Long-Stay and Ageing

  • Claudio Di LoritoEmail author


Older forensic psychiatric patients stay in secure services longer than prisoners sentenced for the same offence, patients in general psychiatric settings and forensic psychiatric patients of all ages. Prolonged stay may reflect that service provision is far from meeting the unique needs of this population, but research in this area is very limited. Drawing from the existing literature in forensic psychiatry and in other restrictive settings, this chapter aims to (1) present data on older patients in relation to their prevalence in forensic psychiatric settings, sociodemographic characteristics, violence, mental health and individual needs; (2) present data on length of stay in comparison with other populations in secure care; and (3) report and discuss issues around the long-term care of older patients, including physical healthcare, the presence of cognitive impairment and dementia, (the potential development of) national long-term units for patients with intensive care needs and the need for age-relevant treatment and activities. Potential implications for service improvement in relation to policy-making and research are also discussed.


  1. 1.
    Mitnitski AB, Graham JE, Mogilner AJ, Rockwood K. Frailty, fitness and late-life mortality in relation to chronological and biological age. BMC Geriatr. 2002;2(1):1.CrossRefGoogle Scholar
  2. 2.
    Cooney F, Braggins J. Doing time. Good practice with older people in prison—the views of prison staff. London: Prison Reform Trust; 2010.Google Scholar
  3. 3.
    Natarajan M, Mulvana S. New horizons: forensic mental health services for older people. Br J Psychiatry Adv. 2017;23:44–53.Google Scholar
  4. 4.
    Di Lorito C, Völlm B, Dening T. Ageing patients in forensic psychiatric settings: a review of the literature. Int J Geriatr Psychiatry. 2018;33(12):1548–55.CrossRefGoogle Scholar
  5. 5.
    Coid J, Fazel S, Kahtan N. Elderly patients admitted to secure forensic psychiatry services. J Forensic Psychiatry. 2002;13:416–27. Scholar
  6. 6.
    Curtice M, Parker J, Wismayer FS, Tomison A. The elderly offender: an 11-year survey of referrals to a regional forensic psychiatric service. J Forensic Psychiatry Psychol. 2003;14:253–65. Scholar
  7. 7.
    Di Lorito C, Dening T, Völlm B. The characteristics and needs of older forensic psychiatric patients: a UK cross-sectional study. 2018. Submitted for publication.Google Scholar
  8. 8.
    Lightbody E, Gow RL, Gibb R. A survey of older adult patients in special secure psychiatric care in Scotland from 1998 to 2007. J Forensic Psychiatry Psychol. 2010;21:966–74. Scholar
  9. 9.
    Völlm B, Edworthy R, Holley J, Talbot E, Majid S, Duggan C, et al. Characteristics and needs of long-stay patients in high and medium secure settings in the UK: implications for service organisation. Southampton: NIHR Journals Library; 2017.Google Scholar
  10. 10.
    Wong MTH, Fenwick PBC, Lumsden J, Fenton GW, Maisey MN, Lewis P, et al. Elderly offenders in a maximum security mental hospital. Aggress Behav. 1995;21:321–4.CrossRefGoogle Scholar
  11. 11.
    Office of National Statistics. Overview of the UK population: July 2017. London: Office of National Statistics; 2017.Google Scholar
  12. 12.
    Di Lorito C, Castelletti L, Tripi G, Gandellini MG, Dening T, Völlm B. The individual experience of aging patients and the current service provision in the context of Italian forensic psychiatry: a case study. J Forensic Nurs. 2017;13(3):118–25.CrossRefGoogle Scholar
  13. 13.
    Frazer L. Ageing inside. school for policy studies working paper series paper number 1. University of Bristol, Bristol. 2003. Retrieved from:
  14. 14.
    Moll A. Losing track of time: Dementia and the ageing prison population. London: Mental Health Foundation; 2013. Retrieved from:
  15. 15.
    Resettlement and Care for Older Ex-Offenders and Prisoners (RECOOP). 2015. Retrieved from:
  16. 16.
    Yorston GA. Managing aggression and violence in older people. London: The Royal College of Psychiatrists; 2015.Google Scholar
  17. 17.
    Cornish N, Kimmett E, Hewson A, War S. Social care or systematic neglect? Older people on release from prison. London: Prison Reform Trust; 2016.Google Scholar
  18. 18.
    Davoren M, Fitzpatrick M, Caddow F, Caddow M, O’Neill C, O’Neill H, Kennedy HG. Older men and older women remand prisoners: mental illness, physical illness, offending patterns and needs. Int Psychogeriatr. 2015;27:747–55.CrossRefGoogle Scholar
  19. 19.
    Joyce J, Maschi T. “In here, time stands still.” The rights, needs and experiences of older people in prison. Dublin: Irish Penal Reform Trust; 2016.Google Scholar
  20. 20.
    World Health Organization. Prisons and health. Geneva: World Health Organization. 2014. Accessed 22 Mar 18.
  21. 21.
    Allen G, Watson C. UK prison population statistics. London: House of Commons Library; 2017. Retrieved from
  22. 22.
    Paradis C, Broner N, Maher LM, O’Rourke T. Mentally ill elderly jail detainees. J Offender Rehabil. 2000;31:77–86. Scholar
  23. 23.
    Shah A. An audit of a specialist old age psychiatry liaison service to a medium and a high secure forensic psychiatry unit. Med Sci Law. 2006;46:99–104.CrossRefGoogle Scholar
  24. 24.
    Tomar R, Treasaden IH, Shah AK. Is there a case for a specialist forensic psychiatry service for the elderly? Int J Geriatr Psychiatry. 2005;20:51–6. Scholar
  25. 25.
    Yorston G, Taylor PJ. Older patients in an English high security hospital: a qualitative study of the experiences and attitudes of patients aged 60 and over and their care staff in Broadmoor Hospital. J Forensic Psychiatry Psychol. 2009;20:255–67. Scholar
  26. 26.
    Steffensmeier D, Motivans M. Older men and older women in the arms of criminal law: offending patterns and sentencing outcomes. J Gerontol Ser B Psychol Sci Soc Sci. 2000;55(3):S141–51.CrossRefGoogle Scholar
  27. 27.
    Cullen AE, Jewell A, Tully J, Coghlan S, Dean K, Fahy T. A prospective cohort study of absconsion incidents in forensic psychiatric settings: Can we identify those at high-risk? PLoS One. 2015;10(9):e0138819.Google Scholar
  28. 28.
    Hare RD. The Hare psychopathy checklist—revised. Toronto: Multi-Health Systems; 1991.Google Scholar
  29. 29.
    Völlm B, Bartlett P, McDonald R. Ethical issues of long-term forensic psychiatric care. Ethics Med Public Health. 2016;2:36–44.CrossRefGoogle Scholar
  30. 30.
    Ferriter M, Gedeon T, Buchan S, Findlay S, Mbulawa D, Powney M, Cormac I. Eight decades of mortality in an English high-security hospital. Crim Behav Ment Health. 2016;26:403–16.CrossRefGoogle Scholar
  31. 31.
    Di Lorito C, Dening T, Völlm B. Ageing in forensic psychiatric secure settings: the voice of older patients. J Forensic Psychiatry Psychol. 2018;29(6):934–60.CrossRefGoogle Scholar
  32. 32.
    Di Lorito C, Dening T, Völlm B. Ageing in forensic psychiatric secure settings: the views of members of staff. J Forensic Psychiatry Psychol. 2018;2018:1–16.Google Scholar
  33. 33.
    Steiner E. Early release for seriously ill and elderly prisoners: should French practice be followed? Probat J. 2003;50(3):267–76.CrossRefGoogle Scholar
  34. 34.
    Handtke V, Wangmo T. Ageing prisoners’ views on death and dying: contemplating end-of-life in prison. J Bioeth Inq. 2014;11(3):373–86. Scholar
  35. 35.
    Williams BA, Stern MF, Mellow J, Safer M, Greifinger RB. Aging in correctional custody: setting a policy agenda for older prisoner health care. Am J Public Health. 2012;102(8):1475–81.CrossRefGoogle Scholar
  36. 36.
    Di Lorito C, Völlm B, Dening T. Psychiatric disorders among older prisoners: a systematic review and comparison study against older people in the community. Aging Ment Health. 2018;22(1):1–10.Google Scholar
  37. 37.
    Rait G, Fletcher A, Smeeth L, Brayne C, Stirling S, Nunes M, et al. Prevalence of cognitive impairment: results from the MRC trial of assessment and management of older people in the community. Age Ageing. 2005;34:242–8.CrossRefGoogle Scholar
  38. 38.
    Age UK. Later life in the United Kingdom. 2016. Retrieved from
  39. 39.
    Alzheimer’s Society. Dementia UK update. 2016. Retrieved from
  40. 40.
    Yorston G. Crime, mental illness, and older people. In: Dening T, Thomas A, editors. Oxford textbook of old age psychiatry. Oxford: Oxford University Press; 2013.Google Scholar
  41. 41.
    Baldwin J, Leete J. Behind bars: the challenges of an ageing population. Aust J Dement Care. 2012;2(1):16–9.Google Scholar
  42. 42.
    United Nations. International convention on the rights of persons with disabilities. New York, NY: United Nations; 2006. Accessed 6 Dec 2017.
  43. 43.
    Fazel S, McMillan J, O’Donnell I. Dementia in prison: ethical and legal implications. J Med Ethics. 2002;28:156–9.CrossRefGoogle Scholar
  44. 44.
    The Centre for Mental Health. Secure mental health services. 2015. Retrieved Oct 27, 2017
  45. 45.
    Boyd-Caine T. Protecting the public?: detention and release of mentally disordered offenders. Abingdon: Routledge; 2012.CrossRefGoogle Scholar
  46. 46.
    Carroll A, Lyall M, Forrester A. Clinical hopes and public fears in forensic mental health. J Forensic Psychiatry Psychol. 2004;15(3):407–25.CrossRefGoogle Scholar
  47. 47.
    Rutherford M, Duggan S. Forensic mental health services: facts and figures on current provision. London: Sainsbury Centre for Mental Health; 2007.Google Scholar
  48. 48.
    Mattar S, Khan F. Personality disorders in older adults: diagnosis and management. Prog Neurol Psychiatry. 2017;21:22–7.CrossRefGoogle Scholar
  49. 49.
    National Institute for Health and Care Excellence. Mental wellbeing and independence in older people. NICE Guideline (NG32). 2015.Google Scholar
  50. 50.
    Atabay T. United Nations Office on Drugs and Crime, Vienna: Handbook on prisoners with special needs. New York: United Nations Publications; 2009.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.School of Medicine, Division of Rehabilitation and AgeingUniversity of NottinghamNottinghamUK

Personalised recommendations