What does it mean to be an older person in prison?

The number of older people in prison in England and Wales is increasing. Some have entered prison for the first time at an older age, and others have been in and out of prison multiple times throughout their lives. People in prison are considered ‘older’ at 50, often in poorer health compared to people of a similar age in the community.

With a national strategy for older prisoners expected soon, our report today sets out the key health care challenges for this population and what they mean for the prison service. As part of this, we spoke to stakeholders including charities, people with lived experience of prison and organisations who provide health care in prison, to understand what it’s like to be an older person in prison and how this affects their experience of health care.

Ageing in prison starts earlier but managing health care needs is harder

Older men in prison experience multiple and varied long-term conditions such as chronic kidney disease, chronic obstructive pulmonary disorder (COPD) and cancer, and for older women there are distinct needs around depression. Research has shown that older prisoners have greater cardiovascular comorbidity at a younger age, and increased risk factors such as obesity and high blood pressure. People also face barriers accessing public health and preventive care for older people, such as bowel cancer screening.

But managing these health care needs effectively in prison is challenging. We found that although older prisoners account for over a third of all hospital admissions by men in prison (37%), age-standardised admission rates for male prisoners aged over 50 are lower than those seen in the general population, suggesting older prisoners are being admitted to hospital less than might be expected given their higher health needs.

A significant number of older people are also missing their outpatient appointments. Pressure on staff, including escorts often as a result of security issues, are thought to be a key reason for why appointments are missed. People who had been to hospital from prison told us about feeling shame and indignity when attending hospital, as well as a lack of emotional support particularly if relating to a terminal diagnosis, which could put people off attending.

Prisons were not designed for older people  

Prisons were not designed to support older people, and they lack the resources to address these needs. We heard about the difficulties of moving around prison (such as to attend health care appointments) for people with mobility issues, as well as broken lifts and a lack of wheelchair-accessible spaces. A study that examined dementia in prison also identified difficulties with the layout of cells and prisons, the prison regime, high staff turnover and limited staff knowledge.

Our research showed that 40% of men aged 50 or over who were admitted to hospital from prison had signs of frailty – the prevalence in the general population aged over 50 is just 8%. Frailty refers to people’s general state of health – people with frailty are at higher risk of falls and take longer to recover if they become unwell. But awareness of frailty in prisons, including how to identify and address it, is limited, and may only become apparent once someone falls or goes to hospital.

Our research showed that some people in prison admitted to hospital were receiving palliative care, but prisons are often not set up to support people at the end of life. Stakeholders told us about examples of good practice – such as palliative care wings and partnerships with local hospices – but there is wide variation. The reality is that staff may need to support people with ill health or who are dying, but staffing is a significant challenge.

The prison regime has a significant impact on older people

Our work paints a complex picture of violence, self-harm and staffing challenges within prisons. This creates significant challenges for older people, whose needs are often deprioritised as a result. We found there are fewer hospital admissions for injury and poisoning (often a result of violence, self-harm or drug use) for people over 50 (5%) compared to 28% of men under 50.

People with lived experience told us that some older people in prison feel unsafe, particularly around younger prisoners, due to the risk of violence or bullying if they were seen to be ‘weak’ due to their age, or had medication that could be taken from them. We also heard about a lack of meaningful activities – such as education or exercise – tailored for older people.

Why does this matter?

People do not lose their right to health care when they go to prison and should receive care that is “equivalent” to the general population. Older people in prison have significant health care needs, but prisons are not well equipped to address these, preventing people from accessing the care they need. Despite examples of good practice, services vary and the needs of older people are often overlooked due to severe staffing and security pressures.  

Alongside the expected strategy, the health and justice framework for integration 2022–25 sets out commitments for integrated care systems on access to health care, including at the end of life for people in prison. The Prisons Strategy White Paper noted the need to build new prisons that are accessible and for training on conditions such as dementia.

While this is undoubtedly welcome, real change requires significant collaborative action and investment to equip prisons and prison staff with the resources and support they need. Given that the number of older people in prison is expected to rise, this must be a priority for health and justice policy-makers alike.