Research Article| Volume 25, ISSUE 2, P241-246, April 2018

Vulnerable prisoners: Dementia and the impact on prisoners, staff and the correctional setting


      The aim of this paper is to increase awareness and highlight the need for prisoner’s early identification of dementia and recommend support strategies within the Australian correctional setting. The number of older people is increasing within the correctional setting, causing a corresponding increase in the number of prisoners with dementia. These older prisoners are at greater risk of developing cognitive impairment and dementia which increases their vulnerability in the correctional environment including their interactions with both correctional services staff and other prisoners. Correctional settings have not been designed for older prisoners or those with dementia, which poses problems for physical and psychological health. People who have encounters with the criminal justice system are generally in poorer physical and mental health than the general population. Identifying dementia in the early stages provides opportunities to initiate strategies and supports to slow the progression. However being incarcerated increases the likelihood of not being identified with dementia until the later stages of the disease process, which significantly reduces opportunities for early intervention.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Collegian
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Australian Bureau of Statistics (ABS)
        Prisoners in Australia.
        National Corrective Services Statistics Unit, cat. No. 4517, Canberra2012
        • Australian Institute of Health and Welfare (AIHW)
        Older Australia at a glance. Cat. no. AGE 52.
        4th ed. Canberra, ACT, 2015 ([retrieved from:])
        • Australian Institute of Health and Welfare (AIHW)
        Dementia in Australia. cat. No. AGE 70.
        Australian Government, Canberra, ACT, 2015 ([retrieved from:])
        • Australian Institute of Health and Welfare (AIHW)
        The health of Australia’s prisoners, cat No. PHE 207.
        Australian Government, Canberra, ACT, 2015
      1. Access Economics, (2010), Caring places: planning for aged care and dementia 2010-2050, Report by Access Economics Pty Limited for Alzheimer’s Australia.

        • Ahalt C.
        • Trestman R.
        • Rich J.
        • Greifinger R.
        • Williams B.
        Paying the price: The pressing need of quality, cost and outcomes data to improve correctional health care for older prisoners.
        Journal of American Geriatric Society. 2013; 61: 2013-2019
        • Alzheimer’s Australia NSW
        Building dementia and age-friendly neighbourhoods.
        Policy and Information Unit Alzheimer’s, Australia, NSW2011
        • Alzheimer’s Australia
        Inquiry into dementia: Early diagnosis and intervention.
        House of Representatives Standing Committee on Health and Ageing, 2012 ([retrieved from:])
        • Atabay T.
        Handbook on prisoners with special needs, united nations office on drugs and crime, criminal justice handbook series.
        United Nations, New York2009
        • Australian Government
        2015 intergenerational report Australia in 2055.
        Commonwealth of Australia, Parkes ACT, 2015
        • Baidawi S.
        • Turner S.
        • Trotter C.
        • Browning C.
        • Collier P.
        • O’Connor D.
        • et al.
        Trends & issues in crime and criminal justice series: Older prisoners – A challenge for Australian corrections, No. 426.
        Australian Institute of Criminology, Canberra, ACT, Australia2011
        • Baldwin J.
        • Leete J.
        Behind bars: The challenge of an ageing prison population.
        Australian Journal of Dementia Care. 2012; 1: 16-19
        • Binswanger I.A.
        • Redmond N.
        • Steiner J.F.
        • Hicks L.S.
        Health disparities and the criminal justice system: An agenda for further research and action.
        Journal of Urban Health: Bulletin of the New York Academy of Medicine. 2011; 89
        • Brown J.-A.
        Dementia in prison, discussion paper #9, north ryde, NSW.
        Alzheimer’s Australia, NSW2014
        • Butler T.
        • Allnutt S.
        • Kariminia A.
        • Cain D.
        Mental health status of Aboriginal and non-aboriginal Australian prisoners.
        Australian and New Zealand Journal of Psychiatry. 2007; 41: 429-435
        • Christodoulou M.
        Locked up and at risk of dementia.
        Lancet, Report for Human Rights Watch. 2012; 11: 750-751
        • de Viggiani N.
        Unhealthy prisons: Exploring structural determinants of prison health.
        Sociology of Health & Illness. 2007; 29: 115-135
        • Duffin C.
        Doing time: Health care in the criminal justice system.
        Nursing Older People. 2010; 22: 14-18
        • Feczko A.
        Dementia in the incarcerated elderly adult: innovative solutions to promote quality care.
        Journal of the American Association of Nurse Practitioners. 2014; 26: 640-648
        • Goulding P.
        Silver bullet or confused greying fox? Best practice support model for older prisoners.
        Wintringham Specialist Aged Care, Flemington, Victoria2013
        • Grant E.
        Prison environments and the needs of Australian Aboriginal prisoners: A South Australian case study.
        Australian Indigenous Law Review. 2008; 12: 66-80
        • Harlin K.
        • Montague C.
        Informing prison healthcare in south Australia, planning, professional practice, promotion, patient safety: Meeting the challenges of the next decade.
        SA Nursing and Midwifery Premier’s Scholarship: International Scholarship Report 2010/2011, 2011
        • Hodel B.
        • Sanchez G.
        The Special Needs Program for Inmate-Patients with Dementia (SNPID): A psychosocial program provided in the prison system.
        Dementia. 2012; 12: 654-660
        • Huxter M.J.
        Prisons: The psychiatric institution of last resort?.
        Journal of Psychiatric and Mental Health Nursing. 2013; 20: 735-743
        • Iftene A.
        • Manson A.
        Recent crime legislation and the challenge for prison health care.
        Canadian Medical Association Journal. 2013; 185: 886-889
        • Kingston P.
        • Le Mesurier N.
        • Yorston G.
        • Wardle S.
        • Heath L.
        Psychiatric morbidity in older prisoners: Unrecognized and undertreated.
        International Psychogeriatrics. 2011; 23: 1354-1360
        • LoGiudice D.
        • Smith K.
        • Thomas J.
        • Lautenschlager N.T.
        Kimberley Indigenous Cognitive Assessment tool (KICA): Development of a cognitive assessment tool for older indigenous Australians.
        International Psychogeriatrics, Online Publication. 2006; 18: 269-280
        • Maschi T.
        • Kwak J.
        • Ko E.
        • Morrissey M.
        Forget me not: Dementia in prison.
        The Gerontologist. 2012; 52: 441-451
        • Miller A.
        Prison health care inequality.
        Canadian Medical Association Journal. 2013; 185: E249-E250
        • Mitchell L.
        • Burton E.
        Designing dementia-friendly neighbourhoods: Helping people with dementia to get out and about.
        Journal of Integrated Care. 2010; 18: 11-18
        • Moll A.
        Losing track of time: Dementia and the ageing prison population: Treatment challenges and examples of good practice.
        Mental Health Foundation, United Kingdom2013
        • Phillips J.
        • Pond D.
        • Goode S.M.
        Timely diagnosis of dementia: Can we do better? A report for Alzheimer’s Australia paper 24, Australia.
        Alzheimer’s Australia, 2011
        • Powell J.
        • Harris F.
        • Condon L.
        • Kemple T.
        Nursing care of prisoners: Staff views and experiences.
        Journal of Advanced Nursing. 2010; 66: 1257-1265
        • Prince M.
        • Bryce R.
        • Ferri C.
        World Alzheimer Report 2011: The benefits of early diagnosis and intervention.
        Alzheimer’s Disease International (ADI), United Kingdom2011
        • Royal College of Nursing (RCN),
        Health and nursing care in the criminal justice service: RCN guidance for nursing staff.
        RCN, London2009
        • Redgewell S.
        Patient or prisoner? Caring in a secure environment.
        Centre for Crime and Justice Studies. 2010; 81: 6-7
        • Trotter C.
        • Baidawi S.
        Older Prisoners: Challenges for inmates and prison management.
        Australian & New Zealand Journal of Criminology. 2015; 48: 200-218
        • Turner S.
        • Trotter C.
        Growing old in prison? A review of national and international research on ageing offenders, corrections research paper series, paper No. 03 July 2010.
        Department of Justice Melbourne, Victoria2010
        • Vickland V.
        • Morris T.
        • Draper B.
        • Low L.-F.
        • Brodaty H.
        Modelling the Impact of interventions to delay the onset of Dementia in Australia, A report for Alzheimer’s Australia, Paper 30, NSW.
        Alzheimer’s Australia, 2012
        • World Health Organization (WHO)
        Dementia: A public health priority.
        WHO, United Kingdom2012
        • Watson R.
        • Stimpson A.
        • Hostick T.
        Prison health care: A review of the literature.
        International Journal of Nursing Studies. 2004; 41: 119-128
        • Williams B.
        • Stern M.
        • Mellow J.
        • Safer M.
        • Greifinger R.
        Aging in correctional custody: Setting a policy agenda for older prisoner health care.
        American Journal of Public Health. 2012; 102: 1475-1481
        • Yorston G.A.
        The elderly offender.
        in: Abou-Saleh M.T. Katona C. Kumar S. Principles and practice of geriatric psychiatry. 3rd ed. John Wiley & Sons Ltd., London2011