MacRae Rhoda, Chalmers Natalie, Tolson Debbie, Taylor James, Anderson Kirstin, Thomson Lindsay, Russ Tom
Alzheimer Scotland Centre for Policy and Practice, School of Health and Life Sciences, University of the West of Scotland, Lanarkshire Campus, Glasgow, G72 0LH, Scotland.
School of Health in Social Science, The University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, Scotland.
Health Justice. 2024 Nov 6;12(1):43. doi: 10.1186/s40352-024-00294-5.
The number of older people in prisons is increasing across the globe. Many have poor physical and mental health, higher prevalence of head injury, cognitive impairment and dementia than found in community populations. Meeting the complex needs of this vulnerable group has become an increasing concern for prison and prison healthcare services. The aim of this multi method qualitative study was to investigate how men with diagnosed or suspected dementia were identified, assessed, and cared for in Scottish prisons. It also explored the lived experience of individuals being assessed for or diagnosed with dementia within four prisons. The data from twenty nine interviews was thematically analysed and used to collaboratively propose principles for dementia care in prison and present the resultant co-designed care pathway.
At the time of data collection almost all the men known to have a dementia diagnosis or suspected dementia had complex health and social care needs, and some were living with advanced dementia. Prison healthcare staff reported taking a 'case by case' approach to their pre- and post-diagnostic care. Meeting these prisoner's needs was complicated by the absence of organisational leads for care of older adults or people with dementia and there was no pathway or model in place to guide staff. Prison healthcare teams often had difficulty accessing specialist community services to support diagnosis. There was a lack of dementia education and knowledge about how to provide pre and post diagnostic dementia care in this setting amongst staff. The findings arising from this research have informed the co-production of two important evidence informed innovations namely a Model of Care and a pre- and post-diagnostic Care Pathway.
This research adds insights critical to understanding the adequacy of current approaches to meeting dementia related needs within the prison setting. To our knowledge this paper offers the first co-produced evidence informed pre- and post- diagnostic dementia care pathway and model of care for use in prisons. These could serve as tools for change that could enable prison healthcare staff to deliver the right care, at the right time, by the right people, and provide an opportunity to assess risk and plan care for the future.
全球范围内，监狱中老年囚犯的数量正在增加。许多老年囚犯身心健康状况不佳，与社区人群相比，头部受伤、认知障碍和痴呆症的患病率更高。满足这一弱势群体的复杂需求已日益成为监狱及监狱医疗服务机构关注的问题。这项多方法定性研究的目的是调查在苏格兰监狱中，被诊断或疑似患有痴呆症的男性是如何被识别、评估和护理的。研究还探索了在四所监狱中接受痴呆症评估或诊断的个人的生活经历。对来自29次访谈的数据进行了主题分析，并共同提出了监狱痴呆症护理原则，呈现了由此共同设计的护理路径。
在数据收集时，几乎所有已知患有痴呆症诊断或疑似痴呆症的男性都有复杂的健康和社会护理需求，有些还患有晚期痴呆症。监狱医疗人员报告称，在诊断前后的护理中采取了“个案处理”的方法。由于缺乏照顾老年人或痴呆症患者的组织牵头人，满足这些囚犯的需求变得复杂，而且没有现成的路径或模式来指导工作人员。监狱医疗团队在获取专业社区服务以支持诊断方面往往存在困难。工作人员缺乏痴呆症教育，也不了解在这种情况下如何提供诊断前后的痴呆症护理。这项研究的结果为两项重要的基于证据的创新成果的共同产生提供了信息，即护理模式和诊断前后护理路径。
本研究为理解当前满足监狱环境中与痴呆症相关需求的方法是否充分提供了关键见解。据我们所知，本文提供了首个共同产生的、基于证据的诊断前后痴呆症护理路径和监狱护理模式。这些可以作为变革工具，使监狱医疗人员能够在正确的时间、由合适的人员提供正确的护理，并为评估风险和规划未来护理提供机会。
