Geriatrics may seem tame, but so far it has taken me to SF County Jail and, recently, to Rikers Island.
I and several other geriatricians were hosted by the medical services and the Deputy Medical Director, Dr. Zachary
Rosner, our guide through multiple checkpoint and buildings. With this crew of geriatricians, we spent a day and
a half doing trainings for about 30 health services staff and 30 correctional
officers as part of Dr.
Brie Williams' Community
Aging Health Project (CAHP). We did hands-on exercises on geriatric
syndromes such as hearing and vision loss, dementia, incontinence, medication
issues, mobility impairment and assistive devices, and we even taught exercises for
inmates to do in their cells to prevent falls. We helped them think about critical issues,
such as when “behavior” could be a sign of dementia, or failure to follow an
order may be a sign of hearing loss.
There
is no corner of U.S. society that is not affected by growing numbers of older
adults in our population. This
includes jail and prison populations. While the US population saw a
doubling of adults over 55 years old from 1990 to 2009, in prisons the number more
than tripled.
This
presents problems for many who serve criminal justice-involved
populations. Older criminal justice populations have more chronic health
conditions and different social service needs. Functional impairments can
impact their ability to care for themselves independently, inside and
outside of correctional environments. On all fronts-- "inside" and
"outside"-- the need is growing for geriatrics training and
sensitivity.
Dr.
Willams has made this need her mission. CAHP, supported by Tideswell at UCSF and the Langeloth Foundation,
developed geriatrics training for a spectrum of professional networks that face
the reality of an aging criminal justice population-- social workers,
correctional offers, police, and jail and prison health service providers. They
have already delivered many trainings across California to jail and prison health
services staff, correctional officers, and SF police.
Rikers
Island was the first dissemination site.
“The Island” is New York City's main jail though it is actually a huge
complex of buildings, accessed by only one bridge. It has many buildings;
one is a woman's facility ("Rosie's") and the rest of the 10 jails
are for men. Rikers also has an extra prison on a barge that is floating
just off the Bronx. All in all, they house over 11,000 people a day.
On
top of our trainings, we were able to see the Geriatrics housing unit with a
capacity for 30 men over 50 years old. At the time we visited they were
all lying in bed. The communal room was not open and dinner was not yet
served (at about 4:30pm to mirror the 4:30am breakfast). One older
gentleman who appeared about 80 listened quietly to something on his headphones
and several others greeted us and briefly asked us for medical advice.
One of the biggest problems: the low toilet seats and wet floors in the
communal, one-room bathroom. It was hard to get on and off of them and
even scarier to contemplate a serious fall. They can have canes, but not
walkers or wheelchairs in most units (one medical unit allows these if needed). The policy varies across jails and units, but even a raised toilet seat, a common remedy in the community, could be
a weapon here. For mobility and frailty issues, no solutions are simple or obvious in a correctional setting.
We
also saw the women's jail and attached clinics (medicine, specialty, dentistry)
and infirmary where sicker inmates are housed. Among the women there was
one, just over 50, who described myriad medical problems, including a wound
that was so difficult to heal she had been in the infirmary for weeks.
Another approached us to ask about what could be done for her- she fell on a
wet floor after a property search left debris and food on the ground on her
unit, and she said she still did not know what was wrong with her back.
After
our visit, we all agreed that the staff and officers were one of the most
engaged group of people we had ever trained. While Rikers is a huge
place, and the aging of the population will continue to put huge pressure on
their system, I feel hopeful that this training made an impact and may help
this particularly vulnerable and incarcerated population.
Photos:
1) Tim Gruber (http://www.motherjones.com/politics/2012/09/massachusetts-elderly-prisoners-cost-compassionate-release)
2) Rikers Island, wikipedia: http://commons.wikimedia.org/wiki/File:USGS_Rikers_Island.png#mediaviewer/File:USGS_Rikers_Island.png
by Anna Chodos, MD
