The Prison Service needs to develop a strategy to deal with the growing number of older prisoners so that staff can manage age-related conditions such as dementia better, said Prisons and Probation Ombudsman (PPO) Nigel Newcomen. Today he published a bulletin on lessons that can be learned from investigations into deaths of prisoners with dementia.
Those aged over 60 are the fastest-growing segment of the prison population, increasing 125% between 2004 and 2014. The Ministry of Justice projects the population in prison aged over 60 to increase from 4,100 in 2015 to 5,500 in 2020. Dementia is a condition often associated with the ageing population. There have been relatively few investigations into deaths in custody which have highlighted issues relating to dementia, but this will be a growing issue as the prison population continues to age. The number of prisoners affected is unknown, although the Mental Health Foundation has estimated it at approximately 5% of prisoners over 55 years old. If this is the case, there are likely to be several hundred prisoners with dementia.
Mr B was 63 years old when he was sent to prison. He had several health problems, but in particular he had been diagnosed with vascular dementia, caused by a lack of blood to his brain, thought to have been caused by high blood pressure and previous strokes.
A number of professionals assessed him to identify his care needs. He had a disability care plan, received appropriate medication and healthcare staff monitored him frequently.
However, no one took overall responsibility to ensure that all his needs were met. Healthcare staff decided that the cause of his dementia was largely physical, and the mental health team did not assess him for almost a year.
Mr B did not always remember to take his medication as prescribed and his personal hygiene deteriorated. He was seen by a doctor when he complained of painful feet, and the doctor noted that this was due to poor hygiene. The doctor made a referral to a podiatrist, but there is no record of this ever happening. A healthcare manager at the prison told our investigator that Mr B would have had to make a written application to see a podiatrist himself, if he wanted to be treated.
We found this to be neglectful for a man with his poor mental capacity.
At the end of life, prison managers decided that Mr B should be restrained by an escort chain in hospital, without a proper risk assessment that took into account his health and mobility. He was restrained for three days in hospital before the restraints were removed, two days before he died.
The report found that:
- when someone has dementia, they may, over time, lose the capacity to make decisions about their care and treatment;
- lack of appropriate space or facilities can make it difficult for prisons to provide care that would be equivalent to that in the community;
- prisoners are likely to need support, such as with collecting their food and cleaning their cells and, when used effectively, prisoner carers can provide essential support to prisoners with dementia; and
- when elderly and infirm prisoners travel to and from hospitals for appointments and treatment, restraints are often used inappropriately.
The lessons from the bulletin are that:
- support should be given to those with dementia to help them make informed decisions about their care and, where they lack capacity, there should be appropriate assessments and documented decisions;
- all prisons should have a local lead for adult social care to coordinate the care of individual prisoners with dementia;
- prisons should share best practice and consider innovative ways of coping with the increasing number of prisoners with dementia;
- prisoner carers must be given training and safeguards need to be put in place to ensure arrangements are appropriate;
- when a prisoner is taken to hospital, a risk assessment should fully take into account their health, mobility and mental capacity and the use of restraints should be based on the actual risk they present; and
- prisons should make reasonable adjustments to help prisoners with dementia and their families keep in touch.
Nigel Newcomen said:
“Dementia is a potentially life-limiting condition affecting both physical and mental capacity, although most people with dementia die of other complications, such as pneumonia or a stroke.
“In my investigations, I have frequently been struck by how ill-prepared prisons were to deal with this new challenge, essentially because they were designed to meet the needs of younger people and not chronic age-related conditions. Things are beginning to move in the right direction in some prisons, with examples of good practice, but there is still a long way to go.
“The Prison Service badly needs a properly resourced national strategy for its rapidly growing population of older prisoners, to guide its staff in their management of age-related conditions such as dementia.”