Living (and dying) as an older person in prison

The number of older people in prison in England and Wales is increasing, but prisons are not well set up to meet health care needs associated with ageing.  

Prisoners tend to be in poorer health than the general population, and this is particularly the case for older prisoners. Tough conditions in prison – regime constraints, poor living conditions and the threat of violence – disproportionately affect older prisoners.  

This report uses hospital data to look at the health care needs of older people in prison in England. We found significant health care needs associated with frailty among our older prisoner population. We consider the implications for the prison service of managing increasing numbers of older prisoners as the population continues to age. 

Key findings 

• More than 40% of men in prison aged 50 or more who were admitted to hospital in an emergency showed signs of frailty, risking poorer health outcomes.  A much higher proportion of older people in prison are frail than in the general population, where the prevalence of frailty in adults aged 50+ has been estimated to be just 8%. We found that 44% of men aged 50+ in prison who were admitted to hospital in an emergency between 2018/19 and 2019/20 were classified as having either intermediate or high-risk frailty. Prisoners who were frail were found to be more likely to suffer from mobility problems, anxiety and depression, incontinence and dementia.  

• With an ageing prisoner population, prison staff have to manage death, dying and ill-health associated with old age as a part of their job role. This adds to an already complex staffing picture. Between 2016 and 2020, 190 older men with a palliative care diagnosis were admitted to hospital. 40% of cases had a primary diagnosis of cancer when admitted to hospital. 

• Older people in prison face possible health risks associated with high blood pressure. We found that approximately 30% of hospital admissions by older men in prison had a diagnosis of high blood pressure recorded. Prisoners’ hospital admissions where there was a diagnosis of hypertension were 162 per 1,000, compared with 213 per 1,000 for men in the general population. The difference is likely to reflect the challenges that older people face in accessing hospital care while in prison and raises questions about how effectively high blood pressure in the prison population is identified and treated. High blood pressure increases the risk of stroke and heart disease. 

• The number of older women in prison is relatively small, but they were found to have significant health care needs associated with depression. Older women in prison have different health care needs from those of older men in prison. More than 20% of admissions to hospital by older women in prison had a diagnosis of depression recorded, while for their male counterparts this was under 8%. 

The upcoming Older Offenders strategy provides an opportunity to highlight the needs of older prisoners and ensure that the prison system is equipped and supported to address them. But success requires a coordinated response. Action is required from across the system to equip prisons and prison staff with the resources they need, particularly in light of the increasing number of older people in prison.  

This includes:  

• ensuring prisons have access to the resources and equipment necessary to support older people in prison living with frailty  

• supporting prison staff to develop the skills and confidence to manage older people in prison  

• sharing best-practice examples of health care support for older people in prison.