Older forensic mental healthcare patients in England: demographics, physical health, mental wellbeing, cognitive ability and quality of life.

ABSTRACT

Background: Older individuals (e.g., 55 years and over) constitute a growing proportion of the forensic mental health patient population. As a group, they are vulnerable to health outcomes similar to other individuals with serious mental disorders of the same age; however, these concerns can be compounded by complex forensic-related care backgrounds and clinical presentations, lengthy periods of time spent in prison or psychiatric hospitals, substance use histories, and crime perpetration or victimisation. The healthcare needs and strengths of this group are not well understood.The aim of this study was to identify and describe the demographic, physical health, mental wellbeing, cognitive ability, and quality of life profiles of older forensic patients in community, low, medium, and high security settings in England. Methods: A cross-sectional quantitative study design was used. N=37 forensic patients aged 55 years and over completed six questionnaires. Data were also collected from patient records. Results: Most patients were male and were diagnosed with psychosis. The most frequently committed index offence types were violent offences. Patients were prescribed 7.6 medications on average and had average anticholinergic effect on cognition scores of 2.4. Nearly half the sample had diabetes, with an average BMI score of 31.7 (indicating obesity). Possible cognitive impairment was identified in 65% of the sample. Patients' assessments of their recovery-related quality of life and mental wellbeing were comparable to published UK general population values. Assessments of quality of life were positively correlated with the ability to undertake everyday activities and cognitive performance. Conclusions: We suggest that forensic services are well-placed to provide holistic mental and physical care to this group but that they should co-develop with patients a greater range of age-appropriate meaningful activities that are mindful of mobility issues and consider implementing more cognition-based and physical health interventions.

Forensic mental health services provide care for people who have committed a crime or are at risk of harm to themselves or others. This care takes many forms, including mental health support, physical health care, and assistance to re-enter the community after spending time in secure mental health hospitals. Due to changes in the general population, there is a growing number of patients over the age of 55 in care. Despite this, we do not know enough about the healthcare needs of this older patient group and how these needs differ from younger patients. This study aimed to find out more about this patient group. In the current study, thirty-seven forensic patients aged 55 years and older were recruited from low, medium and high security hospitals and community care. These patients completed six questionnaires. Patients were asked about their physical health, mental wellbeing, cognitive ability, and quality of life. Information about medical diagnoses and socio-demographic backgrounds were collected from hospital records. The study found that these patients had complex health needs. Most patients were diagnosed with psychosis (e.g., schizophrenia), were men, and had committed a violent criminal offence. On average patients were prescribed 7.6 medications, many of which carry significant side effects. Nearly half of the patients had diabetes, and most patients were obese or overweight. Quality of life scores were lower for patients who also reported having problems undertaking everyday activities and patients with cognitive impairment. Patients subjectively rated their mental wellbeing and quality of life similarly to the general population's ratings as reported in other studies. We suggest that services should work with patients to develop a greater number of age-appropriate activities and interventions aimed at improving cognitive and physical health.