A vulnerable population – assessing and managing frailty in older prisoners


Kathryn Waldegrave, Lecturer – Adult Nursing & PhD student, School of Healthcare, University of Leeds, email – K.E.Waldegrave@leeds.ac.uk @waldyPhD

An ageing prison demographic is fuelled by increasingly long sentences and historical cases being brought to prosecution. Many arguments suggest older prisoners should not be imprisoned, that the financial impact on the health and justice systems is too great. However, the ageing prison population continues to rise, with Prisons and Probation Ombudsman (PPO) predicting 14,000 prisoners over the age of 50 will be in the system by June 2020 (PPO, 2017). A vulnerable population, older prisoners have unique, often challenging health care needs, increased risks and decreased resources to support their health. Compounded by the effects of lifestyle factors and possible lack of prior medical care, they are often considered ‘geriatric’ or ‘old’ at the age of 50 as opposed to 65 as seen in the community and can acquire and experience health conditions prematurely. Older prisoners are often seen as a compliant, almost invisible group who do not attract attention and whose health needs are easily overlooked in favour of other, more demanding prisoners.

A lack of understanding of the term ‘frailty’ in regard to older prisoners leads to misconceptions and poor management. ‘Frailty’ indicates a distinctive health state; multiple body systems are challenged over a time period of 5-10 years, which results in a loss of in-built reserves (British Geriatric Society, 2014; Britton, 2017). Often compounded by exposure to stressful situations and associated with poor health outcomes (Salem et al, 2014), vulnerable populations, such as older prisoners, are at risk of accelerated frailty making them more likely to experience poor health outcomes, premature morbidity and mortality (Salem et al, 2014). Timely identification of frailty provides opportunities to apply appropriate interventions for preventing exacerbation and acceleration of the condition, promoting independence, health and well being. However, identification relies on assessments that currently lack standardisation, and screening which is aimed at a primary care target population of 65 years and older (Britton, 2017). Consequently, unmet and unrecognised health needs, multiple co-morbidities, exposure to a stressful situation with little control over the wider determinants of health and lack of a standardised, age appropriate screening tools leaves a vulnerable older prison population at risk of developing an unmanaged but manageable long term condition.


British Geriatrics Society. 2014. What is Frailty? [Online] . [Accessed 19 October 2017]. Available from: http://www.bgs.org.uk/frailty-explained/resources/campaigns/fit-for-frailty/frailty-what-is-it

Britton, H. 2017. What are community nurses experiences of assessing frailty and assisting in planning subsequent interventions? British Journal of Community Nursing. 22(9), pp. 440-445.

Prisons and Probation Ombudsman. 2017. Learning from PPO investigations: Older Prisoners. [Online]. [Accessed 02 October 2017]. Available from: https://s3-eu-west-2.amazonaws.com/ppo-dev-storage-4dvljl6iqfyh/uploads/2017/06/6-3460_PPO_Older-Prisoners_WEB.pdf

Salem, B; Nyamathi, A; Phillips, L; Mentes, J; Sarkisian, C and Brecht, L. 2014. Identifying Frailty Among Vulnerable Populations. Advances in Nursing Science. [Online]. 37(1), pp. 70-81. [Accessed 05 October 2017]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4162317/


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