Rising numbers of ageing prisoners and goals on implementing equivalent health care in prison raise issues surrounding end-of-life care for prisoners. The paucity of research on this topic in Europe means that the needs of older prisoners contemplating death in prison have not been established. To investigate elderly prisoners' attitudes towards death and dying, 35 qualitative interviews with inmates aged 51 to 71 years were conducted in 12 Swiss prisons. About half of the prisoners reported having thought about dying in prison, with some mentioning it in relation with suicidal thoughts and others to disease and old age. Themes identified during data analysis included general thoughts about death and dying, accounts of other prisoners' deaths, availability of end-of-life services, contact with social relations, and wishes to die outside of prison. Study findings are discussed using Allmark's concept of "death without indignities," bringing forth two ethical issues: fostering autonomy and removing barriers. Attributing the identified themes to these two ethical actions clarifies the current needs of ageing prisoners in Switzerland and could be a first step towards the implementation of end-of-life services in correctional systems.

Background: The number of older prisoners entering and ageing in prison has increased in the last few decades. Ageing prisoners pose unique challenges to the prison administration as they have differentiated social, custodial and healthcare needs than prisoners who are younger and relatively healthier. Objective: The goal of this study was to explore and compare the somatic disease burden of old and young prisoners, and to examine whether it can be explained by age group and/or time served in prison. Methods: Access to prisoner medical records was granted to extract disease and demographic information of older (>50 years) and younger (≤49 years) prisoners in different Swiss prisons. Predictor variables included the age group and the time spent in prison. The dependent variable was the total number of somatic diseases as reported in the medical records. Results were analysed using descriptive statistics and a negative binomial model. Results: Data of 380 male prisoners from 13 different prisons in Switzerland reveal that the mean ages of older and younger prisoners were 58.78 and 34.26 years, respectively. On average, older prisoners have lived in prison for 5.17 years and younger prisoners for 2.49 years. The average total number of somatic diseases reported by older prisoners was 2.26 times higher than that of prisoners below 50 years of age (95% CI 1.77-2.87, p < 0.001). Conclusion: This study is the first of its kind to capture national disease data of prisoners with a goal of comparing the disease burden of older and younger prisoners. Study findings indicate that older inmates suffer from more somatic diseases and that the number of diseases increases with age group. Results clearly illustrate the poorer health conditions of those who are older, their higher healthcare burden, and raises questions related to the provision of healthcare for inmates growing old in prison.

Most prisoners wish to spend their last days outside prison. Early release of seriously ill and ageing prisoners, commonly termed compassionate release, can be granted based on legal regulations but is rarely successful. The aim of this paper is to present the views of ageing prisoners on compassionate release using qualitative interviews. Participants argued for compassionate release on the grounds of illness and old age, citing respect for human dignity. Their hopes of an early release however often contradicted their actual experiences. Framing these results within Garland’s depiction of the criminology of the self and the criminology of the other, it is evident that in reality, the punitive strategy prevails. This strategy explains the rare use of compassionate release and how it negatively impacts prisoners’ access to end-of-life care. A possible solution is the welfarist criminology, strongly supported by a human rights approach. Awareness of the dominance of the punitive strategy is crucial for medical personnel as they are best placed to ensure access to end-of-life care for prisoners through compassionate release.

This qualitative article presents and compares the views of older prisoners and expert stakeholders on the topic of nutrition and exercise. The study highlights measures for improving the health of older prisoners. Older prisoners report the need to improve quality of meals provided in prison. They note that prison food is of poor quality and not adapted to their needs. With regard to exercise, they point out the lack of proper opportunities to engage in exercise and sports, and describe several factors that make physical activities either unsuitable or unfeasible. Expert stakeholders see prison as an opportunity to improve the health of those convicted of crimes. In light of the increasing number of older prisoners, age-appropriate nutritional and exercise interventions should take priority in prisons.

The debate on age-segregated housing for older prisoners has seldom captured the perspectives of older prisoners and professionals (‘stakeholders’) working in a European prison setting. To address this gap in the research, 35 older prisoners from Switzerland and 40 stakeholders from three European countries (including Switzerland) were interviewed for the study. Data analysis was conducted thematically, and the validity of coding was established independently from the primary author. Interpretation of study results was agreed upon by all authors. Participants' opinions regarding age-segregated housing for older prisoners were split. An almost equal number of prisoners and stakeholders had similar arguments in favour of and against such living arrangements. The findings encompassed three major themes: ‘prisons should mirror society’ and thus age-mixed housing was preferable as it ensured generational exchange; a ‘separate unit within the prison’ would allow continuity of personal and other relationships and at the same time respond to older prisoners' specific health and environmental needs; finally, participants felt it was important to think critically about ‘the criteria’ for placing older prisoners in an age-segregated arrangement. We conclude that the debate on consolidated versus separate housing is bifurcated. Any push towards segregation based only on high prison violence and unvalidated context-specific information may result in unreliable public policy.

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BackgroundThe care needs of patients with a limited prognosis (<12 months median) are complex and dynamic. Patients and caregivers must cope with many challenges, including physical symptoms and disabilities, uncertainty. and compromised self-efficacy. Healthcare is often characterized by disruptions in the transition between healthcare providers. The Milestones Communication Approach (MCA) is a structured, proactive, interprofessional concept that involves physicians and nurses and is aimed at providing coherent care across the disease trajectory. This study aims to evaluate these aspects of MCA: (1) the training of healthcare professionals, (2) implementation context and outcomes, (3) patient outcomes, and (4) effects on interprofessional collaboration.Methods/designA multiphase mixed-methods design will be used for the study. A total of 100 patients and 120 healthcare professionals in a specialized oncology hospital will be involved. The training outcomes will be documented using a questionnaire. Implementation context and outcomes will be explored through semi-structured interviews and written questionnaires with healthcare professionals and with the training participants and through a content analysis of patient files. Patient outcomes will be assessed in a pragmatic non-blinded randomized controlled trial and in qualitative interviews with patients and caregivers. Trial outcomes are supportive care needs (SCNS-SF34-G), quality of life (SeiQol and Fact-L), depression and anxiety symptoms (PHQ-4), and distress (Distress Thermometer). Qualitative semi-structured interviews on patients’ views will focus on shared decision-making, communication needs, feeling empathy, and further utilization of healthcare services. Interprofessional collaboration will be explored using the UWE-IP-D before the implementation of MCA (t0) and after 3 (t1), 9 (t2), and 12 (t3) months.DiscussionUsing guideline-concordant early palliative care, MCA aims to foster patient-centered communication with shared decision-making and facilitation of advance care planning including end-of-life decisions, thus increasing patient quality of life and decreasing aggressive medical care at the end of life. It is assumed that the communication skills training and interprofessional coaching will improve the communication behavior of healthcare providers and influence team communications and team processes.Trial registrationGerman Clinical Trials Register, DRKS00013649 and DRKS00013469. Registered on 22 December 2017.Electronic supplementary materialThe online version of this article (10.1186/s13063-018-2814-1) contains supplementary material, which is available to authorized users.

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