Over the past decades, there has been a sharp increase in the elderly prisoner population in Europe. However, most prisons were built for young detainees who are usually in good health. Infrastructures, services, activities and practices are often not adapted to older detainees. The isolation and physical and mental problems suffered by these detainees require specific care.

How can prisons be adapted to the needs of elderly detainees? How can we prevent their isolation? Few older prisoners are visited by their families, and when they suffer from physical impairments, they often cannot participate in daily activities either. Should a prisoner die in prison or outside? European prisons are all facing these same questions. Guaranteeing the dignity of these prisoners is not only a matter of humanity, but also the right of every detained individual.

"In my work, I have been coming across this category of prisoners. I am concerned about how fragile they are and that the conditions in which they are held are not always appropriate," "Prison administrations have increasingly been acknowledging and trying to address the issue, but tackling the numerous and complex needs of many elderly detainees is not an easy task". Elisa Querci, prison delegate of the ICRC regional delegation in Paris.

How can we better ensure that these prisoners are treated in a dignified way? This article contains insights from experts who attended a workshop* organised by the International Committee of the Red Cross in December 2016. This workshop was an opportunity to discuss recommendations to improve responses to older prisoners' specific needs. These recommendations can be found in the workshop report, available at the end of this article.

Who are elderly prisoners?

At what age are we "elderly"? Do we grow old in the same way if we are in prison? Experts distinguish between "biological" and "chronological" age. "If someone is 65, this doesn't tell us everything about their condition," underlines Sonja Snacken, Criminology Professor at the Vrije Universiteit Brussel in Belgium. Certainly, our chronological age is not enough when it comes to determining both our physical and mental health. Nevertheless, given their backgrounds, and specific conditions and needs in detention, prisoners might reasonably be considered "elderly" from the age of 50.

What are their specific needs?

Obviously, the older we are the less healthy we become. Depending on the individual, old age has different repercussions, such as mobility or eyesight loss, the development of chronic diseases, cancer or even psychological issues. Yet in certain prisons, medical services are based on the emergency service model and do not therefore provide health promotion or the necessary resources to treat severe pathologies such as chronic illnesses or senile dementia (see video).

Furthermore, imprisonment can accelerate the ageing process. It is thought that on average, an individual detained in prison is biologically 10 years older than a person of the same age living outside. Moreover, some prisoners may suffer from pre-existing health issues, especially linked to their former lifestyle, for instance to do with narcotics, alcohol or tobacco abuse and overall limited access to preventive or curative medical care.

Prisons also face the delicate issue of the death of an elderly prisoner. How can we ensure a prisoner dies in a dignified way? And should they die in prison or outside? "This issue is not only legal but medical and ethical," underlines Elisa Querci. "Prison administrations, as well as health-care providers and other actors working in detention, are concerned by these questions."

Specific recommendations made in the report:
• Training in geriatrics should be provided for all prison health care professionals.
• Palliative care programmes should focus on symptom relief and quality of life throughout the course of a serious illness rather than just end-of-life care.

Many Western prisons were not designed to accommodate elderly detainees and meet their needs in terms of health and activities.

Activities were also designed for younger prisoners, which may result in exclusion, isolation and idleness of older prisoners. "Examples of activities set up in prisons are sports or education, but of course if you're 80..." stresses Sonja Snacken, Criminology Professor at the Vrije Universiteit Brussel in Belgium. "We need to imagine other kinds of activities for older detainees, but also consider their reintegration, life after prison. If you don't have a family anymore and are not capable of working, and people expect you to have your own network and income when you come out of prison, then it is definitely tougher than for young people".

Not assisting these elderly detainees has a negative impact on both their physical and psychological well-being. And in a prison environment, this may put them at risk from younger prisoners. "One may think that protecting vulnerable individuals in such a controlled environment as a prison is easy," states Eamon O'Moore, National Lead Health & Justice Team, Public Health England. "But, in reality, ensuring their protection is difficult, as they are a minority in prisons, and in comparison to the daily problems and constraints of the overall detained population... This issue is actually neglected".

"They are like forgotten prisoners. As discussed during the (ICRC) workshop, they are not particularly troublesome detainees for the monitoring staff. As elderly people don't necessarily express themselves, their problems will not always be detected and therefore addressed". Anne-Sophie Bonnet, in charge of external relations of the CGLPL (Contrôleur général des lieux de privation de liberté – The General Inspector of Confinement Centres).

How should detention schemes be adapted?

In light of the increase in the elderly prisoner population, prison administrations have to adapt their services to address the specific needs of older detainees, guarantee their dignity and also anticipate their integration in society once out of prison.

Specific recommendation made in the report:
• Older detainees should have access to rehabilitation, and have the right to hope and plan for release. Professional training and all types of education should also be available to them.

Some prison administrations are already looking for solutions. But many challenges remain, as meeting the needs of older prisoners requires significant adaptation of the penitentiary system as a whole, for example, as regards access to healthcare, and a range of other services and activities, and even the structure itself. According to Eamon O'Moore, National Lead Health & Justice Team, Public Health England, the ideal solution is to address all these issues globally.

Council of Europe Member States also have to implement the decisions of the European Court of Human Rights concerning prisoners' rights in their States. These decisions are not binding on other countries, yet they can and should influence policy changes. "If for instance there is a case in one country (...) for which the Court maintains that an individual suffering from a certain health issue should not be kept in prison, this decision also should be into taken into consideration by the other countries," explains Sonja Snacken. "We have witnessed the European Court strengthening detainee rights protection over the last 20 years, often under the influence of the European Committee for the Prevention of Torture, which visits detention premises".

Prisoners have rights, and the situation involving elderly individuals reveals shortcomings in the prison systems of many countries. The goal of the ICRC workshop was to gather together the highest possible number of stakeholders concerned by this issue, in order to share practical recommendations to improve the living conditions of elderly prisoners. "The ICRC has long experience in the field of detention and it is important that it can act as facilitator, bringing together experts, organisations and prison authorities to facilitate reflection," states Elisa Querci.

"It is obvious that some recommendations – which come from the ICRC but are based on the experience of experts and administrative staff of several countries – will be useful to us in formulating the messages we want to convey to the Ministries of Justice and Health in France." Anne-Sophie Bonnet, in charge of external relations of the CGLPL (Contrôleur général des lieux de privation de liberté – The General Inspector of Confinement Centres).

Download the report