The aging process in prison: pathologies and health conditions in old inmates. An epidemiological research in Italy.

BACKGROUND AND AIMS: Elderly may suffer from different pathologies during their detention in jail because of their age. Conditions in jails were tough and adapting to that life could be problematic for the elder population. This article aimed to analyse the pathologies and health conditions in a sample of elder inmates from Italy. METHODS: The sample was composed by 94 elderly inmates. The research is multicentric. We selected jails from the cities of Bari, Taranto, Foggia, Lecce, Brescia, Bergamo, Cremona and Mantua. The study was conducted by interviewing the prisoners over 60 years of age, in the period between September and December 2017. RESULTS: 64% of the sample was in a "Not Optimal" health status. Most of pathologies were Cardiac pathologies (23.4%), Diabetes (12.8 %) and Surgery (9.6%). Statistically significant differences were found for heart disease (p=0.02) and Neoplasia (p=0.025) in the prison of Bari compared to all the other prisons. Statistically significant differences were found for Hypertension in Foggia and Taranto prisons compared to all the other (p=0.023). Furthermore, 18.1% of inmates ended up having an addiction. CONCLUSIONS: Our analysis showed that in our sample physical problems were more frequent than psychological one. In fact, in spite of in the literature there was a high prevalence of mental health problems among elderly inmates, we did not find this result. However, stress conditions may increase the risk of pathologies: for example, being in jail and adapt to new hard environment may increase the risk of getting sick. Heart disease pathologies and diabetes were very common in our sample as confirmed by the literature.

Subthreshold depression in older subjects: an unmet therapeutic need.

Major depression, defined according to DSM IV TR criteria, is less common in older subjects, while other types of depression are two to three times more prevalent. This heterogeneous group of disturbances has received different names: depression not otherwise specified, minor depression, subthreshold or subsyndromal depression. Moreover, each condition has been defined using heterogeneous criteria by different authors. The term of subthreshold depression will be adopted in this position statement. Subthreshold depression has been associated with the same negative consequences of major depression, including reduced well being and quality of life, worsening health status, greater disability, increased morbidity and mortality. Nevertheless, there is a dearth of clinical trials in this area, and therefore older patients with subthreshold depression are either not treated or they are treated with the same non pharmacological and pharmacological therapies used for major depression, despite the lack of supporting scientific evidence. There is an urgent need to reach a consensus concerning the diagnostic criteria for subthreshold depression as well as to perform clinical trials to identify effective and safe therapies in this too long neglected patient group.

Antipsychotic utilisation and polypharmacy in Italian residential facilities: a survey.

OBJECTIVE: To evaluate the prescribing practices in psychiatric residential facilities, with particular focus both on the antipsychotic dose and polypharmacy as well as the variation of antipsychotic patterns during a patient's stay within the facilities. METHODS: Fifteen residential facilities of Liguria region in Italy were included. Data were collected through a chart review during a one-day census. Frequency of psychotropic patterns was estimated. Different non-parametric tests were used to analyse the changes in prescription patterns as well as the relationship among antipsychotic dose, the number of antipsychotics and anticholinergic use. RESULTS: The study sample includes 362 patients, 61.9% males. On the census day 77.5% of patients received psychotropic polypharmacy and 57.2% antipsychotic polypharmacy. Antipsychotic polypharmacy was related to the total antipsychotic daily dose and to anticholinergic use. A trend towards an increase of antipsychotic and psychotropic polypharmacy and higher doses of antipsychotics over the period of stay within the facilities was noted. This tendency was related to the length of stay in the facility. CONCLUSIONS: Compared to earlier studies in the same clinical environment a significant increase in the use of psychotropic and antipsychotic polypharmacy was observed. The risk of prescribed polypharmacy seems to be related to time spent in the facility.