Kimberly Marselas

You’ve heard it often: By 2030, every last baby boomer will be 65 or older.

Our nation’s aging demographics will no doubt shift how we live in America, how communities are designed, how healthcare is delivered, and — one hopes — how we’ll afford modern medical services and supportive senior care.

Fans of the silver tsunami rhetoric have been trying to drum up concern for years, and to an extent, it’s working. Policymakers are advocating for services that better reach seniors as they strive to age in place, and operators are trying to find ways to broaden their reach to seniors across income levels.

But there’s one rapidly aging group that not many pundits are thinking of in their equations. And it’s growing explosively.

In May’s issue of Health Affairs, out Monday, senior editor and correspondent Jonathan S. Bor offers a data-filled examination of this vulnerable group of seniors: prisoners whose aging has taken place in an intentionally less-than desirable environment.

Between 1999 and 2016, the proportion of older adults in the nation’s prisons rose from 3% to 11%, Bor reported. By 2020, 14% of male prisoners and 9% of female prisoners were ages 55 and older.

And by 2030, experts estimate older people will represent one-third of the entire prison population. That is unless major reforms take shape.

While Bor makes a case for more early and compassionate release programs, the fact is many Americans leave prison at the end of their full terms having paid their debt to society. Some of them do so after decades behind bars, years that are marked by limited exercise, poor diet and jailhouse habits that may increase their odds of developing chronic disease and multiple comorbidities.

In short, aging in place ages them faster than it does us..

“The graying of the prison population has brought into question the definition of words such as ‘aged,’ ‘elderly, and ‘geriatric,’” Bor explained. “Although society generally regards people ages sixty-five and older to have crossed the geriatric threshold, experts who have observed the health trajectories of long-serving prisoners say that many experience ‘accelerated aging’ while incarcerated.” 

So much so that experts are debating whether they’re geriatric at 55 or maybe even 50. 

These are not healthy people, and prison medical units are notoriously unequipped to handle the kinds of conditions prisoners develop there. Often, getting to outside medical appointments is a complex, if not impossible, challenge.

Supporters of compassionate release see it as a solution: Allow infirm prisoners who present little chance of committing future crimes to leave state-supported care and get help on the outside. But for many prisoners, there are no family caregivers, no homes to go to, no way to ensure continuity of or access to medical care.

“Society hasn’t quite figured out the most appropriate destination for many of the older people who are released after spending much of their lives behind prison walls,” Bor wrote. 

One place they rarely go: to the very nursing homes that might help meet their skilled care needs. In way too many cases, that’s the truth for indigent patients over 65 who qualify for Medicaid and have serious, often debilitating health issues. Most nursing homes don’t want them.

But this population has needs, and many nursing homes are fighting for survival. More should consider where demographics and policy decisions might take nearby prisoners in the next decade. If their state’s prison population is aging, might there be an opportunity to build a real program that seeks to usher those who’ve done their time into the next chapter of their lives? 

Could the right care bring dignity to a former prisoner’s final months or years? Could specializing in this kind of care make a financially strapped facility viable again?

These are but a few of the questions providers must consider in working with this population, which has higher-than-average mental health needs and a history of traumatic experiences that may have occurred both before and while serving their sentences.

I urge you to take a look at Bor’s article and consider your stance on post-prison patients. They’re here, their numbers will only grow, and they’ll need providers willing to care for them as they, too, ride the silver tsunami.