The health and wellbeing of people living with dementia in prison

Background
The number of older people with cognitive impairment in prisons is increasing across the globe. Meeting the complex needs of this vulnerable group has become an increasing concern for prison and prison healthcare services.

Methods
This multi method qualitative study investigated how people with diagnosed or suspected dementia were identified, assessed, and cared for in Scottish prisons. We report how this evidence was used to collaboratively propose principles for dementia care in prison and present the resultant co-designed care pathway. This project was funded by the Dunhill Medical Trust RPGF2006\236.

Results
Almost all the men known to have a dementia diagnosis or suspected dementia had complex health and social care needs, and some were living with advanced dementia. Prison healthcare staff reported taking a ‘case by case’ approach to their pre- and post-diagnostic care. Meeting healthcare needs was complicated by the absence of organisational leads for care of older adults and a lack of a care pathway to guide staff. Prison healthcare teams often had difficulty accessing specialist community services to support diagnosis. There was a lack of dementia education and knowledge amongst staff.

Conclusion
This research adds insights critical to understanding the adequacy of current approaches to the meeting dementia related needs within the prison setting. To our knowledge this paper offers the first co-produced evidence informed pre- and post- diagnostic dementia care pathway and model of care for use in prisons.