**1. Introduction**

The percentage of the population in the over 65 year age group is estimated to double by the year 2055. This increase in life expectancy is related to developments around improved education, health and public safety [1]. Internationally, all countries are experiencing increasing growth in the population aged over 65 years and in turn there is an expected rise in chronic diseases including dementia [2]. Dementia is a growing challenge for society, and is expected to increase further in coming decades [3]. In the general population of those people aged 65 years and older, dementia is recognised as the leading reason for disability [3].

© 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. © 2018 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Dementia is a chronic condition represented by impaired functions of the brain with the affected areas being memory, cognitive skills, perception, behaviour, language, mobility and personality [3, 4]. Another area impacted by the development of dementia is executive function, causing problems with word-finding, judgement and reasoning [5]. These impairments are irreversible and generally have a gradual onset and progression, leading to a decline in the person's ability to perform self-care activities [3, 4].

deemed they are dangerous to the public [14]. They are placed in correctional facilities to be segregated, to protect the population of that country from their actions and to maintain societal laws [14]. There are many different terms used across the world to refer to the correctional environment including corrections, correctional setting, correctional facility, correctional institution, prison, gaol, jail, lock-up, penal institution, penitentiary and incarceration [15].

Re-Framing and Re-Thinking Dementia in the Correctional Setting

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There are many different terms used to describe the people who reside in correctional facilities including prisoner, crim, criminal, inmate, offender, convict, con, incarcerated, gaolbird [16]. The morbidity classification of an aged or elderly prisoner commences at 50 years whereas in the broader population group the morbidity classification begins at 60–65 years of age which is an equivalent disparity of 10 years [8, 17–19], therefore someone 50 years old is classified as being aged in the correctional setting. This difference in age is related to lifestyle factors including minimal medical care, substance misuse, low education levels prior to the prisoner entering the correctional environment, as well as the effect of life in prison with isolation from

Dementia has been defined by the World Health Organisation [4] (p. 2) as "a syndrome, usually of a chronic or progressive nature, caused by a variety of brain illnesses that affect memory, thinking, behaviour and ability to perform everyday activities [9]." The impairment that this causes is permanent and not reversible, resulting in the person not being able to live

Cognitive impairment is where the person is unable to make everyday decisions, has problems with remembering things, being unable to concentrate on activities or learn new things [21]. Cognitive impairment can be an early sign for the development of dementia and has

The World Health Organisation has developed a prison health guide [13], 'Health In Prisons', to firstly set out the critical requirements in health service provision and delivery of care, including information around standards in prison health. Secondly, it argues that prisoners should receive health care that is comparable to the general community and cites several international standards to support this entitlement. Thirdly, the guide highlights best practice based on the idea that there should not be any discrimination against prisoners based on their legal situation. Furthermore, it argues that prisoners have the right to receive the same quality

The World Health Organisation [4] has identified that the incidence of dementia is increasing at an alarming rate across the world and therefore all countries need to place dementia on the public health agenda. Many countries have developed plans and policies for addressing the increasing concerns relating to dementia, including Australia, England, Scotland, France, South Korea, Norway, Denmark, Netherlands, Japan, United States of America and Canada [23].

and level of healthcare as the general population in the country [13, 22].

family and threats of violence [18, 20].

independently [3, 4].

many differing causes [21].

**2. Current policy agenda**

Due to modern technologies and changes in sentencing requirements there has been an increase in the number of people entering the correctional environment and an increase in admissions of older people, which is expected to continue rising in correlation with the increased ageing population in the general community [6, 7]. Being classified as old in the correctional setting occurs at a younger age than in the general population and with this comes the incidence of chronic diseases and dementia as found in the general community, but at a younger age [8]. Prisoners have poorer health status than the general community due to their pre-incarceration lifestyle which increases their health risk resulting in poor health outcomes [9].

Identifying dementia in the early stages provides the opportunity to put strategies and supports in place with the person, while they are still able, and allows the person to be informed about their diagnosis [10]. Being informed about a diagnosis of dementia provides a chance for the person to make decisions about their care in the future and their continued wellbeing [10]. Early identification and diagnosis in the correctional setting presents the opportunity to build awareness of staff and other prisoners about the condition and its progression [10]. Even though healthcare providers have acknowledged that early identification of dementia is important, about two thirds of those with dementia die without it being diagnosed [11, 12]. This means that many people will never receive important interventions in the early stages, or have the opportunity to prioritise their care into the future [11].

There is minimal information around policies, organisational systems and practices in relation to management of prisoners with cognitive impairment and dementia, and evidence shows that this section of the community is marginalised and victimised. There is growing urgency to improve access by prisoners to appropriate healthcare for screening and management of cognitive impairment, as well as general health promotion to improve long-term outcomes. The World Health Organisation guide for prison health suggests adopting a simple model for correctional settings to create a healthy prison and provides a resource for prisons that are struggling to address the increasing older prisoner population [13].

This chapter highlights the issue generally and sets out strategies for organisations to use in identifying dementia and developing a healthier correctional environment which will lead to improved health outcomes for prisoners and also for staff and for the communities where these prisoners will be released.
