Extract

Background and study aims Older prisoners (those aged 50 and over) are the fastest growing subgroup in English prisons. Between 2000 and 2010, the number of older prisoners grew by a striking 128%. In the last three years, the proportion of prisoners aged 50 and over has increased, whereas the proportion of all other age groups in prison has remained the same or reduced. Older prisoners have more complex health problems than younger prisoners and than those of the same age living in the community. Around 85% of older prisoners suffer from one or more chronic illness. The most commonly reported health conditions amongst older prisoners are cardiovascular diseases, arthritis and/or back problems, respiratory diseases, endocrine disorders and sensory deficits. Furthermore, it is estimated that more than half of older prisoners have a psychiatric diagnosis, most frequently depressive illness, often inadequately treated. Older prisoners also have unmet social needs. It is estimated that on average, older prisoners cost between three and eight times as much to care for in prison as their younger counterparts. There is currently no national strategy for older prisoners; consequently their care is not well planned. The NHS is now responsible for prison-based healthcare services. Healthcare for prisoners must be equivalent, in terms of quality and range, to services provided in the community. However, this is frequently not the case for older prisoners. Prisons are generally designed for younger people and often do not fully meet older prisoners' needs. For example, only 19% of prisons undertake specific needs assessments for older prisoners and there has been no published research to date evaluating the effectiveness of the assessments currently in use. In a previous study, we supported a group of older prisoners, healthcare and prison staff in a prison in England to design and implement the Older prisoner Health and Social Care Assessment and Plan (OHSCAP). The Older Prisoner Lead (a prison officer) carries out the assessments with the older prisoner seven to ten days after prison entry. The OHSCAP includes a series of questions around relationships, activities, mobility, emotional wellbeing, physical wellbeing and release planning. Questions are asked in such a way as to give older people time and opportunity to fully talk about the issues they face. Following this discussion, a care plan is drawn up, detailing any referrals and special arrangements to be made. The OHSCAP has been piloted with 24 older prisoners at a prison in England and its content and format were received positively by prisoners and prison staff. The OHSCAP resulted in more efficient multi-agency working and older prisoners valued the opportunity to discuss anxieties which they felt they would have otherwise not shared with staff. The previous research was a small-scale study; the proposed research will be a full-scale study to examine wider outcomes for older prisoners and the quality of the delivery of the OHSCAP, including an evaluation of the costs and possible savings use of the OSHCAP would create. The aims of the study are: 1) To train prison staff to deliver OHSCAP 2) To implement OHSCAP in four prisons in England 3) To evaluate the effectiveness of OHSCAP in improving i) the meeting of older male prisoners' health and social care needs (primary outcome) ii) health-related quality of life and iii) depression iv) functional health and wellbeing and activities of daily living 4) To assess the quality of care plans produced through the OHSCAP 5) To explore the experiences of older prisoners receiving the OHSCAP, and staff involved in conducting the OHSCAP 6) To evaluate the cost-effectiveness of the OHSCAP, compared to treatment as usual Who can participate? Male adults aged 50 or over entering a prison participating in the study and who are likely to remain in prison for a minimum of 3 months. What does the study involve? Part 1 of the proposed study will involve training the Older Prisoner Leads at each prison to deliver the OHSCAP. In part 2 of the study, prisoners will be randomly allocated to receive either OHSCAP or treatment as usual. We will assess how well prisoners' health and social needs are met before they receive the OHSCAP or treatment as usual, and three months after they have received the intervention. We will then establish whether the OHSCAP results in increased met health and social needs, health-related quality of life, depression and functional health and wellbeing and activities of daily living compared to the control group. Part 3 consists of an audit of the care plans produced through OHSCAP to determine the processes involved and the quality of the care planning and health service delivery. This will help to improve staff training on the use of the tool. Part 4 involves interviews with older prisoners who have received the intervention to understand the facilitators and barriers involved. Interviews will also be held with staff involved in the intervention to gain an understanding of the processes involved. Part 5 will evaluate the cost-effectiveness of the OHSCAP as compared to treatment as usual. What are the possible benefits and risks of participating? Taking part may help to meet your health and social care needs. Findings from the research may help improve services for future older prisoners. For all participants there is the risk that you may become distressed during the interview as we will talk about your health and social care needs. If you are upset you can talk to the researcher, a listener, a member of prison staff or a member of healthcare staff. If you feel you require further support they will be able to tell you about other possible sources of help or advice. Where is the study run from? The proposed study will involve implementing the OHSCAP at four prisons in England. One of these prisons holds prisoners who are likely to be transferred to other prisons; one is a training prison holding prisoners with medium to long prison sentences; one of the prisons is a high secure prison that holds prisoners that are likely to have long sentences and one prison holds prisoners on a variety of short-term, medium-term and long-term sentences. When is the study starting and how long is it expected to run for? The study started in November 2013 and will run until October 2016. Who is funding the study? National Institute for Health Research (NIHR), UK Who is the main contact? Mrs Katrina Forsyth [email protected]

Inclusion criteria

• Topic: Primary Care Research Network for England; Subtopic: Not Assigned; Disease: All Diseases

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