Compassionate Release: A Call to Social Workers.

An increase in the number of older people incarcerated in prisons has given rise to increased costs of correctional health care. Despite the many benefits of compassionate release, it is rarely used. Citing barriers at the micro, mezzo, and macro levels, we contend that social workers are uniquely suited to increase the number of people released through this mechanism owing to a unique knowledge and skill set. We offer eight specific strategies for how social workers can increase the use of compassionate release by working with individuals, conducting and disseminating research, and engaging in advocacy as shaped by core professional principles and values and related curricula.

Supporting Older, Frail, and Vulnerable Adult Prisoners Through Peer Care: Observations, Reflections, and Recommendations Based on a UK/U.S. Researcher Exchange Visit.

This article describes key findings from a UK/U.S. prison health researcher exchange in September 2023. The aims were to increase familiarity with the research context and to observe the roles of peer caregivers in U.S. prison settings. The researchers identified several differences and similarities in peer caregiving between UK and U.S. sites and detail six recommendations related to policy and practice concerning both sides of the Atlantic. It is believed that the adoption of such recommendations will contribute to improved care and, thereby, the health and well-being of vulnerable people incarcerated in prison.

Forgotten and without Protections: Older Adults in Prison Settings.

The number of older adults incarcerated in prisons is growing significantly, and there is a great need for legal authority, processes, and resources to mitigate individual and social burdens of elder neglect and abuse within these settings. Older adults in prison may be particularly vulnerable to abuse, neglect, or exploitation. They are dependent on the carceral system for basic resources, are at risk for retaliatory actions for reporting mistreatment, and bear disproportionately high health burdens. This essay first considers standards and resources for mitigating elder mistreatment in the community and residential-care settings in contrast to the available resources in prisons. Arguing that a conceptual model of elder abuse tailored to the prison population is needed, the essay proposes a research agenda through which such a model could be developed. The model could then be used in the creation of policy for detecting and mitigating elder mistreatment of incarcerated people. The essay concludes with a call to action to address the rift in legal protections and processes that leave older adults in prison at increased risk of abuse and neglect without a clear pathway for recourse.

Psychometric properties of the WHOQOL-BREF in a population of older adults in prison: measuring quality of life in a carceral setting.

PURPOSE: Valid and reliable measurement is critical to the assessment and evaluation of health interventions. However, few scholars have examined the psychometric properties of "gold standard" measures in carceral settings, and no research has explored the reliability, validity and factor structure of the 26-item World Health Organization Quality of Life (WHOQOL) BREF among older adults incarcerated in prison, a large and growing population marked by substantial chronic and life-limiting illness. This study aims to examine the reliability, validity and factor structure of the WHOQOL-BREF. DESIGN/METHODOLOGY/APPROACH: Secondary data from a large-scale study with older adults (age 45+) incarcerated in a Midwestern state were used (N = 499). Floor and ceiling effects were examined, as was the reliability of the measure (Cronbach's alpha). The structural validity of a four-factor and second-order four-factor model of the WHOQOL-BREF was examined using confirmatory factor analysis. Model data fit was examined using chi-square, standardized root mean square residual, comparative fit indices, Akaike information criterion and the Bayesian Information Criterion. Pearson product-moment correlation coefficients were also used to assess validity. FINDINGS: Results indicate adequate construct validity and reliability for the WHOQOL-BREF using the current sample. Model-data fit indexes also reveal adequate structure of the measure relative to other older adult samples. Non-random data and item exclusion are noteworthy limits, and future researchers are encouraged to co-conceptualize and operationalize life quality with older adults who are incarcerated. ORIGINALITY/VALUE: To the best of the authors' knowledge, this is the first study to explore the psychometric properties of the WHOQOL-BREF among older adults incarcerated in prison.

Racial disparities in visitation and health among older adults incarcerated in prison.

OBJECTIVES: I sought to identify racial disparities in visitation and health between Non-White and White older adults incarcerated in prison and to examine the contribution of visitation to health among this vulnerable population. METHODS: Descriptive and bivariate statistics were calculated to describe the cross-sectional sample and relationships between visitation and health. Independent t-tests, Chi-square tests, and effect sizes were used to identify racial disparities in measures of and relationships between visitation and health. Hierarchical multiple linear regression was used to examine the contribution of visitation to physical functioning, chronic disease, and mental health. RESULTS: Older adults rated their physical functioning higher than their mental health. Over 70% of older adults received zero visits during their current incarceration (∼13 years) and White older adults received 10 times the number of visits than Non-White older adults. Increased visitation related to decreased physical functioning among Non-White older adults, a relationship distinct from that of White older adults (z=-3.14, p<.001) and visitation contributed to variation in older adults' mental health. CONCLUSION: Future scholars are encouraged to examine factors associated with visitation and the quality of such visits for older adults. Further, visitation policies warrant amendment to increase visits and to enhance social support for older adults.

Symptom Agreement Between Patients and Their Peer Caregivers in Prison.

Peer caregivers are incarcerated people who provide adjunct, nonclinical support to other incarcerated people. We described patient-caregiver symptom agreement in prison and correlates of symptom agreement to explore peer caregivers' ability to understand their patients' experience. We found dyads were aligned closely (N = 52; k = .86; αbinary = .86), though patients and peer caregivers often reported no symptoms during the assessment period. Peer caregivers were capable of matching their patients' self-reported symptoms beyond chance alone, though few correlates of patient-caregiver symptom agreement in prison emerged. The role of reverence and social homophily are discussed as potential drivers of symptom agreement. Future examination of caregiver burden or measures that account for both patient and caregiver characteristics are encouraged.

Standardized outcome measures of mental health in research with older adults who are incarcerated.

PURPOSE: The targeted use of standardized outcome measures (SOMs) of mental health in research with older adults who are incarcerated promotes a common language that enables interdisciplinary dialogue, contributes to the identification of disparities and supports data harmonization and subsequent synthesis. This paper aims to provide researchers with rationale for using "gold-standard" measures used in research with community-dwelling older adults, reporting associated study sample psychometric indexes, and detailing alterations in the approach or measure. DESIGN/METHODOLOGY/APPROACH: The authors highlight the mental health of older adults who are incarcerated. They also discuss the benefits of SOMs in practice and research and then identify gold-standard measures of mental health used in research with community-dwelling older adults and measures used in research with older adults who are incarcerated. Finally, the authors provide several recommendations related to the use of SOMs of mental health in research with this population. FINDINGS: Depression, anxiety and post-traumatic stress disorder are common among older adults who are incarcerated. Researchers have used a variety of measures to capture these mental health problems, some parallel to those used with community-dwelling samples. However, a more targeted use of SOMs of mental health in research with this population will contribute to important strides in this burgeoning field. ORIGINALITY/VALUE: This review offers several practical recommendations related to SOMs of mental health in research with older adults who are incarcerated to contribute to a rigorous evidence base and thus inform practice and potentially improve the health and well-being of this population.

Visitation and quality of life among older adults in jail.

PURPOSE: The purpose of this paper aims to examine differences in measures of and relationships between visitation and quality of life (QOL) among older and younger jailed adults. The authors also explored the contribution of visitation to QOL among adults in this setting. The authors anticipated fewer visits and lower QOL among older adults. Framed by psychosocial developmental theory, the authors also anticipated a larger effect in the relationship between visitation and QOL among older rather than younger adults and that visitation would contribute most readily to psychological QOL. DESIGN/METHODOLOGY/APPROACH: Cross-sectional data from a large US jail were used (n = 264). The authors described the sample regarding visitation and QOL measures among older (≥45) and younger adults (≤44) and examined differences in measures of and relationships between visitation and QOL using independent sample t-tests and bivariate analyses. The authors explored the contribution of visitation to psychological, social relationships, physical and environmental QOL among jailed adults using hierarchical multiple linear regression. FINDINGS: Older adults had fewer family visits and lower physical QOL than younger adults, disparities were moderate in effect (d range = 0.33-0.35). A significant difference also emerged between groups regarding the visitation and environmental QOL relationship (z = 1.66, p <0.05). Visitation contributed to variation in physical and social relationships QOL among jailed adults (Beta range = 0.19-0.24). ORIGINALITY/VALUE: Limited research exists among jailed older adults and scholars have yet to examine the relationship between visitation and QOL among persons in these settings.

Prisons and COVID-19: A Desperate Call for Gerontological Expertise in Correctional Health Care.

The large and continued growth of the older adult population within U.S. prisons affects not only criminal justice policy and correctional health practice, but also gerontology. Amidst the unfolding COVID-19 crisis, associated knowledge and skills surrounding older adulthood will be critical to assuring the needs of older adults incarcerated in prisons are met during their detention, while undergoing off-site intervention in community settings, and when preparing for release. We outline several key areas for which gerontologists and associated practitioners are especially well suited in the effort to curtail morbidity and mortality driven by the disease caused by the novel coronavirus. Critical gerontological knowledge and skills needed in prison health care include awareness regarding the unusual clinical presentations of COVID-19 among older adults, deconditioning among older adults due to immobility, challenges in prognostication, and advance care planning with older adults. Specific, targeted opportunities for gerontologists are identified to reduce growing risks for older adults incarcerated in prisons.

Older adults incarcerated in state prison: health and quality of life disparities between age cohorts.

OBJECTIVES: This research sought to describe the physical and psychological health and quality of life among older adult men incarcerated in a state prison and to examine the role of age and historical time between age cohorts. METHODS: Survey responses from male respondents incarcerated in a medium-security prison (N = 186) were described using frequencies and descriptive statistics; chi-square and analysis of variance analyses were used to examine differences between age cohorts. RESULTS: The average number of chronic health conditions for the sample was higher than those in similar samples; the proportion of older adults with four or more chronic conditions was 10% higher than the national average for adults age 65 or older. Depression and post-traumatic stress (PTS) symptom severity scores were higher than those found in community-based samples. Significant differences were identified between cohorts regarding physical (number of chronic conditions, F = 12.48, p < .01); functional impairment, F = 4.28, p < .05) and psychological health (PTS symptom severity, F = 3.16, p < .05). CONCLUSION: Policy and practice implications are discussed including the expansion of on- and off-site services for older adults in prisons, enhanced accessibility, and the use of grief counseling and stress management strategies.

The End of Life Within Social Work Literature: A Conceptual Review.

The current conceptual review sought to identify and describe how the end of life was conceptualized and operationalized in top-ranking, peer-reviewed social work journals considering the highly individualized and multidimensional experience of dying put forth by modern scholars and social work practitioners. An iterative content analysis of included articles (N = 103) revealed six themes within reported definitions and four themes within eligibility criteria. Definitions (n = 66) related to treatment responsiveness, the death process, dying, prognosis, admission to specific services, and old age. Eligibility criteria (n = 18) related to proxy assessment, diagnosis, prognosis, and functional ability assessments. Over one-third of included articles did not define what was meant by the end of life (36%; n = 37) and the majority did not include eligibility criteria (83%; n = 85). In conclusion, the complex lived experience of dying was not manifest within included articles raising important implications for research (e.g., measurement, meta-analysis) and social work practice (viz. service eligibility).

Professional quality of life and intent to leave the workforce: Gender disparities in child welfare.

BACKGROUND: Efforts to enhance professional quality of life (ProQOL) may prove a promising area for intervention to reducing workforce jettison and maintaining a healthy and resilient workforce necessary for supporting children and families in the child welfare system. OBJECTIVE: The current study aimed to describe the relative contributions of measures of ProQOL to intent on leaving the workforce among child welfare professionals. We also aimed to describe gender differences in ProQOL, intent to leave, and associated correlations among child welfare professionals. Such an investigation is a critical extension of earlier efforts as women constitute a markedly larger proportion of the workforce compared to men and evidence exists pointing to gender disparities in helping professionals' work experiences. PARTICIPANTS AND SETTING: Secondary data were used from a survey of child welfare professionals across five sites. METHODS: Univariate and bivariate statistics, hierarchical linear regression, and associated z-scores and p-values were used to meet the aforementioned aims. RESULTS: Burnout accounted for the greatest variation in intent to leave among all professionals. However, gender disparities were found for all ProQOL measures with the largest difference observed for burnout, an effect more pronounced in males. Compassion satisfaction was significantly higher among females. CONCLUSIONS: Burnout shapes intentions to leave for child welfare professionals; however, the effects of emotional exhaustion and hopelessness are stronger predictors of turnover among male than females in the current sample. Organizational strategies to reduce burnout and future research directions are discussed.

The light and dark sides of social capital: Depressive symptoms among incarcerated older adults.

BACKGROUND: Adults aged 55 or above represent a large and growing proportion of the US and international correctional populations and more physical and mental health problems than their non-incarcerated peers. Social capital represents the collective cognitive and network structure resources accessible through social relationships and may serve as a potential asset in carceral settings in the amelioration of depressive symptoms among older adults. METHOD: A sample of men drawn from a study of older adults in Kentucky prisons (n = 91) was used to meet the following aims: (1) explore relationships among cognitive and structural facets of social capital, chronic health conditions and depressive symptoms and (2) identify the role of social capital (viz. trust) alongside chronic health conditions as a determinant of depressive symptoms. We hypothesized that each indicator of social capital would relate negatively to depressive symptoms and that trust would emerge as most strongly associated with depressive symptoms. RESULTS: Bivariate correlations between depression and social capital variables related as we hypothesized. However, our hypotheses were only partially supported. Higher trust was correlated to fewer depressive symptoms (r = .21, p < .05) revealing a lighter side of trust in the correctional milieu but was unrelated to depression when controlling for variables. An interaction term in the final model indicated a different role for trust. Factors accounted for 64% of variance in depressive symptoms among older adults in a state prison (F(10, 80) = 14.25, p < .001). In this model, higher trust was related to depressive symptoms when included alongside additional measures of social capital, indicating that a darker side of this facet may exist within correctional settings. CONCLUSION: Many indicators of social capital (e.g., network size) demonstrated potentially protective benefits against depression, while trust revealed a more complex role related to chronic health conditions. Limited measures and the agnostic behavior of trust require attention by future researchers.

Characteristics of Hospice and Palliative Care Programs in US Prisons: An Update and 5-Year Reflection.

Individuals with terminal illness are dying behind bars and many state prison administrators have incorporated on-site hospice and palliative care services. Little is known, however, about these programs since a 2010 study of prison hospice characteristics. We provide an updated description and reflection of current hospice and palliative care programs in state prisons serving incarcerated persons with terminal illness. A cross-sectional survey was sent to representatives of all known prisons offering hospice and palliative care programs and services (N = 113). Questions were drawn from an earlier iteration regarding interdisciplinary team (IDT) membership, training length and topics, peer caregivers, visitation policies, bereavement services, perceived stakeholder support, and pain management strategies. Additional questions were added such as estimated operational costs, peer caregiver input in patient care, and the strengths and weaknesses of such programs. Frequency distributions were calculated for all study variables. Responding representatives (n = 33) indicated IDTs remain integral to care, peer caregivers continue to support dying patients, and perceived public support for these programs remains low. Reduced enthusiasm for the programs may negatively influence administrative decision-making and program resources. Further, peer caregiver roles appear to be changing with caregivers charged with fewer of the identified tasks, compared with the 2010 study.

Quality of Life in Jail: Gender, Correlates, and Drivers in a Carceral Space.

Quality of life (QOL) is an important area of exploration in U.S. corrections linked closely to well-being and an important indicator of intervention efficacy. Little is known of QOL in U.S. jails despite the admittance of over 10-million people to these settings every year. Research regarding the dimensions, correlates, and gender disparities in QOL in jails is important to shaping gender-responsive supports and reducing recidivism. Independent t tests and correlational and regression analyses were used to explore dimensions, correlates, and gender disparities in QOL among persons incarcerated in a large, southeastern jail (N = 299). All QOL domains were significantly related to overall QOL, and psychological QOL contributed most readily to respondent's overall QOL. Females, on average, reported lower QOL than males with significant differences between the groups in physical health and psychological domains. The importance of psychological QOL intervention and healthcare continuity are discussed.

U.S. Department of Corrections Compassionate Release Policies: A Content Analysis and Call to Action.

Large and increasing numbers of inmates with chronic and terminal illnesses are serving time, and dying, in U.S. prisons. The restriction of men and women to die in prisons has many ethical and fiscal concerns, as it deprives incarcerated persons of their autonomy and requires comprehensive and costly health-care services. To ameliorate these concerns, compassionate release policies, which allow inmates the ability to die in their own communities, have been adopted in federal and state prison systems. However, little is known about the content of compassionate release policies within U.S. states' department of corrections, despite recent calls to release incarcerated persons who meet eligibility criteria into the community. The current study provides an overview of compassionate release policies in the United States, which vary widely across the compassionate release process. Specific policy recommendations are made to assure the timely access and utilization of compassionate release among eligible incarcerated individuals.

Measurement in Correctional Health Research: Unique Challenges and Strategies for Enhanced Rigor.

It is essential to identify valid and reliable measurement strategies to enhance accurate, comprehensive, and meaningful health assessment and evaluation to improve health outcomes among justice-involved and incarcerated populations. This article identifies and describes three primary challenges related to measurement in correctional health care and makes four recommendations for enhanced measurement rigor from a social justice perspective. First, incorporate incarcerated persons into the measurement research process; second, enhance psychometric investigation in correctional health settings; third, increase the collection of individual-level, health-related data from incarcerated populations; and fourth, create and maintain centralized databases and comprehensive codebooks to promote data sharing.