Type of research

Pilot implementation and process evaluation

Background and scientific rationale

The prevalence of dementia in the UK is growing due to an increased life expectancy and growing proportion of older people. There is acknowledgment that the prison population mirrors society and, in fact, may be affected disproportionately due to ‘accelerated ageing’ in the prison environment (Aday, 2003). Often, people are not only affected by dementia but also other medical conditions requiring a range of care and support. Without appropriate advice, care and support, people with dementia and their carers fail to get the best possible health care (Goodman, 2013). Even in the community, health and care services and providers are not always aware or sufficiently informed to understand how dementia might interact with the care offered (e.g. longer stays in A&E) (Goodman, 2013). As a consequence, strategies and guidelines have been developed in the community focusing on staff training, such as Dementia Champions and other Dementia Friendly Initiatives, yet, on the ground uptake and effectiveness varies greatly across the UK (Goodman, 2013).

This CLAHRC Implementation Project will explore, implement and evaluate the potential effectiveness of the Dementia Friends approach in the closed setting of the prison environment. Building upon the CLAHRC Prison Peer Support Project (“Buddying”) and complementing the work of Professor Clare Goodman and Dr Frances Bunn at the University of Hertfordshire who have investigated the key factors or mechanisms supporting dementia friendly initiatives and uptake and development of an impact evaluation framework. The project will pilot the implementation of dementia champions and dementia friendly awareness sessions in up to three diverse prison settings in the East of England.

The Dementia Friends (DF) Initiative is a key activity of the Alzheimer’s Society Dementia Friendly Communities Programme, which aims to create communities and individuals who are more understanding of and welcoming towards people living with dementia. Based on CLAHRC prison research and the DF Programme, this CLAHRC Implementation Project aims to adapt the DF approach to the prison setting with the aim of creating DF prison communities (and consequently more ‘age-friendly’ prison settings and regimes).

We would expect a dementia friendly prison community to be one where people with dementia would be supported to live independently (i.e. to be supported, where needed, to cope with the prison regime) for as long as possible, and with as much choice and control as exercised by their peers in prison. Examples could include: improved signage, access to activities, fitting in-cell adaptations, and greater awareness of physical, behavioural and psychological symptoms of dementia and their implications for everyday prison life. Ensuring greater independence, self-management and awareness will also decrease the potential burden on the social care and health system as well as the stigma and discrimination attached to a lack of understanding the condition.

Based on our current research, we know that there are examples of initiatives in prison which have had a positive impact on the prison regime to the benefit of older prisoners. Prisoners who have demonstrated reliability and trustworthiness over a period of time may be well-placed to pick up on indications of dementia and pass on concerns to key officers in a position to make referrals to appropriate action. The current systematic review from our CLAHRC ‘Peer Support/Buddying’ project will also report on evidence from the United States where prison inmates (with appropriate behavioural background) provide this support and service as well as more hands-on support roles with prisoners with dementia.

Aims

  • Tailor, implement, and evaluate the Dementia Champions / Dementia Friendly initiative (Public Health England and Alzheimer’s Society) to the prison environment.
  • Raise awareness of dementia across all levels in prison (offenders, officers, staff and Governors).
    Train Dementia Friends (both staff and inmates) in prisons.
  • Train 3 researchers and several prisons staff (e.g. diversity and equality officer or older prison officer) as Dementia Champions in order to carry forward the longer term goals and ensure sustainability.

Research questions

  • Can the Dementia Champions/Dementia Friendly Initiative Approach be adapted and adopted in the prison setting?
  • Does the approach have an impact on prison regime, attitudes and reported behaviour (e.g. has older offender well-being improved? Indicators: increased social interaction, increased satisfaction / perceived better understanding of their needs)?
  • Has understanding of dementia and ageing improved at all levels (e.g. Offender-offender interactions; staff-offender interactions)?

For further information on this project, contact Dr Tine Van Bortel, Senior Research Associate, Cambridge Institute of Public Health, University of Cambridge

email: tv250@medschl.cam.ac.uk


Aday, R. H. (2003). Aging prisoners: Crisis in American corrections. Westport, CT: Praeger.

Goodman C, (2013). A realist evaluation of interventions that support the creation of dementia friendly environments in health care.

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