Older forensic mental healthcare patients in England: demographics, physical health, mental wellbeing, cognitive ability and quality of life

Abstract

Background: Older individuals (e.g., 55 years and over) constitute a growing proportion of the forensic mental health patient population. As a group, they are vulnerable to health outcomes similar to other individuals with serious mental disorders of the same age; however, these concerns can be compounded by complex forensic-related care backgrounds and clinical presentations, lengthy periods of time spent in prison or psychiatric hospitals, substance use histories, and crime perpetration or victimisation. The healthcare needs and strengths of this group are not well understood. The aim of this study was to identify and describe the demographic, physical health, mental wellbeing, cognitive ability, and quality of life profiles of older forensic patients in community, low, medium, and high security settings in England. Methods: A cross-sectional quantitative study design was used. N=37 forensic patients aged 55 years and over completed six questionnaires. Data were also collected from patient records. Results: Most patients were male and were diagnosed with psychosis. The most frequently committed index offence types were violent offences. Patients were prescribed 7.6 medications on average and had average anticholinergic effect on cognition scores of 2.4. Nearly half the sample had diabetes, with an average BMI score of 31.7 (indicating obesity). Possible cognitive impairment was identified in 65% of the sample. Patients’ assessments of their recovery-related quality of life and mental wellbeing were comparable to published UK general population values. Assessments of quality of life were positively correlated with the ability to undertake everyday activities and cognitive performance. Conclusions: We suggest that forensic services are well-placed to provide holistic mental and physical care to this group but that they should co-develop with patients a greater range of age-appropriate meaningful activities that are mindful of mobility issues and consider implementing more cognition-based and physical health interventions.

Care for older forensic mental health patients: A consensus guidance document

“…Four compared older patients to their younger counterparts in the same services [2,[13][14][15]. "Old age" was defined as 45+ for indigenous patients [18], 50+ [6], and 50+ for nonindigenous patients [18], 55+ [7,19], 60+ [2,13,17], and 65+ [16]. Girardi [15] did not define "old age," instead grouping a cohort of patients aged 18 and older into six age categories (see Table 1).…”

“…This is appropriate as we aim to summarize the extant evidence for this broadly defined population whose needs are influenced by age but not solely contingent upon age. Studies took place across low, medium, and high-security psychiatric inpatient settings (with the exception of Tomlin et al [ 19 ] in which 27% of their sample were community patients).…”

“…The sample from Coid et al [ 2 ] had a mean age at first court appearance of 43 years. Most patients were reported as being in forensic care following criminal charges or convictions: 89% [ 2 ], 56% [ 7 ], 98% [ 6 ], and 83% [ 19 ]. Di Lorito et al’s [ 6 ] sample was primarily detained following a hospital order (section 37/41 MHA, 1983; 42%) or prison transfer (section 47/49 MHA, 1983; 34%); this pattern was also found in Tomlin et al [ 19 ].…”

“…Most patients were reported as being in forensic care following criminal charges or convictions: 89% [ 2 ], 56% [ 7 ], 98% [ 6 ], and 83% [ 19 ]. Di Lorito et al’s [ 6 ] sample was primarily detained following a hospital order (section 37/41 MHA, 1983; 42%) or prison transfer (section 47/49 MHA, 1983; 34%); this pattern was also found in Tomlin et al [ 19 ]. In the study by Lightbody et al [ 7 ], on admission, 39% of patients were on a hospital order with restrictions, 11% on a hospital order without restrictions, 17% were under assessment as a prisoner prior to sentencing, and 14% were under a civil section for medium to long-term treatment.…”

“…Similarly, they found that the average number of medications at admission doubled (from 3.1 to 6.3). Tomlin et al [ 19 ] report that on average, patients in their sample were prescribed 7.6 regularly taken medications and 2.1 psychotropic medications and had an average anticholinergic effect on cognition (AEC) score of 2.4. Note that AEC scores range from 0 to 3, with a lower score being desirable.…”