Prevalence of Disability Among Older Adults in Prison.

Importance: The number of older adults in long-term correctional facilities (prisons) has increased rapidly in recent years. The cognitive and functional status of this population is not well understood due to limitations in the availability of longitudinal data. Objective: To comparatively examine the prevalence and disability status of the population of adults 55 years and older in prisons and adults living in community settings for a 14-year period (2008-2022). Design, Setting, and Participants: This repeated cross-sectional study used nationally representative data from the American Community Survey to identify cohorts of community-dwelling adults 55 years or older and adults 55 years or older in prisons. Data were accrued from surveys from 2008 to 2022 and analyzed from August 25, 2023, to October 18, 2024. Exposure: Residence in federal or state prison. Main Outcomes and Measures: Self-reported cognitive, ambulatory, independent living, or self-care difficulties. Results: The population of older adults in prisons increased between 2008 and 2022 from 102 700 to 171 700, but the pace of growth slowed during the COVID-19 pandemic. The analysis included 32 623 adults 55 years or older in prison (mean [SD] age, 62.6 [8.3] years; 28 927 [89.64%] male) and 13 877 665 living in the community (mean [SD] age, 67.4 [9.5] years; 7 497 784 [54.02%] female). Disability prevalences in all categories, including cognitive, ambulatory, independent living, and self-care difficulties, were significantly higher compared with their community-dwelling peers. The difference was particularly stark for cognitive difficulty, which was 15.2% (95% CI, 14.8%-15.7%) for older adults in prisons vs 7.1% (95% CI, 7.1%-7.2%) in the community, after adjusting for demographic characteristics. These prevalences have remained stable over the sample period, including the COVID-19 pandemic. Conclusions and Relevance: Results of this cross-sectional study suggest that adults in prison are more likely to report disability than those in community settings, with the largest differences in cognitive difficulties. These differences persisted during the COVID-19 pandemic. The notable increase among older adults in prisons coupled with the high prevalences of disability has important implications for identifying care models and environmental policies to address the chronic and end-of-life care needs of this population, particularly within the context of constrained resources of health care in prisons.