Purpose In the literature, 65 years is commonly used as the age to designate an older person in the community. When studying older prisoners, there is much variation. The purpose of this paper is to investigate how researchers define older offenders and for what reasons. Design/methodology/approach The authors reviewed articles on health and well-being of older offenders to assess terminology used to describe this age group, the chosen age cut-offs distinguishing younger offenders from older offenders, the arguments provided to support this choice as well as the empirical base cited in this context. Findings The findings show that the age cut-off of 50 years and the term “older” were most frequently used by researchers in the field. The authors find eight main arguments given to underscore the use of specific age cut-offs delineating older offenders. They outline the reasoning provided for each argument and evaluate it for its use to define older offenders. Originality/value With this review, it is hoped to stimulate the much-needed discussion advancing towards a uniform definition of the older offender. Such a uniform definition would make future research more comparable and ensure that there is no ambiguity when researchers state that the study population is “older offenders”.

No abstract

Switzerland has a unique position among countries permitting some form of assisted dying. However, not all Swiss citizens and institutions are welcoming this fact and have coined the term "suicide tourism" for the phenomenon of foreign residents coming to Switzerland in order to request assisted dying. This reflection shows how the term was created and why it is misleading.

This article describes the Swiss law on advance directives that was passed at the beginning of 2013 and led to more certainty about the legally binding character of such directives. However, for various reasons the drafting of advance directives is not yet widespread in Switzerland, and many resources might be put to better use if this became a common practice. A recent proposal by members of a political party to make the discussion, although not the actual drafting, of advance directives mandatory was rejected by the Swiss Federal Parliament, and the proposal was written off after having been pending for 2 years. We consider that the rejection of this proposal was not justified and that discussion of advance directives should become mandatory, so that individuals can fully assume their role as responsible citizens taking proactive decisions. The decision not to draft advance directives should be a deliberate one, marking a shift from the current "opt-in" approach to an "opt-out" scenario.

Purpose According to the principle of equivalence of care, health care in prison has to be of the same standard and quality as in the general population. This study aims to determine the geographic accessibility of dialysis services for older prisoners and the older general population in Switzerland and whether accessibility and availability of dialysis care are equivalent. Design/methodology/approach Spatial accessibility analysis incorporated four different data types: population data, administrative data, street network data and addresses of prisons and hemodialysis services. Findings Analysis revealed that the average travel time to the nearest dialysis service was better for prisoners (11.5 min) than for the general population (14.8 min). However, dialysis service for prisoners is hampered by the necessary lead-time in correctional settings, which, ultimately, leads to longer overall access times (36.5 min). Accordingly, the equivalence of dialysis care for older Swiss prisoners is not entirely respected for availability and accessibility. Originality/value The strength of the study lies in the combination of ethical principles and the highly tangible results of a spatial accessibility analysis. The ethics-driven empirical analysis provides arguments for policy-makers to review the current practices.

Imprisoned persons are transported for several purposes including transfers to a different prison, legal-procedural reasons such as court hearings, and to receive medical treatments. The availability and acceptability of transportation may limit access to healthcare if health services cannot be provided within the prison grounds. The aim of this article is to examine the conditions of medical transport for older prisoners in Switzerland and to assess whether or not these practices are in line with international recommendations. Interviews with experts working in the prison context and with older prisoners were conducted. Results show that handcuffing practices and space restrictions during medical transport are not adapted to prisoners’ health condition. Older prisoners risk being exposed and humiliated by transport conditions. The reasons for delayed medical transport can be administrative constraints or erroneous medical judgement. Switzerland’s cantonal system results in a variety of regulations for transports, so that cantonal differences, administrative constraints and inappropriate conditions can delay access to necessary healthcare and increase suffering.

Background Mental health professionals (MHP) working in court-mandated treatment settings face ethical dilemmas due to their dual role in assuring their patient’s well-being while guaranteeing the security of the population. Clear practical guidelines to support these MHPs’ decision-making are lacking, amongst others, due to the ethical conflicts within this field. This qualitative interview study contributes to the much-needed empirical research on how MHPs resolve these ethical conflicts in daily clinical practice. Methods 31 MHPs working in court-mandated treatment settings were interviewed. The interviews were semi-structured and our in-depth analysis followed the thematic analysis approach. Results We first outline how mental health professionals perceive their dual loyalty conflict and how they describe their affiliations with the medical and the justice system. Our findings indicate that this positioning was influenced by situational factors, drawing the MHPs at times closer to the caring or controlling poles. Second, our results illustrate how participating MHPs solve their dual loyalty conflict. Participants considered central to motivate the patient, to see the benefits of treatment and its goals. Further, transparent communication with patients and representatives of the justice system was highlighted as key to develop a trustful relationship with the patient and to manage the influences from the different players involved. Conclusions Even though individual positioning and opinions towards dealing with the influences of the justice system varied, the results of our research show that, in spite of varying positions, the underlying practice is not very different across participating MHPs. Several techniques that allow developing a high-quality therapeutic alliance with the patient are key elements of general psychotherapy. Transparency appears as the crucial factor when communicating with the patient and with representatives of the justice system. More specifically, patients need to be informed since the beginning of therapy about the limits of medical confidentiality. It is also recommended to develop guidelines that define the level of detailed information that should be disclosed when communicating with the authorities of the justice system.

The increasing numbers of aging prisoners raise the issue of how they maintain their personal identity and self-esteem in light of long-standing detention. This study sought to answer this question since identity and self-esteem could influence mental and physical health. We conducted a secondary analysis of 35 qualitative interviews that were carried out with older inmates aged 51-75 years (mean age: 61 years) living in 12 Swiss prisons. We identified three main themes that characterized their identity: personal characterization of identity, occupational identity, and social identity. These main themes were divided into sub-themes such as familial network, retirement rights or subjective social position. Personal characterization of identity mostly happened through being part of a network of family and/or friends that supported them during imprisonment and where the prisoner could return to after release. Individual activities and behavior also played an important role for prisoners in defining themselves. Occupational identity was drawn from work that had been carried out either before or during imprisonment although in some cases the obligation to work in prison even after reaching retirement age was seen as a constraint. Social identity came from a role of mentor or counselor for younger inmates, and in a few cases older prisoners compared themselves to other inmates and perceived themselves as being in a higher social position. Identity was often expressed as a mix between positive and negative traits. Building on those elements during incarceration can contribute to better mental health of the individual prisoner which in turn influences the chances for successful rehabilitation.