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J Am Geriatr Soc. 2018 Nov;66(11):2065-2071. doi: 10.1111/jgs.15521. Epub 2018 Sep 19.

Cognition and Incarceration: Cognitive Impairment and Its Associated Outcomes in Older Adults in Jail.

Author information

1
Division of Geriatrics Department of Medicine, University of California, San Francisco, San Francisco, California.
2
Department of Neurology, University of California, San Francisco, San Francisco, California.
3
Memory and Aging Center, University of California, San Francisco, San Francisco, California.
4
Global Brain Health Institute, University of California, San Francisco, San Francisco, California.
5
Department of Psychiatry, University of California, San Francisco, San Francisco, California.
6
Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California.
7
Research Service, San Francisco Veterans Affairs Health Care System, San Francisco, California.
8
Tideswell, University of California, San Francisco, San Francisco, California.

Abstract

OBJECTIVES:

To determine prevalence of, and outcomes associated with, a positive screen for cognitive impairment in older adults in jail.

DESIGN:

Combined data from cross-sectional (n=185 participants) and longitudinal (n=125 participants) studies.

SETTING:

Urban county jail.

PARTICIPANTS:

Individuals in jail aged 55 and older (N = 310; mean age 59, range 55-80). Inclusion of individuals aged 55 and older is justified because the criminal justice system defines "geriatric prisoners" as those aged 55 and older.

MEASUREMENTS:

Baseline and follow-up assessments of health, psychosocial factors, and cognitive status (using the Montreal Cognitive Assessment (MoCA)); 6-month acute care use and repeat arrest assessed in those followed longitudinally.

RESULTS:

Participants were of low socioeconomic status (85% annual income < $15,000) and predominantly nonwhite (75%). Many (70%) scored less than 25 on the MoCA; those with a low MoCA score were more likely to be nonwhite (81% vs 62%, p<.001) and report fair or poor health (54% vs 41%, p=.04). Over 6 months, a MoCA score of less than 25 was associated with multiple emergency department visits (32% vs 13%, p=.02), hospitalization (35% vs 16%, p=.03), and repeat arrests (45% vs 21%, p=.01).

CONCLUSIONS:

Cognitive impairment is prevalent in older adults in jail and is associated with adverse health and criminal justice outcomes. A geriatric approach to jail-based and transitional health care should be developed to assess and address cognitive impairment. Additional research is needed to better assess cognitive impairment and its consequences in this population. J Am Geriatr Soc 66:2065-2071, 2018.

KEYWORDS:

cognition; cognitive impairment; criminal justice; jail; vulnerable population

PMID:
30232805
PMCID:
PMC6512774
DOI:
10.1111/jgs.15521
[Indexed for MEDLINE]
Free PMC Article

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