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J Am Geriatr Soc. 2016 Nov;64(11):2349-2355. doi: 10.1111/jgs.14310. Epub 2016 Aug 18.

Detained and Distressed: Persistent Distressing Symptoms in a Population of Older Jail Inmates.

Author information

School of Medicine, University of California, Davis, Davis California.
Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, California.


Distressing symptoms are associated with poor function, acute care use, and mortality in older adults. The number of older jail inmates is increasing rapidly, prompting calls to develop systems of care to meet their healthcare needs, yet little is known about multidimensional symptom burden in this population. This cross-sectional study describes the prevalence and factors associated with distressing symptoms and the overlap between different forms of symptom distress in 125 older jail inmates in an urban county jail. Physical distress was assessed using the Memorial Symptom Assessment Scale. Several other forms of symptom distress were also examined, including psychological (Generalized Anxiety Disorder Scale, Patient Health Questionnaire), existential (Patient Dignity Inventory), and social (Three Item Loneliness Scale). Information was collected on participant sociodemographic characteristics, multimorbidity, serious mental illness (SMI), functional impairment, and behavioral health risk factors through self-report and chart review. Chi-square tests were used to identify factors associated with physical distress. Overlap between forms of distress was evaluated using set theory analysis. Overall, many participants (74%) reported distressing symptoms, including having one or more physical (44%), psychological (37%), existential (54%), or social (45%) symptoms. Physical distress was associated with poor health (multimorbidity, functional impairment, SMI) and low income. Of the 93 participants with any symptom, 49% reported three or more forms of distress. These findings suggest that an optimal model of care for this population would include a geriatrics-palliative care approach that integrates the management of all forms of symptom distress into a comprehensive treatment paradigm stretching from jail to the community.


distressing symptoms; jail; older inmates; palliative care

[Indexed for MEDLINE]
Free PMC Article

Conflict of interest statement

Dr. Williams has served as an expert witness and as a court consultant in legal cases related to prison conditions of confinement. These relationships have included: the National ACLU; Squire Patton Boggs; The Center for Constitutional Rights; the Disability Rights Legal Center; Holland and Knight LLP; The University of Denver Student Law Office; and The Office of the Independent Medical Monitor, MI. These relationships had no role in the decision to write this manuscript and did not influence the preparation, review, or approval of the manuscript. No other authors have conflicts of interest to report (see table). Elements of Financial/Personal Conflicts MB CA CSR ISC BW Yes No Yes No Yes No Yes No Yes No Employment or Affiliation X X X X X Grants/Funds X X X X X Honoraria X X X X X Speaker Forum X X X X X Consultant X X X X X Stocks X X X X X Royalties X X X X X Expert Testimony X X X X X Board Member X X X X X Patents X X X X X Personal Relationship X X X X X

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