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The get-tough-on-crime and mandatory sentencing policies that swept the United States beginning in the 1970s did more than drive up the inmate population and prison costs. They also ensured that inmates who once might have been seen as rehabilitated and given parole would grow old and even die behind bars. As a result, prisons are struggling to furnish costly, specialized care to ever more inmates who suffer from age-related infirmities, especially dementia.

According to a report from Human Rights Watch, in 2010 roughly 125,000 of the nation’s 1.5 million inmates were 55 years of age and over. This represented a 282 percent increase between 1995 and 2010, compared with a 42 percent increase in the overall inmate population. If the elderly inmate population keeps growing at the current rate, as is likely, the prison system could soon find itself overwhelmed with chronic medical needs.

There is no official count of how many inmates suffer from dementia. But some gerontologists say the current caseload represents the trickle before the deluge. They say the risk of the disease is higher behind bars because inmates are sicker to start with with higher rates of depression, diabetes, hypertension, HIV/AIDS and head trauma. Given these risk factors, the dementia rate in prison could well grow at two or three times that of the world outside.

This is a daunting prospect for prison officials whose difficulties in keeping pace with the present dementia caseload were underscored in a recent report by The New York Times’ Pam Belluck. The article portrayed officials in crowded, understaffed correctional facilities scrambling to care for ailing inmates who can no longer feed, dress or clean themselves and who create conflict and disorder because they can no longer follow simple commands.

The Human Rights Watch study said the cost of providing medical care to elderly inmates is between three and nine times the cost for younger ones. Another study found that the annual average health care cost per prisoner is about $5,500; about $11,000 for inmates ages 55 to 59 and $40,000 for inmates 80 or older. A specialized unit for cognitively impaired inmates in the New York state system costs more than $90,000 per bed per year, more than twice the figure for general inmates.

Many inmates, obviously, can never be released, and they will continue to require special care. But the states must pursue other avenues as well. They can foster partnerships between prisons and nursing homes to improve the quality of care; consider compassionate release programs for frail inmates who no longer present a threat to public safety; and, no less important, revisit the mandatory sentencing policies that did away with judicial discretion and filled the prisons to bursting in the first place.

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