Team of HSC experts develops national position statement for NCCHC on care for aging patients in correctional facilities

Addressing an overlooked and sometimes neglected patient population, a group of experts from The University of North Texas Health Science Center at Fort Worth partnered with the National Commission on Correctional Health Care to write a “Care for Aging Patients in the Correctional Setting” position statement. The position statement assists correctional facilities nationwide in designing policies and procedures to care for aging inmates and was adopted by the NCCHC in March of 2024.

Mills John
Dr. Mills

“If you look at the literature, the inmate population in the United States Bureau of Prisons is aging and presents a significant cost burden,” said Dr. John Mills, the medical director for HSC’s Correctional Medicine Program. “Inmates in prison are about 10 years older than their stated age due to living a hard life. Health providers in prisons should screen for dementia, assess them for fall risks and review the type of prescriptions they are taking.”

The team from the Texas College of Osteopathic Medicine’s Department of Internal Medicine and Geriatric’s HRSA Workforce Enhancement in Healthy Aging and Independent Living (WE HAIL) Program provided expert consultation to the NCCHC in developing this position statement.

Along with Dr. Mills, the experts included Dr. Janice Knebl, UNT regents pofessor and WE HAIL principal investigator, Dr. Jennifer Severance, the WE HAIL associate director, TCOM assistant professor Dr. Tyson Garfield, College of Nursing associate professor Dr. Jan Jowitt, TCOM assistant professor Dr. Sara Murphy and PhD candidate Maria Soto.

Jennifer Severance
Dr. Severance

“People who experience incarceration have worse health outcomes than the general population,” said Severance. “There is a need to support health care workers in correctional settings in a way that can mitigate health disparities in older age among people in this population. Knowing this prompted us to develop recommendations using a proven framework and account for the distinct challenges and vulnerabilities of aging in carceral settings and in transitioning back into the community.”

Dr. Mills, who sits on the NCCHC Policy and Research Committee, helped champion a partnership between the NCCHC and WE HAIL. More than a year ago, the group put together an interdisciplinary workgroup to develop recommendations for age-friendly care in correctional medicine settings based on the Institute for Healthcare Improvement’s Age-Friendly Health System 4Ms framework.

“Looking around we saw there was no policy on the care for older inmates, so I went to the executive directors of the NCCHC and told them we have this outstanding group of geriatricians in Texas who would be happy to tackle this project,” said Mills. “I kept hammering them until they finally came around to it. We had a meeting with the team, and it took about a year until we got it completed, which is just a remarkable time to accomplish something like this.”

The statement gives recommendations for older adults in the carceral setting and how they should be evaluated and treated for health care conditions by evidence-based guidance. The statement highlights seven key clinical care components that should be considered, which include immunizations, screening for depression, falls, dietary intake, cognitive impairment and health professionals watching for the signs and symptoms of potential elder abuse during clinical encounters.

“These clinical care components ensure a comprehensive approach to address the unique needs of this vulnerable, often forgotten population,” said Jowitt, RN, AGPCNP-BC, CCHP, associate professor at HSC’s College of Nursing. “We framed this statement to support the growing needs of older incarcerated adults with compassion and dignity. As facilities adopt these recommendations, we can better serve our older adults, identify individual needs, promote safety and well-being and provide support.”

The mission of the National Commission on Correctional Health Care, a nonprofit 501(c)(3) organization, is to improve the quality of health care in jails, prisons and juvenile confinement facilities. NCCHC establishes standards for health services in correctional facilities, operates a voluntary accreditation program for institutions that meet those standards, produces, and disseminates resource publications, conducts educational conferences, and offers a certification program for correctional health professionals.

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