As policy changes and reforms result in reduced incarceration among some younger age groups, adults who are 65 and older are making up a greater proportion of the incarcerated population. This shift has been documented in jail populations, and similar increases are noted in state and federal prisons: Projections indicate more than one-third of the incarcerated population will be over 55 years of age by 2030. Correctional facilities and reentry service providers face unique challenges surrounding the care of aging adults.

Accelerated Aging

Aging is associated with physical and mental changes, the extent and speed of which are highly dependent on a variety of factors, including access to holistic health care, proper nutrition, physical and mental activity, stress management, and social interaction. Research suggests that the physical and emotional stress of incarceration prompts accelerated aging, meaning individuals are considered geriatric by age 50, as indicated by high rates of chronic medical conditions and early onset of geriatric syndromes (e.g., hearing impairments, difficulty performing activities of daily living). Persistent health disparities and outcomes for people of color demonstrated in the general population add an additional layer of complexity to discussions about accelerated aging, since people of color are overrepresented in the criminal justice system. In 2020, Black adults were incarcerated at five times the rate of White adults.

Undiagnosed and untreated substance use disorders contribute to chronic diseases, such as cirrhosis of the liver and hepatitis, which are more prevalent among individuals in correctional facilities than the general public. Mental health conditions, also more common among those in custody, are exacerbated by incarceration.

In addition to providing health services that meet community standards for managing chronic diseases and mental health conditions, correctional facilities are encouraged to provide staff training on geriatric care, including topics such as signs of aging and communication techniques.

Laura Roan, vice president of prison services for the Osborne Association, a nonprofit serving individuals and families impacted by the criminal justice system across New York State, explains, “Being age-informed means recognizing potential physiological reasons for changes in behavior. For example, a man with few infractions during the 30 years of his incarceration starts to repeatedly be ticketed for being out of place and for not obeying a direct order. It may very well be that he is developing dementia or has hearing loss. Treatment, not discipline, is in order. Another example, one far easier to address, is the person whose hand tremor worsens to the point of interfering with managing his food tray. A one-handed tray greatly improves accessibility.”

Returning to the Community

From work on Osborne’s Elder Reentry Initiative, Roan recognizes that older adults who reenter the community from repeated, shorter periods of incarceration often struggle with substance use and mental health challenges, in addition to the housing and employment challenges that are persistent for all people returning from incarceration.

Dan Pfarr, president and CEO of 180 Degrees, a nonprofit organization launched in 1973 to help men rebuild their lives following incarceration, agrees. “Too many men return to jail or prison due to custody violations,” he explains. “Why? Instability is one reason. Failing to maintain gainful employment is often a short step away from recurrence of mental health conditions or return to substance use, especially if you don’t have the money for medication. With our older clientele, physical limitations or chronic health conditions may prevent their ability to work full-time.”

For individuals who have served very lengthy sentences, reentry is further complicated by a world that is now unrecognizable to them. Roan notes, “Technology drives so much of our lives. People who may never have held a cell phone are now expected to apply for jobs and benefits, make appointments, and find housing online. It quickly adds to cognitive overload—for anyone, but more so for folks who are older.”

After years of incarceration, the challenge of being reintroduced to society can be anxiety-producing, particularly for individuals who have untreated mental health conditions. Among other manifestations of this anxiety, Roan has observed that some individuals stop eating for days before release, which can interfere with the effectiveness of medications for chronic health conditions that must be taken with food.

Responding to the Challenge

For individuals of any age, reentry plans must be tailored to the needs of the individual, and understanding older adults’ unique needs is an important consideration. For example, incontinence issues coupled with mobility challenges may prompt high anxiety among older adults about using public transportation to attend appointments with community service providers. Reentry planners need to be aware of these concerns by asking the right questions; in such a case reentry planners may, for instance, choose to avoid including in the reentry plan connections to providers who are reachable only by public transportation.

The ability to carry out activities of daily living (ambulating, feeding, dressing, personal hygiene, continence, and toileting) may diminish with age and should be assessed. A geriatric assessment may also involve cognitive screenings with simple exercises such as drawing a clock, referring individuals to geriatricians for further testing when needed. Such assessment may indicate a high probability of lower functioning in settings less regimented than prison. Tools for screening and assessing for substance use disorders and mental health conditions should be validated for the older adult population.

Upon release, chronic health issues, such as substance use disorders and mental health concerns, must be stabilized to support compliance with conditions of release. Stabilization may include connecting individuals who are reentering the community with peers or a social network, providing education on risks of substance use interaction with prescription medication, and investigating mobility and accessibility limitations related to treatment services.

Stabilization will also help individuals focus on housing, employment, recovery, family reunification, and other pillars of reentry. Each pillar should be adjusted to accommodate age-related issues, such as providing referrals to jobs that do not require heavy physical stamina and education on technological innovations.

Incorporating these and other aging-informed practices both within correctional facilities and upon reentry to the community supports individuals, often already grappling with mental health conditions and substance use disorders, in an especially vulnerable time of their lives.