Challenges posed by an ageing prison population

Experts say involving both prisoners and prison staff in research is one way to respect prisoners' autonomy Keystone

The over-50s make up just over 10% of Switzerland’s prison inmates, and that number is set to increase with Europe’s ageing population. But are prisons equipped to meet the needs of older inmates?

With a total agricultural land area of 612 hectares, the minimum security prison Witzwil, located outside the Swiss capital, Bern, is also the largest farm in Switzerland. It takes a while to tour all the outbuildings, even for someone young and mobile.

With the head of security, Christian Ambühl, I enter a barnlike structure full of machines and wood dust. It’s hard to hear over the sound of a saw. An older man comes up to greet us, and I assume he’s the foreman. But he’s wearing grey pants with a red stripe. “That’s so at a glance you can tell the prisoners from the supervisors and the people who are making deliveries,” Ambühl says.

Witzwil can hold 184 male prisoners. The typical prisoner in Switzerland is young and male. But it’s not just young men who commit crimes. In January, for example, a dispute in the laundry room of an apartment building in canton Ticino resulted in a 76-year-old woman attacking a 75-year-old man and a 73-year-old woman with a knife.

Prisons are typically designed for a younger clientele. But older prisoners function differently, says Hans-Rudolf Schwarz, Witzwil prison director.

“They want to sit a bit after eating. They eat more slowly,” he says. And they are less social. “We notice that if there’s no planned activity in the living group, older inmates very quickly retreat to their cells.”

The general ageing of the population is one factor contributing to an increase in the number of old prisoners. Another is more stringent and longer sentences, which result not only in a greater number of prisoners, but also in more prisoners becoming old in jail. 

Studying prisoners’ needs 

In 2010, the fact that there were almost no data about the demographic changes in Swiss prisons led a multidisciplinary group of Swiss researchers to launch the Swiss National Science Foundation project “Agequake in prisons: Reality, policies and practical solutions concerning custody and health care for ageing prisoners in Switzerland”External link.

The project, headed by Bernice Elger, Professor of Biomedical Ethics at the University of Basel, included interviews with experts from different cantons and countries, with prison directors and staff, and with 35 prisoners. “They talked about what they had seen. Where they thought were problems. What they thought were solutions,” she says. 

According to Bernice Elger, the researchers were “very positively surprised about all the input received from prison directors, all the interest, because they were themselves facing this difficult issue, and making decisions without having any data and evidence is a lot more difficult.” 

Among the issues investigated were ageing prisoners’ increased use of healthcare services, protection of prisoners’ autonomy, prisoners’ attitudes toward death and dying, availability of end-of-life services such as palliative care, and how to compensate for the declining abilities of older prisoners within the unsuitable physical environment of the prison. 

The researchers concluded that guidelines are needed that acknowledge and address the needs of ageing prisoners, and that involving both prisoners and prison staff in research is one way to respect prisoners’ autonomy and improve their health. 

Prison conditions 

Most of the research studies on prisoners are from the United States or the United Kingdom, countries that have very high incarceration rates, notes Elger. “In the United States it’s more than ten times higher than in Germany, and in Germany it’s twice as high as in Switzerland.” 

The number of old prisoners in US prisons is exploding. According to a report from the NGO Human Rights Watch, the number of state and federal prisoners age 65 and older in the US increased by 63% between 2007 and 2010. 

“Prison conditions in Switzerland, compared with prison conditions in the United States, are still quite good,” says Elger, who has been a prison physicianExternal link for 15 years. 

But many prisons are not equipped to meet the needs of the elderly, both in terms of building conditions as well as in expertise in nursing and geriatrics, according to Jörg Pont, a retired professor of Internal Medicine at the Medical University of Vienna, Austria. 

Pont, who serves as a consultant to the Council of EuropeExternal link on the topic of healthcare in prisons, says elderly people are a part of the prison population defined as ‘vulnerable’.  

“Many elderly prisoners have the one or the other kind of physical disability. Could be loss of hearing, of vision, of concentration, of memory, of mobility,” he says. 

Previous research in prisons has shown that a 50-year-old prisoner tends to be as healthy as someone 10–15 years older living in the community. The Agequake study confirmed that older prisoners in Switzerland are less healthy and make more use of healthcare services.

An evaluation of the medical records of 380 male prisoners from 13 different Swiss prisons found that prisoners 50 and older reported an average of 4.3 somatic diseases, compared with 1.6 in prisoners below 50 years of age. 

Equal treatment 

According to international and European law, prisoners retain all their human rights except the right to liberty. 

The principle of ‘equivalence of care’ holds that people in prison should have the same level of medical care as people in society. “And if the prison cannot guarantee this, then the prison is not the right place to treat these people,” says Pont. 

Old prisoners are thus also entitled to self-determination regarding healthcare decisions. But Bernice Elger believes that “great caution must be exercised to prevent care being withdrawn or withheld from inmates who actually want to receive it.” 

Sometimes exceptions are made for older prisoners. In December 2015, Switzerland’s Federal Office of Justice deported 83-year-old former FIFA Vice President Eugenio Figueredo to Uruguay, where he could face a prison term of two years, instead of to the United States, where he could face a term of 20 years. The decision reportedly took into consideration Figueredo’s advanced age and medical problems.

On the other hand, in February 2016 the European Court of Human Rights in Strasbourg ruled that prisoners who have reached retirement age can still be required to work. 

Nowadays “you can be healthy even if you are 72,” says 72-year-old Jörg Pont. “But of course with increasing age, more and more illnesses are coming. There is a growing need for treatment, for nursing. At some point, prisons will not be able to cope anymore.” 

You can contact the author via Twitter @JeannieWurzExternal link