Department of Medicine, Division of Gerontology, Geriatrics and Palliative Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA.
Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA.
J Gerontol A Biol Sci Med Sci. 2024 Nov 1;79(11). doi: 10.1093/gerona/glae200.
The adverse health effects of incarceration are well-documented, affecting individuals throughout their life course. However, the influence of a history of incarceration on end-of-life (EOL) experiences remains unexplored. This study aims to examine how prior incarceration affects individuals' experiences and care needs as they approach the EOL.
Leveraging the Health and Retirement Study, we conducted secondary analyses on 1 710 individuals who participated between 2012 and 2018. Through retrospective cohort analysis, we explored the association between incarceration history and EOL care, focusing on pain and symptom burden.
Analyses showed that individuals with a history of incarceration experienced significantly higher levels of pain (65% reported "moderate" or "severe" pain) compared to nonincarcerated individuals (50%; adjusted odds ratio = 1.45, 95% confidence interval [CI]: 1.22-1.71, p < .001). Additionally, the symptom burden index revealed that formerly incarcerated individuals had a higher average symptom score (2.8 vs 2.1; β = 0.7, 95% CI: 0.5-0.9, p < .001), indicating a greater range of symptoms in their final year of life. These disparities persisted after adjusting for demographic, health, and socioeconomic variables.
This study reveals that a history of incarceration significantly affects EOL experiences, with formerly incarcerated individuals facing higher levels of pain and a greater symptom burden compared to nonincarcerated individuals. This underscores the need for tailored palliative care to address the unique needs of this vulnerable population. This research highlights a critical area for intervention and calls for healthcare systems to adapt their practices to better serve those with incarceration histories.
监禁对健康的不良影响已有充分记录，影响个人的整个生命过程。然而，监禁史对临终体验的影响仍未得到探索。本研究旨在探讨先前的监禁如何影响个人在接近生命终点时的体验和护理需求。
利用健康与退休研究，我们对 2012 年至 2018 年期间参与的 1710 个人进行了二次分析。通过回顾性队列分析，我们探讨了监禁史与临终关怀之间的关联，重点关注疼痛和症状负担。
分析表明，有监禁史的个体经历的疼痛水平显著高于未监禁的个体（65%报告“中度”或“重度”疼痛，而非监禁个体为 50%；调整后的优势比=1.45，95%置信区间[CI]：1.22-1.71，p<.001）。此外，症状负担指数显示，以前被监禁的个体的平均症状评分更高（2.8 与 2.1；β=0.7，95%CI：0.5-0.9，p<.001），表明他们生命的最后一年有更多的症状。这些差异在调整人口统计学、健康和社会经济变量后仍然存在。
本研究表明，监禁史显著影响临终体验，以前被监禁的个体经历的疼痛水平和症状负担均高于未被监禁的个体。这突显了需要为这一弱势群体提供量身定制的姑息治疗，以满足他们的独特需求。这项研究突出了一个干预的关键领域，并呼吁医疗保健系统调整其做法，以更好地为有监禁史的人服务。
