Six-Month Emergency Department Use among Older Adults Following Jail Incarceration

Abstract

Although the number of older adults who are arrested and subject to incarceration in jail is rising dramatically, little is known about their emergency department (ED) use or the factors associated with that use. This lack of knowledge impairs the ability to design evidence-based approaches to care that would meet the needs of this population. This 6-month longitudinal study aimed to determine the frequency of 6-month ED use among 101 adults aged 55 or older enrolled while in jail and to identify factors associated with that use. The primary outcome was self-reported emergency department use within 6 months from baseline. Additional measures included baseline socio-demographics, physical and mental health conditions, geriatric factors (e.g., recent falls, incontinence, functional impairment, concern about post-release safety), symptoms (pain and other symptoms), and behavioral and social health risk factors (e.g., substance use disorders, recent homelessness). Chi-square tests were used to identify baseline factors associated with ED use over 6 months. Participants (average age 60) reported high rates of multimorbidity (61%), functional impairment (57%), pain (52%), serious mental illness (44%), recent homelessness (54%), and/or substance use disorders (69%). At 6 months, 46% had visited the ED at least once; 21% visited multiple times. Factors associated with ED use included multimorbidity (p = 0.01), functional impairment (p = 0.02), hepatitis C infection (p = 0.01), a recent fall (p = 0.03), pain (p < 0.001), loneliness (p = 0.04), and safety concerns (p = 0.01). In this population of older adults in a county jail, geriatric conditions and distressing symptoms were common and associated with 6-month community ED use. Jail is an important setting to develop geriatric care paradigms aimed at addressing comorbid medical, functional, and behavioral health needs and symptomatology in an effort to improve care and decrease ED use in the growing population of criminal justice-involved older adults.

The health care utilization of people in prison and after prison release: A population-based cohort study in Ontario, Canada

“…Several studies have determined that in prison, people have high rates of ambulatory care utilization [ 10 – 14 ] and hospitalization [ 13 – 16 ]. Research similarly shows that after release from prison, people have high rates of primary care use [ 17 , 18 ], emergency department use [ 19 – 22 ], and hospitalization [ 5 , 20 , 21 , 23 ], though findings regarding ambulatory care use are inconsistent [ 20 , 21 ]. Several studies found that compared to use by the general population, ambulatory care use was higher in prison [ 10 ], and emergency department use and hospitalization were higher post-release [ 5 , 22 , 23 ].…”

Local Evaluation Report for Los Angeles County's Mentally Ill Offender Crime Reduction (MIOCR) Program

“…The AUDIT-C has been used in studies of a number of criminal justice system involved populations (Bolano et al, 2016;Caviness et al, 2009;Humphreys et al, 2017;Kinner et al, 2015;Kinner et al, 2014;Myers et al, 2018;Thibodeau et al, 2009). For example, Myers et al (2018) administered the AUDIT-C to 270 HIV-infected adults incarcerated in the San Francisco County Jail who were not held in a high level of security during the time of initial recruitment.…”

“…The DAST-10 has been used in a number of studies of criminal justice system involved populations (Alpert et al, 2013;Bolano et al, 2016;Evren et al, 2014;Humphreys et al, 2017;Izenberg et al, 2014;Mukherjee et al, 2016;Myers et al, 2018;Owens, Rogers, and Whitesell, 2011;Shiu-Yee et al, 2018;Thibodeau et al, 2009;Walker, 2011). For example, Owens, Rogers, and Whitesell (2011) administered the DAST-10 to 100 individuals who were on probation or parole in two counties in a southeastern state.…”

“…Bolano et al (2016) administered the DAST-10 to 125 older jail inmates in an urban county jail. Humphreys et al (2017) administered the DAST-10 to 101 adults over the age of 55 in an urban county jail. Thibodeau et al (2009) administered the DAST-10 to a convenience sample of 49 men incarcerated in a minimum-security Wisconsin state prison.…”

Toward Structural Competency in Emergency Medical Education

“…Health policy, material deprivation, inequality, and stigma are implicated in poor health outcomes among emergency department (ED) patients . Researchers have emphasized the role of the social determinants of health, structural racism, gender discrimination, homophobia, and transphobia on the health of ED patients.…”