Aging in Prison

Recently I attended the monthly general meeting of the New York NGO Committee on Ageing. The topic was “Aging in Prison – a Human Rights Issue.” Two academics who have specialized on treatment of US prisoners presented some of their research. They were:

Tina Maschi, PhD, LCSW, ACSW, who is now Associate Professor at Fordham University Graduate School of Social Services (FUGGS); she’s also a Social Fellow at the New York Academy of Medicine, a Research Scholar at the Ravazzin Center on Aging, and Coordinator for the FUGGS Human Rights and Social Justice sequence. The second speaker, Deborah Viola, PhD., is Associate Professor and Associate Director, Doctoral Program, Department of Health Policy & Management at New York Medical College, and Research Scholar at the Center for Long Term Care Research & Policy.

General Facts

The US population makes up about 5 percent of the world’s population. About 10 million people are imprisoned world-wide. Surprisingly, 25 percent of those are “doing time” are held in US prisons. Among them, 16 percent of the 10 million are 60 years and older. The US exceeds all nations in the number of old people incarcerated in its prisons. At present, the older population is the most rapidly growing group in US prisons. In fact, the number of older prisoners is growing faster than the number of older persons in the US population. In the US, 756 human beings out of every 100.000 people are incarcerated.

Why are there so many people in US prisons?

One would think since the US has the largest prison population in the world that the nation must be home to very dangerous criminals who everyone would agree are “bad” people. But wait a minute, are they?

About three decades ago the US introduced a “tough on crime” policy. State and federal legislators adopted laws that increased the likelihood and length of prison sentences, by including mandatory minimum sentences and three strikes laws. It seems a bit strange that while the crime rate had declined since the 1980's; nevertheless the US prison population grew six-fold.

It is very interesting that the US has privately owned prisons. The two largest private prison companies combined to bring in close to $3,000, 000, 000 in revenue in 2010. Earlier in the 1980's, there were no privately owned prisons in the US. Since then the number of incarcerated people has exploded. It does not take a genius to see what is going on here.

Last year the largest private prison in the US, Corrections Corporation of America (CCA), received $ 74 million of taxpayers’ money to run immigration detention centers. There are numerous reports on human rights’ abuses in these private prisons. For example, when auditors visited one private prison in Texas, they “got so much fecal matter on their shoes they had to wipe their feet off on the grass outside.” The prisoners were literally living in their own excrement. To make a phone call to a lawyer or loved ones, the CCA charges its inmates $ 5 per minute, yet the prison only pays inmates who work at the facility $1 per day. To me, it looks like the more people the “justice system” can put behind bars, the more money the private prisons will make.

A lot of people go to US prisons because of drug crimes. Examining who actually goes to prison because of a drug crime speaks very loud. About 14 million whites and 2.6 million Afro-Americans report using an illicit drug. While five times as many whites are using drugs as African Americans, yet African Americas are sent to prison for drug offenses at 10 times the rate of whites. African Americans serve virtually as much time in prison for a drug offense (58.7 months) as whites do for a violent offense (61.7 months). Surely this is not “equal treatment under the law.” One out of every 12 Afro-American men of working age is in prison. These statistics tell us that if you commit a drug crime and are not white, you will go to prison. If you are white, it is considered a public health problem.

What are the problems facing an older population behind bars?

Prisons in general are designed for the young and able-bodied. For example, when people grow older they have different medical and health needs than the young. Older persons are more likely to develop disabilities that require the use of assistive devices such as glasses, hearing aids, wheelchairs, walkers and canes. As in the community, the elderly in prison suffer from falls, which contribute to hip fractures and high health costs. Even if these conditions are provided for, many elder inmates are confined in facilities that cannot meet the structural or programmatic needs of mobility-impaired persons. Because of their higher rates of illness and impairments, older prisoners incur medical costs that are three to nine times higher than those of younger prisoners. In general a younger prisoner costs about $22.000 per year while an older person can cost as much as $65,000 per year.

It is also documented that the older prisoners “age” about 15 years faster than people who are not incarcerated.

Sooner or later, one of two things will happen to an aging prisoner. Either he/she will die in prison, or will be released. Neither of these alternatives has gained that much attention. Reentry into society is very difficult for any former prisoner. Older persons face additional challenges. Older women and men find it extremely hard to find work, housing and transportation, as well as necessary medical and mental healthcare. Some have the assistance from former friends and family, but many have lost contact with their families because of the length of time incarcerated or the nature of their crimes.

As the number of older prisoners increases, so too does the number of men and women dying of natural causes behind bars.

For references and more information please visit:

Human Rights Watch's report “Old Behind Bars”

Statistics 

Sanna Klemetti

s.klemetti@globalaging.org

Seniors! Are you taking one of the 110 most dangerous drugs for older people? Want to know? Read further!

The April 15, 2013, New York Times reports that US medical doctors are routinely prescribing drugs that can be harmful to older patients.  Medicare recipients in the US South are getting prescriptions that can hurt them seriously.  Apparently one in five older persons living in the South are taking drugs that are dangerous. Other US regions have fewer seniors who are taking such drugs regularly.

Are the patients poor? Do they lack education? Have unqualified doctors?  Are they persons of color? Researchers say that poor people are more likely to be taking these drugs.  As socioeconomic status declined, for example, the likelihood of being prescribed a high-risk drug increases.

New York Times reporters drew much of their information from medical experts who published their findings in the latest issue of The Journal of General Internal Medicine. "For the study, they referred to a list of 110 drugs to avoid in the elderly, compiled by the National Committee for Quality Assurance. Many of these drugs are widely used, often with few or moderate side effects in younger patients.  However, risks get bigger among elders.

On the list are anti-anxiety medications like Valium. This drug can be harder for older patients to metabolize.  It stays in the system and "can lead to prolonged sedation, and in turn potentially deadly falls and fractures." Several muscle relaxants and diabetes medications can also remain in elderly patients’ bodies for longer periods, causing complications.

Researchers examined records of more than six million older men and women in the US enrolled in Medicare Advantage plans. "Over all, they found that 1.3 million of those seniors, or roughly one in five, had been prescribed at least one high-risk medication in 2009 even though many of the drugs were available in safer versions. About 5 percent of the seniors in the study had been prescribed at least two medications from the list," the NY Times reports.

Using many medications, known as "polypharmacy," is a growing problem among seniors. Researchers found that the "average person over 65 takes at least four prescription drugs — a practice that can lead to dangerous and unexpected interactions."  Taking many drugs is creating a serious public health problem. . . and it affects seniors more than anyone else.

What drugs are you taking?  Check out their safety.  Now!

What can you do?  Talk to your doctor and your pharmacist to find out about the drugs that you are taking.  Are they safe?  What is their record?  If these resources are too busy to tell you, reporters  suggest using the internet to query the records and warnings of medications you are taking.

Protect yourself.

Susanne Paul for Global Action on Aging

How Does Depression Wreck Your Life?

All too often stereotypes cast older persons as “grumpy.” Many people think that being down and depressed is normal in old age. Attention!

It is NOT a natural part of aging. 

Depression can happen to anyone at any age and is common among older adults and seniors. Some 15 out of 100 adults over the age of 65 suffer from depression in the US. Who are these older adults and why do so many of them suffering from depression? Studies show that the disorder affects people in nursing homes and hospitals in even greater numbers. Recognizing depression among old persons is not always easy. Depressed elders may find it difficult to describe their feelings. Many fear revealing their sadness since they may associate it with being “crazy” or lacking self-control. In the youth of today’s elders, they learned that depression often was associated with being “crazy” or weak-minded. Today, we know hat depression is a fully treatable medical or biological illness.

The Movie Grumpy Old Men

Aging, HIV and Depression

Experts have discovered a link between HIV-positive older adults and depression. To find out more about this development, I met up with Stephen Karpiak to talk about HIV positive older adults and seniors. A PhD, Karpiak joined ACRIA (AIDS Community Research of America) in 2002, as Assistant Director of Research. He served as primary investigator at the agency's new behavioral research effort, including conducting groundbreaking Research on Older Adults with HIV(ROAH) study. Earlier, he had worked for over 20 years at Columbia University's Medical School as a research scientist in neurobiology and immunology. Karpiak also started a Phoenix, Arizona, project to provide housing for homeless people living with HIV/AIDS. Dr. Karpiak has documented over 250 articles in scientific journals and books, and has been holding lectures all over the world.

 Dr. Karpiak

Karpiak told me that the ROAH goal focused on understanding the situation of those over the age of 50 who are living with HIV. ROAH sought answers to identify their psycho-social needs and determine how to support them most effectively to live longer, healthier and happier lives. ROAH assessed a 1,000-person cohort in New York City, examining a comprehensive array of issues, including health status, stigma, depression, social networks, spirituality, sexual behavior, and substance abuse.

ROAH showed that stigma, isolation and depression are the major problems for this group. The stigma against HIV/AIDS and is usually associated with homophobia, racism, ageism, etc.

ROAH demonstrated that by repressing the immune system, depression may render people more vulnerable to infectious diseases. Stress and depression have a harmful effect on cellular immunity, including those aspects of the immune system affected by HIV. Body cell mass depletion is associated with significant increase in fatigue, global distress and depressive symptoms, and reduced life satisfaction. Elevated symptoms of depression associated with a faster progression to AIDS and a higher risk of mortality.

Stigma often leads to isolation, depression and loneliness. Older HIV positive adults who are depressed are more likely to have financial problems, have fewer people to turn to for support, lack critical HIV-related information, live alone, have thoughts of suicide, and experience greater levels of stigma related to HIV and aging as compared to older adults who are not depressed. Depression may also stop persons from getting treated, avoiding doctor visits, social activities and other relationships. ROAH found that aging HIV-positive adults experience significant levels of depression, at a rate at least five times higher than the general New York City population.

Dr. Karpiak and Sanna Klemetti

Solutions?

I asked Dr. Karpiak what has or can be done about this situation. As a matter of fact, successful projects exist. One example is the MacArthur Foundation Model that expects participants to make one phone call every week to ask the HIV affected person how he/she is doing. The effect of this simple and effective program has been great. Another ACRIA project is The Go 4 Part Program, funded by Mac AIDS fund. It's a two day HIV – aging training program. Around 25 educators visit about two cities per year, to bring AIDS, health and aging organizations together to educate them about these issues. They also introduce ideas on how to reduce the problems. They usually invite one person from the meetings to New York to see the work carried out at ACRIA.

More about ROAH

Sanna Klemetti

s.klemetti@globalaging.org

Will President Obama sell Out US Seniors and our children for a Deal with the Republicans?

Salivating Over Social Security Cuts

Dear Global Action on Aging Friends,

Wherever you live, please note the very real possibility that President Obama will seriously weaken or even destroy the Social Security Program for a "deal" with Republicans over the US Budget.  Not only will such action undercut the modest living standard of US elders but it also threatens young workers who have contributed to the program since they entered the workforce. 

Mind you, US citizens have already seen the Federal Government "borrow" from Social Security to support other programs--and failed to re-pay the debt.  Read excerpts from Robert Reich's Blog (April 10, 2013) for the full story:

ohn Boehner, Speaker of the House, revealed why it's politically naive for the President to offer up cuts in Social Security in the hope of getting Republicans to close some tax loopholes for the rich. "If the President believes these modest entitlement savings are needed to help shore up these programs, there's no reason they should be held hostage for more tax hikes,” Boehner said in a statement released Friday.

House Majority Leader Eric Cantor agreed. He said on CNBC he didn't understand "why we just don't see the White House come forward and do the things that we agree on” such as cutting Social Security, without additional tax increases.

Get it? The Republican leadership is already salivating over the President's proposed Social Security cut. They've been wanting to cut Social Security for years.

But they won't agree to close tax loopholes for the rich.

They're already characterizing the President's plan as a way to "save” Social Security - even though the cuts would undermine it - and they're embracing it as an act of "bi-partisanship.”

"I'm encouraged by any steps that President Obama is taking to save and preserve Social Security,” cooed Texas Republican firebrand Ted Cruz. "I think it should be a bipartisan priority to strengthen Social Security and Medicare to preserve the benefits for existing seniors.”

Oh, please.

And the day Ted Cruz agrees to raise taxes on the wealthy or even close a tax loophole will be when Texas freezes over.

The President is scheduled to dine with a dozen Senate Republicans Wednesday night. Among those attending will be John Boozman of Arkansas, who has already praised Obama for "starting to throw things on the table,” like the Social Security cuts.

That's exactly the problem. The President throws things on the table before the Republicans have even sat down for dinner.

The President's predilection for negotiating with himself is not new. But his willingness to do it with Social Security, the government's most popular program - which Democrats have protected from Republican assaults for almost eighty years - doesn't bode well.

The President desperately wants a "grand bargain” on the deficit. Republicans know he does. Watch your wallets.

GAA Readers:  Write the President and your Congressional Representatives to protest!  Organize a Demonstration (with your family and friends in your Community) demanding a stop to this disastrous plan to ruin US Social Security! Take action to alert citizens, young and old! 

Susanne Paul for Global Action on Aging