**5. Healthcare in correctional settings**

of this group of prisoners [10]. Prisoners need to meet special requirements for entry into this facility, with dementia being one of the requirements [10]. The facility offers a 'Special Needs Program for Inmate-Patients with Dementia (SNPID)' which supports prisoners by modifying either their social or physical environment [10, 45]. This program includes the use of specially selected prisoners to provide support to the prisoner with dementia and ultimately

Training of prisoners to become carers has been used as a strategy in Queensland (Australia) by providing Carers Certificate 2 training to selected prisoners to assist with older prisoner care [46]. This provides extended care for the prisoner with cognitive impairment when needed, while also providing the prisoner carer with a potential career on discharge from prison [46]. These carers work under the direction of a registered nurse to ensure safe and

Long Bay Correctional Complex in Sydney (Australia) is developing access to allied health professionals who specialise in areas of need for prisoners with dementia [10]. They will provide long term supported care in the correctional health service, which will include an '…aged-care offender's independent living in segregation from the mainstream prison, with

There have been various strategies for early identification and support for people in the general community with cognitive impairment and dementia for some time, however this has not translated into the prison setting. Specialised tools are used in the community to assess a person's functional abilities as these skills are the first ones affected by cognitive impairment and dementia [5]. Two of the community tools are 'activities of daily living' (ADLs) and 'instrumental activities of daily living' (IADLs). A person in a correctional environment would not be responsible for developing or using these skills so an alternative tool has been developed in the United States of America called 'prison activities of daily living' (PADLs) [5]. Although this tool has been identified by a couple of authors it does not appear to have been picked up in other countries. Each country and each correctional facility will have slightly different processes and these could be used to modify the PADLs to suit their specific facility.

In Australia, 'The National Framework for Action on Dementia', which aimed to make dementia a national priority, was developed to support communities to provide assistance to carers and those in the community with dementia [23]. A national framework for action was agreed upon by Australian Health Ministers and this framework listed five priority areas [3]. These priority action areas were: 'care and support services, access and equality, information and education, research and workforce and training strategies' [3]. Even though this was developed for the general Australian population, the correctional setting is yet to follow these recommendations [10]. In England a national dementia strategy was developed to provide support for early diagnosis and intervention, and Scotland developed a dementia strategy to achieve similar outcomes [23]. In the United States of America preventing and reducing

dementia has been identified as a 'national public health priority' [30].

improving their quality of life [10, 45].

126 Cognitive Disorders

quality healthcare is provided.

**4.4. Community settings**

support from a disability service…' [10] (p. 15).
