• Religious services/ positive thinking

Specific programs have been initiated in several state departments of corrections to deal with those inmates already exhibiting dementia. The Fishkill Unit in New York uses interdisciplinary collaboration, a more social environment, specific lighting w/ windows, and common social space.  They use art and pet therapy to socially engage the men. The True Grit program in Nevada has increased physical activity and employs a staff chaplain, among other interventions. They have found that the program has reduced medical visits and medication costs. In addition, recidivism is down. The California Men’s Colony employs a peer support program to enhance socialization and assist with activities of daily living. This program provides opportunity for the development of compassion among the inmate care providers; an important redemptive element.

What can nurses do to assist inmates with dementia? Dr. Maschi suggests thinking about simple ways to improve general welfare and health of the inmate population. She also suggests vitamin therapy, use of lower bunks for the elderly, providing more time to eat and improving food choices. As a final challenge, Dr. Maschi suggests  correctional nurses consider using action research in creating programs to improve the general welfare of correctional inmate populations.

Resources:

Human Rights Framework Map

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