**2. Current policy agenda**

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

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

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,

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

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

Correctional facilities are where people are housed when they have been accused or convicted of breaking the law by committing crimes in a country, and the criminal justice system has

lifestyle which increases their health risk resulting in poor health outcomes [9].

or have the opportunity to prioritise their care into the future [11].

struggling to address the increasing older prisoner population [13].

these prisoners will be released.

**1.1. Definitions**

person's ability to perform self-care activities [3, 4].

120 Cognitive Disorders

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

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]. However, these plans and policies concentrate on the general community and do not translate into the correctional setting or provide any plans for moving into this environment.

a person with a cognitive impairment or care for someone who is disabled, rather, they are

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

http://dx.doi.org/10.5772/intechopen.73161

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Despite the fact that an increased awareness of the ageing population and dementia has been a major focus of literature on older people, there is minimal documentation about how this is impacting the correctional setting [5]. Maschi et al. [30] (p. 442) state that there is 'no national study to estimate prevalence of dementia among the U.S. prison population'. Williams et al. [32] also identified that there has been minimal research into the prevalence of dementia in the correctional setting, and based on other data, they expect cognitive impairment to be high and unrecognised in the older prisoner population. There is limited research into the early identification of dementia in the prisoner population, with correctional healthcare services having a strong focus on acute healthcare issues rather than long term preventive measures [33]. This correctional setting has given rise to increasingly complex healthcare needs in the prisoner population which is directly linked to the increase in the ageing population in this

A high proportion of those people who enter the correctional environment are from disadvantaged and/or minority groups in society, with the majority of the marginalised being well represented and generally from a particular socioeconomic quintile [35]. Those people who become involved in the criminal justice system have a higher incidence of health problems, such as untreated chronic conditions and mental illness, than the general population [35, 36]. It is well documented that people from low socioeconomic lifestyles have a high incidence of unhealthy behaviours such as alcohol and substance misuse, smoking, poor nutrition and living conditions and they rarely visit healthcare services [35, 37]. Health conditions such as mental illness and some unhealthy choices and behaviours, for example alcohol and illicit substance misuse place people at greater risk of arrest and once they are incarcerated, they sometimes enter an overcrowded and at times violent environment [36]. These lifestyle factors prior to incarceration and then within the correctional environment creates negative effects on the mental health of the prisoners due to overcrowding, isolation, lack of mental stimulation, lack of privacy, and separation from family or supports, which in turn puts prisoners at

Prisoners who have early stages of dementia are treated the same as the rest of the inmates within the correctional environment which causes additional problems. For example, a person with dementia is unable to follow simple instructions or directions from correctional staff which can result in or to lead punishment for non-compliance [31]. This subsequently increases the prisoner's confusion, leading to an exacerbation of the dementia symptoms and processes [5, 31]. It was also identified that the dementia process could cause confusion for a

prisoner around social standards or customs in the correctional setting.

employed to manage prisoners' behaviour [31].

**4. Community and correctional settings**

greater risk of developing dementia [17, 35].

**4.1. Individual (national framework and health status)**

setting [34].

Australia has developed the 'Corrections Ageing Prisoner and Offender Policy Framework 2015-20', which identifies that ageing prisoners have varying individual and system needs, and these needs should both be considered [24]. There are four fundamental principles characterised: supporting age-appropriate regimens and accommodation, enhancing health and wellbeing, tailored age and interest-relevant programs and building strong partnerships [24]. Situated under these principles there are four key priority areas. The first requires support for staff to ensure they are delivering evidence-based best practice within the facility as well as system enhancement. Secondly, prisoners require access to age appropriate services for their health and well-being. The third priority is about building staff capacity to ensure the workforce is assessing and supporting common ageing conditions. Finally, the fourth provision requires of monitoring of ageing demographics to ensure all prisoners and staff needs are being addressed in a timely manner [24].
