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Agequake in prisons: Reality, policies and practical solutions concerning custody and health care for ageing prisoners in Switzerland

English title Agequake in prisons: Reality, policies and practical solutions concerning custody and health care for ageing prisoners in Switzerland
Applicant Elger Bernice
Number 135035
Funding scheme Interdisciplinary projects
Research institution Institut für Bio- und Medizinethik (IBMB) Universität Basel
Institution of higher education University of Basel - BS
Main discipline Legal sciences
Start/End 01.10.2011 - 31.07.2015
Approved amount 442'886.00
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All Disciplines (3)

Discipline
Legal sciences
Sociology
Medico-Social Problems of the Elderly

Keywords (6)

Human rights; Medical ethics ; Ageing; Criminology; Prison; Public health

Lay Summary (English)

Lead
Lay summary

1. Background

This project was developed because of two different problems that we face today. First, the continuously increasing older population is changing the family structure of our society and putting greater healthcare demands on the health sector. Second, the number of individuals imprisoned is also rising exponentially along with increasing prison sentences. It is estimated that more than 8.75 million people are currently imprisoned worldwide. Many of these prisoners are likely to grow old in prison and will need access to medical health care. Very little is known about the provision and quality of health care available to older prisoners. It is necessary to study the present provision of health care in prisons in order to provide guidance to prison administrators and prison physicians about practical difficulties concerning health care in prison and to provide guidelines for policy concerning the maintenance of older prisoners. In this project, national and international experts in the academic field of ageing, economy, human rights and prison systems will work together as an interdisciplinary team. The project will take place in prisons located in the German and French speaking parts of Switzerland to compare cultural and regional differences in health care delivery systems. From this project, we hope to develop new insights about the ethically appropriate delivery of health care supply to ageing prisoners. 

2. Questions

The project aims to address four questions concerning the context of ageing prisoners in Switzerland: (1) What is the socio-demographic situation of ageing prisoners? (2) What is the health care situation of ageing prisoners? (3) What are the economic implications of health care provided to the rising number of older prisoners? (4) What are the ethical and legal issues involved and what is the content of existing guidelines and legislation?

3. Methods

The project will initially review the existing literature in the field of ageing in prison and health care of older prisoners. This theoretical review is followed by a more practical approach involving a retrospective screening of approximately 200 medical records of prisoners, half of them aged 50 years and older and the other half younger than 50. This medical records screening will be performed to compare the health care needs and related costs of younger and older prisoners. In addition, 30-40 prisoners above the age of 50 will be interviewed to obtain detailed information about their health care situation and ageing circumstances in prison. To better understand the working of the prison system, we will also conduct interviews with approximately 60 public health specialists, directors of local health authorities and prison administrators in Switzerland and international experts in this field. All data will be confidential and will be anonymised before publication.

4. Possible results and their impact

The results based on the analysis of the data from the literature review, the medical record data and the interviews will provide unique information that will be useful for decision making by public health authorities. In light of the ethical, legal and economic analysis, we will also make suggestions concerning the improvement of the provision of health care to older prisoners. The results, therefore, may be potentially helpful not only for the prison health care providers and administrators but also for politicians, researchers, ethicists and human rights advocates. Furthermore, the study will contribute new knowledge that could be useful for other countries that are also facing challenges with delivering appropriate health care to ageing prisoners. To have the greatest impact possible, the study results will also be communicated via existing networks on ageing populations worldwide, published in scientific journals and presented at various conferences.

Direct link to Lay Summary Last update: 21.02.2013

Responsible applicant and co-applicants

Employees

Publications

Publication
Exploring differences in healthcare utilization of prisoners in the Canton of Vaud, Switzerland.
Moschetti Karine, Zabrodina Véra, Stadelmann Pierre, Wangmo Tenzin, Holly Alberto, Wasserfallen Jean-Blaise, Elger Bernice S, Gravier Bruno (2017), Exploring differences in healthcare utilization of prisoners in the Canton of Vaud, Switzerland., in PloS one, 12(10), 0187255-0187255.
Accessibility of prison healthcare for elderly inmates, a qualitative assessment
Heidari Raheleh, Wangmo Tenzin, Galli Serena, Shaw David M., Elger Bernice S., Handtkea Violet, Bretschneider Wiebke (2017), Accessibility of prison healthcare for elderly inmates, a qualitative assessment, in Journal of Forensic and Legal Medicine, 52, 223-228.
Identity as an older prisoner: findings from a qualitative study in Switzerland
Haesen Sophie, Wangmo Tenzin, Elger Bernice S. (2017), Identity as an older prisoner: findings from a qualitative study in Switzerland, in European Journal of Ageing, 1-12.
Can routine data from prisoners’ files be used to estimate prevalence rates of illicit drug use among prisoners?
Annaheim Beatrice, Wangmo Tenzin, Bretschneider Wiebke, Vogel Marc, Elger Bernice S. (2017), Can routine data from prisoners’ files be used to estimate prevalence rates of illicit drug use among prisoners?, in International Journal of Public Health, 1-8.
Prisons should mirror society: The debate on age-segregated housing for older prisoners
Wangmo Tenzin, Handtke Violet, Bretschneider Wiebke, Elger Bernice Simone (2017), Prisons should mirror society: The debate on age-segregated housing for older prisoners, in Ageing and Society, 37(4), 675-694.
New guidance for an old problem: Early release for seriously ill and elderly prisoners in Europe
Handtke Violet, Wangmo Tenzin, Elger Bernice, Bretschneider Wiebke (2016), New guidance for an old problem: Early release for seriously ill and elderly prisoners in Europe, in Prison Journal, 97(2), 224-246.
The collision of care and punishment: Ageing prisoners’ view on compassionate release
Handtke Violet, Bretschneider Wiebke, Elger Bernice, Wangmo Tenzin (2016), The collision of care and punishment: Ageing prisoners’ view on compassionate release, in Punishment and Society, 19(1), 5-22.
Aging prisoners in Switzerland: An analysis of their healthcare utilization.
Wangmo T, Andrea M, Handtke V, Bretschneider W, Page J, Sommers J, Stuckelberger A, Aebi M, Elger B (2016), Aging prisoners in Switzerland: An analysis of their healthcare utilization., in Journal of Aging and Health, 28(3), 481-502.
Patterns of older and younger prisoners’ primary healthcare utilization in Switzerland
Wangmo Tenzin, Hauri Sirin, Meyer Andrea H., Elger Bernice S. (2016), Patterns of older and younger prisoners’ primary healthcare utilization in Switzerland, in International Journal of Prisoner Health, 12(3), 173-184.
The collision of care and punishment: Ageing prisoners view on compassionate release
Handtke V., Bretschneider W., Elger B., Wangmo T. (2016), The collision of care and punishment: Ageing prisoners view on compassionate release, in Punishment & Society, 1.
Ageing prisoners in Switzerland: An analysis of their healthcare utilization
Wangmo T, Meyer A, Handtke V, Bretschneider W, Page J, Sommer J, Stuckelberger A, Aebi M, Elger BS (2015), Ageing prisoners in Switzerland: An analysis of their healthcare utilization, in Journal of Ageing and Health, 1.
Disease profiles of detainees in the Canton of Vaud in Switzerland: Gender and age differences in substance abuse, mental health and chronic health conditions Chronic Disease epidemiology
Moschetti Karine, Stadelmann Pierre, Wangmo Tenzin, Holly Alberto, Bodenmann Patrick, Wasserfallen Jean Blaise, Elger Bernice S., Gravier Bruno (2015), Disease profiles of detainees in the Canton of Vaud in Switzerland: Gender and age differences in substance abuse, mental health and chronic health conditions Chronic Disease epidemiology, in BMC Public Health, 15(1), 1.
Improving public health by respecting autonomy: Using social science research to enfranchise vulnerable prison populations
Shaw David, Elger Bernice (2015), Improving public health by respecting autonomy: Using social science research to enfranchise vulnerable prison populations, in Preventive Medicine, 74, 21-23.
Advance directives in the context of imprisonment
Elger BS (2014), Advance directives in the context of imprisonment, in Lack P, Biller-Andorno N, Brauer S (ed.), 134.
Ageing Prisoners' Disease Burden: Is Being Old a Better Predictor than Time Served in Prison?
Wangmo Tenzin, Meyer Andrea H., Bretschneider Wiebke, Handtke Violet, Kressig Reto W., Gravier Bruno, Büla Christophe, Elger Bernice S. (2014), Ageing Prisoners' Disease Burden: Is Being Old a Better Predictor than Time Served in Prison?, in Gerontology, 116.
Ageing Prisoners' Views on Death and Dying: Contemplating End-of-Life in Prison
Handtke Violet, Wangmo Tenzin (2014), Ageing Prisoners' Views on Death and Dying: Contemplating End-of-Life in Prison, in Journal of Bioethical Inquiry, 373.
Conducting Ethics Research in Prison: Why, Who, and What?
Shaw David M., Wangmo Tenzin, Elger Bernice S. (2014), Conducting Ethics Research in Prison: Why, Who, and What?, in Journal of Bioethical Inquiry, 1.
Disclosure of Past Crimes: An Analysis of Mental Health Professionals' Attitudes Towards Breaching Confidentiality
Wangmo Tenzin, Handtke Violet, Elger Bernice Simone (2014), Disclosure of Past Crimes: An Analysis of Mental Health Professionals' Attitudes Towards Breaching Confidentiality, in Journal of Bioethical Inquiry, 347.
Easily forgotten: Elderly female prisoners
Handtke Violet, Bretschneider Wiebke, Elger Bernice, Wangmo Tenzin (2014), Easily forgotten: Elderly female prisoners, in Journal of Aging Studies, 32, 1-11.
Informing patients about limits to confidentiality: A qualitative study in prisons
Elger Bernice S., Handtke Violet, Wangmo Tenzin (2014), Informing patients about limits to confidentiality: A qualitative study in prisons, in International Journal of Law and Psychiatry, 41, 50-57.
Paternalistic breaches of confidentiality in prison: Mental health professionals' attitudes and justifications
Elger Bernice Simone, Handtke Violet, Wangmo Tenzin (2014), Paternalistic breaches of confidentiality in prison: Mental health professionals' attitudes and justifications, in Journal of Medical Ethics, 41(6), 496-500.
Understanding Death in Custody: A Case for a Comprehensive Definition
Ruiz Géraldine, Wangmo Tenzin, Mutzenberg Patrick, Sinclair Jessica, Elger Bernice Simone (2014), Understanding Death in Custody: A Case for a Comprehensive Definition, in Journal of Bioethical Inquiry, 387.
Viewpoint: Will i stay or can i go ¿ Assisted suicide in prison
Handtke Violet, Bretschneider Wiebke (2014), Viewpoint: Will i stay or can i go ¿ Assisted suicide in prison, in Journal of Public Health Policy, 36(1), 67-72.
Ageing Prisoners’ Health Care: Analysing the Legal Settings in Europe and the United States
Bretschneider Wiebke, Elger Bernice, Wangmo Tenzin (2013), Ageing Prisoners’ Health Care: Analysing the Legal Settings in Europe and the United States, in Gerontology, 59(3), 267-275.
Prisoners as research subjects
Elger BS (2013), Prisoners as research subjects, in Jennings B (ed.), 2497.
Protecting prisoners’ autonomy with advance directives: ethical dilemmas and policy issues
Andorno Roberto, Shaw David M., Elger Bernice (2013), Protecting prisoners’ autonomy with advance directives: ethical dilemmas and policy issues, in Medicine, Health Care and Philosophy, 18(1), 33-39.
Response to Open Peer Commentaries on “The Principle of Equivalence Reconsidered: Assessing the Relevance of the Principle of Equivalence in Prison Medicine”
Jotterand Fabrice, Wangmo Tenzin (2013), Response to Open Peer Commentaries on “The Principle of Equivalence Reconsidered: Assessing the Relevance of the Principle of Equivalence in Prison Medicine”, in American Journal of Bioethics, 14(11), W3-W4.
Sleep disorders
Elger BS (2013), Sleep disorders, in Levy M Stöver H. (ed.), 127.
The investigation of deaths in custody: A qualitative analysis of problems and prospects
Wangmo Tenzin, Ruiz Géraldine, Sinclair Jessica, Mangin Patrice, Elger Bernice Simone (2013), The investigation of deaths in custody: A qualitative analysis of problems and prospects, in Journal of Forensic and Legal Medicine, 25, 30-37.
The Principle of Equivalence Reconsidered: Assessing the Relevance of the Principle of Equivalence in Prison Medicine
Jotterand Fabrice, Wangmo Tenzin (2013), The Principle of Equivalence Reconsidered: Assessing the Relevance of the Principle of Equivalence in Prison Medicine, in American Journal of Bioethics, 14(7), 4-12.
Ethische Grundlagen der Gefängnismedizin : Anspruch und Wirklichkeit
Elger BS (2012), Ethische Grundlagen der Gefängnismedizin : Anspruch und Wirklichkeit, in Riklin F (ed.), 39.
Facing the challenges of an increasingly ageing prison population in Switzerland: In search of ethically acceptable solutions
Handtke Violet, Bretschneider Wiebke, Wangmo Tenzin, Elger Bernice (2012), Facing the challenges of an increasingly ageing prison population in Switzerland: In search of ethically acceptable solutions, in Bioethica Forum, 5(4), 134-141.
Management of sleep complaints in correctional settings
Elger B, Management of sleep complaints in correctional settings, in Trestman RL Appelbaum KL Metzner JL (ed.), 1.
Prisoners
Wangmo T, Elger BS, Prisoners, in Ten Have Hank (ed.), 1.

Collaboration

Group / person Country
Types of collaboration
Dr. Tenzin Wangmo, University of Basel Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
Prof. Bruno Gravier, University of Lausanne Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
Dr. Andrea Meyer, University of Basel Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
Dr. (jur) Eric Sottas OMCT, Geneva Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
Prof. A. Capron, University of Southern California, USA; USC Gould School of Law United States of America (North America)
- in-depth/constructive exchanges on approaches, methods or results
Prof. Dr. (jur) Olivier Guillod, Neuchâtel Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
Dr. Cornelia Hummel, Dep. of Sociology, University of Geneva Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
Prof. Reto W. Kressig, Acute Geriatric Clinic, University of Basel Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
Prof. A. Stuck, Professor of geriatrics, University of Bern Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results

Scientific events

Active participation

Title Type of contribution Title of article or contribution Date Place Persons involved
8. Europäische Konferenz zur Gesundheitsförderung in Haft „Gesundheit ist ein Menschenrecht – auch in Haft!“ Talk given at a conference Gesundheitsversorgung von älteren Gefangenen; Risikopatienten in Haft: zu jung, zu alt, zu krank 20.01.2016 Basel, Switzerland Elger Bernice; Bula Christophe;
International Association of Gerontology and Geriatrics – Europe Poster Social Determinants of Healthcare in Ageing Prisoners in Switzerland 23.04.2015 Dublin, Ireland Bretschneider Wiebke; Handtke Violet; Elger Bernice; Stuckelberger Astrid;
14th Annual Conference of the ESC Talk given at a conference How do older prisoners perceive their health? An analysis of geriatric evaluation 10.09.2014 Prague, Czech Republic Elger Bernice; Handtke Violet; Bretschneider Wiebke;
69th Annual Meeting of the American Society of Criminology Talk given at a conference No second chance? Consequences of the 2004 introduction of life long custody in Switzerland. 20.11.2013 Atlanta, United States of America Handtke Violet; Elger Bernice; Bretschneider Wiebke;
66th Annual Scientific Meeting of the Gerontological Society of America Poster Understanding the health and healthcare needs of older prisoners: A national study of older prisoners in Switzerland 20.11.2013 New Orleans, United States of America Bretschneider Wiebke; Bula Christophe; Handtke Violet; Elger Bernice;
ICRC Health Care in detention Seminar Individual talk Agequake in Prisons 31.10.2013 Geneva, Switzerland Handtke Violet;
Conference of the European Society of Criminology Talk given at a conference Healthcare burden of older male prisoners and its consequences for the society 04.09.2013 Budapest, Hungary Elger Bernice; Bretschneider Wiebke; Handtke Violet;
Conference of the European Society of Criminology Talk given at a conference Elderly female prisoners - What does it mean to be old, female, and a prisoner 04.09.2013 Budapest, Hungary Handtke Violet; Elger Bernice; Bretschneider Wiebke;
Conference of the European Society of Criminology Talk given at a conference Becoming Old in Prisons: An Overview of the Swiss National Study of Ageing in Prisons 04.09.2013 Budapest, Hungary Bretschneider Wiebke; Elger Bernice; Handtke Violet;
Swiss Public Health Conference Poster The chronic medical conditions and the health care services use among a minority group: Analysis of the detainees data from the canton of Vaud 15.08.2013 Zurich, Switzerland Holly Alberto; Stadelmann Pierre;
20th IAGG World Congress of Gerontology and Geriatrics Talk given at a conference The blind spot: ethical challenges in the health care for older prisoners 23.06.2013 Seoul, Korean Republic (South Korea) Elger Bernice; Handtke Violet; Bretschneider Wiebke;
Gerontological Society of America (GSA) conference Poster Aging behind Bars: The Medication of Older Prisoners in Switzerland 14.11.2012 San Diego, United States of America Handtke Violet; Ritter Catherine; Elger Bernice; Bretschneider Wiebke; Stuckelberger Astrid;
Gerontological Society of America (GSA) conference Poster Ageing Prisoners Healthcare: Analysing the Legal Settings in Europe and the United States 14.11.2012 San Diego, United States of America Handtke Violet; Elger Bernice; Bretschneider Wiebke;
Gerontological Society of America (GSA) conference Poster Health Care of Elderly Female Prisoners: Is Age Specific Treatment Necessary 14.11.2012 San Diego, United States of America Handtke Violet; Elger Bernice; Bretschneider Wiebke;
European Association of Centres of Medical Ethics (EACME) conference Talk given at a conference Closing the research gap: Analysing the health care for women in prisons. 20.09.2012 Bristol, Great Britain and Northern Ireland Bretschneider Wiebke; Handtke Violet; Elger Bernice;
Eurocrim (European Society of Criminology - ESC) conference Poster Ageing Prisoners Healthcare: Analysing the Legal Settings in Europe and the United States. Eurocrim 12.09.2012 Bilbao, Spain Elger Bernice; Handtke Violet; Bretschneider Wiebke;
11th World Congress of Bioethics, International Association of Bioethics (IAB) Poster Easily forgotten: Elderly women in Prison. 26.06.2012 Rotterdam, Netherlands, Netherlands Bretschneider Wiebke; Handtke Violet; Elger Bernice;
80th Annual Meeting of the Swiss Society of General Internal Medicine Poster The pattern of health care use of older prisoners in Switzerland 23.05.2012 Basel, Switzerland, Switzerland Elger Bernice; Bretschneider Wiebke; Bula Christophe; Handtke Violet;


Associated projects

Number Title Start Funding scheme
166043 Agequake in prisons - second part: Mental health care and forensic evaluation of aging prisoners and persons serving security measures in Switzerland 01.02.2017 Interdisciplinary projects

Abstract

Population ageing is a worldwide phenomenon affecting all sectors of society. The increase in life expectancy is observed in most sub-populations and is shaping the world in unexpected ways. Thus, groups that were suffering premature death during last century are now surviving into old age, bringing along a whole range of new unaddressed health, economic and legislative issues. In this perspective, individuals who have perpetrated crime, violence or abuse at different levels and are incarcerated in prisons live longer today than last century. Recently, some of the most overpopulated prisons have rung the alarm bell regarding the numbers of older prisoners, and have called for rethinking the management of prisoners and prisons.A group of national and international experts from the Universities of Geneva, Lausanne and Zurich (Switzerland) and the University of Southern California (USA), will collaborate to undertake research relating to the health and economical implications as well as to the human rights aspects resulting from the considerable increase of ageing prisoners worldwide (“agequake”), with a special focus on the situation in Switzerland. A collection of data from ageing prisoners in Switzerland, as well as a survey of leading experts, will be used to create new knowledge. The aim is to explore existing problems as well as to investigate potential solutions and recommendations in different areas: a) health-related issues, b) socio-demographic, criminological and economic issues (cost-benefit-analysis), as well as c) legislative, human rights law and ethics. The project aims at gathering data on an important emerging issue and at examining practical solutions and policy options concerning the conditions under which society in Switzerland may solve issues regarding ageing prisoners in ways that are economically sound, but at the same time ethically acceptable and in line with international human rights law. Final results can also serve stakeholders in Switzerland and other countries as advice and/or teaching material on ageing and human rights-related issues. The project will unfold in several steps: 1. STATE OF THE ART AND PREPARATION OF DATA COLLECTION: The started literature and existing data review on health issues will be completed with a special focus on the scientific literature on economical analysis of alternatives (State of the Art) concerning the management of older prisoners in Switzerland and two countries with similar socio-economical background (France, UK). Research questions are: a. What is known about the economic implications of the socio-demographic and health situation of ageing prisoners in these three countries? b. What is known about alternative economic management strategies (health insurance of detainees, specially paid prison doctors) and their ethical and legal consequences? Available information from federal and cantonal authorities will be gathered.2. DATA COLLECTION CONCERNING AGEING PERSONS DETAINED IN SWITZERLAND: Medical records from more than 100 prisoners above the age of 50 (corresponding to a biological age of 60 in the community) will be examined, i.e. a representative sample of 50 to 100 detainees from the French and the same number of detainees from the German speaking part of Switzerland. These data will be used to provide a picture of medical and related problems of ageing detainees and of solutions used in these two Swiss language regions (a). Social problems, as far as transparent in the medical records will be included. Diagnosis, medication and management data will permit to evaluate in particular prescriptions of psychoactive and other drugs in this elderly population, as well as (b) a cost benefit-analysis of different management choices (hospital vs. outpatient care, in prison health care versus transfer of prisoners to outpatient care centers outside the prison etc.). Anonymised data from medical records will be linked with and compared to data from health insurers and from the Swiss Federal Office for Statistics, in order to analyse, where available, costs and benefit data from different sources. To provide an in depth view, (c) a representative sample of 30 to 40 detainees from the oldest age group (above the age of 60) will, after informed consent, undergo comprehensive geriatric assessment and be interviewed about their view on imprisonment and management solutions.3. EXPERT SURVEY: Results from part 1 and 2 will be contrasted with expert views. The major issues identified in parts 1 and 2 will be taken up in the development of a questionnaire and a semi-directive interview guide which will also solicit interviewees’ comments on case vignettes modelled on existing cases (parts 1 and 2) or known from personal experience of team members. Interviews will be held with 60 experts (Expert Opinion Survey), 40 from Switzerland (20 from the French and 20 from the German speaking part), and 20 experts from other European countries, especially the UK and France. Experts will include decision-makers, professionals (administrative, security and health professionals in prisons) and expert network specialists in the area (economists, public health, lawyers, ethicists, etc.), NGOs and associative networks (i.e. defence of prisoners, social and health care networks, human rights activists). The aim is to ask national and international experts about their opinion how ageing prisoners should best be managed in a country like Switzerland. The inclusion of international experts is useful because other countries might have developed strategies that could prove useful for Switzerland.4. SOLUTIONS, RECOMMENDATIONS AND DISSEMINATION: Based on the analysis of data resulting from parts 1-3, the final report will include general recommendations, as well as suggestions of urgent measures to be taken to face the present and anticipated challenges. Final steps will include the dissemination of the study results to policy makers and concerned constituencies (correctional institutions, researchers and the public) via scientific publications and conference presentations, as well as communications using contacts with existing networks on ageing populations worldwide.
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