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      Older adults in jail: high rates and early onset of geriatric conditions

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          Abstract

          Background

          The number of older adults in the criminal justice system is rapidly increasing. While this population is thought to experience an early onset of aging-related health conditions (“accelerated aging”), studies have not directly compared rates of geriatric conditions in this population to those found in the general population. The aims of this study were to compare the burden of geriatric conditions among older adults in jail to rates found in an age-matched nationally representative sample of community dwelling older adults.

          Methods

          This cross sectional study compared 238 older jail inmates age 55 or older to 6871 older adults in the national Health and Retirement Study (HRS). We used an age-adjusted analysis, accounting for the difference in age distributions between the two groups, to compare sociodemographics, chronic conditions, and geriatric conditions (functional, sensory, and mobility impairment). A second age-adjusted analysis compared those in jail to HRS participants in the lowest quintile of wealth.

          Results

          All geriatric conditions were significantly more common in jail-based participants than in HRS participants overall and HRS participants in the lowest quintile of net worth. Jail-based participants (average age of 59) experienced four out of six geriatric conditions at rates similar to those found in HRS participants age 75 or older.

          Conclusions

          Geriatric conditions are prevalent in older adults in jail at significantly younger ages than non-incarcerated older adults suggesting that geriatric assessment and geriatric-focused care are needed for older adults cycling through jail in their 50s and that correctional clinicians require knowledge about geriatric assessment and care.

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          Most cited references33

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          The drug abuse screening test

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            Geriatric care management for low-income seniors: a randomized controlled trial.

            Low-income seniors frequently have multiple chronic medical conditions for which they often fail to receive the recommended standard of care. To test the effectiveness of a geriatric care management model on improving the quality of care for low-income seniors in primary care. Controlled clinical trial of 951 adults 65 years or older with an annual income less than 200% of the federal poverty level, whose primary care physicians were randomized from January 2002 through August 2004 to participate in the intervention (474 patients) or usual care (477 patients) in community-based health centers. Patients received 2 years of home-based care management by a nurse practitioner and social worker who collaborated with the primary care physician and a geriatrics interdisciplinary team and were guided by 12 care protocols for common geriatric conditions. The Medical Outcomes 36-Item Short-Form (SF-36) scales and summary measures; instrumental and basic activities of daily living (ADLs); and emergency department (ED) visits not resulting in hospitalization and hospitalizations. Intention-to-treat analysis revealed significant improvements for intervention patients compared with usual care at 24 months in 4 of 8 SF-36 scales: general health (0.2 vs -2.3, P = .045), vitality (2.6 vs -2.6, P < .001), social functioning (3.0 vs -2.3, P = .008), and mental health (3.6 vs -0.3, P = .001); and in the Mental Component Summary (2.1 vs -0.3, P < .001). No group differences were found for ADLs or death. The cumulative 2-year ED visit rate per 1000 was lower in the intervention group (1445 [n = 474] vs 1748 [n = 477], P = .03) but hospital admission rates per 1000 were not significantly different between groups (700 [n = 474] vs 740 [n = 477], P = .66). In a predefined group at high risk of hospitalization (comprising 112 intervention and 114 usual-care patients), ED visit and hospital admission rates were lower for intervention patients in the second year (848 [n = 106] vs 1314 [n = 105]; P = .03 and 396 [n = 106] vs 705 [n = 105]; P = .03, respectively). Integrated and home-based geriatric care management resulted in improved quality of care and reduced acute care utilization among a high-risk group. Improvements in health-related quality of life were mixed and physical function outcomes did not differ between groups. Future studies are needed to determine whether more specific targeting will improve the program's effectiveness and whether reductions in acute care utilization will offset program costs. clinicaltrials.gov Identifier: NCT00182962.
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              Self-report and medical record report agreement of selected medical conditions in the elderly.

              This study assessed agreement between self- and medical record report of medical conditions in an elderly population. Medical charts of 120 participants in a screening program were abstracted, and the questionnaire report of eight major conditions was compared with the medical record. There was substantial or moderate agreement between self-report and medical record report for each condition, although strength of agreement varied by condition. Self-report by elderly individuals compares favorably with medical record report of medical conditions.
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                Author and article information

                Contributors
                Meredith.greene@ucsf.edu
                cyrus.ahalt@ucsf.edu
                irena.stijacic@ucsf.edu
                liakmetzger@gmail.com
                brie.williams@ucsf.edu
                Journal
                Health Justice
                Health Justice
                Health & Justice
                Springer Berlin Heidelberg (Berlin/Heidelberg )
                2194-7899
                17 February 2018
                17 February 2018
                December 2018
                : 6
                : 3
                Affiliations
                ISNI 0000 0001 2297 6811, GRID grid.266102.1, Department of Medicine, Division of Geriatrics, , University of California San Francisco, ; San Francisco, CA USA
                Author information
                http://orcid.org/0000-0002-5792-3397
                Article
                62
                10.1186/s40352-018-0062-9
                5816733
                29455436
                d7e4b020-9d33-4f32-a97c-7c975f245874
                © The Author(s). 2018

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

                History
                : 29 November 2017
                : 5 February 2018
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/100000049, National Institute on Aging;
                Award ID: 3P30AG044281–02S1
                Award Recipient :
                Funded by: Tideswell at UCSF
                Award ID: n/a
                Award Recipient :
                Funded by: Jacob and Valeria Langeloth Foundation (US)
                Award ID: n/a
                Award Recipient :
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2018

                criminal justice,jail,geriatric conditions
                criminal justice, jail, geriatric conditions

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