School of Population Health’s Dr Adrienne Withall will lead a NHMRC funded project to enhance screening capacity for health conditions in older prisoners (aged 50+ years). The grant, amounting to $844,050, will help researchers develop a tool that can overcome barriers to fill the information gap in health data of older prisoners. The project team includes Professor Peter Schofield from the University of Newcastle, Dr Natasha Ginnivan, Dr Jane Hwang, Professor Tony Butler and Mr Adam Howie from SPH, and other researchers from UNSW, University of Sydney, government agencies and research institutes.

Older prisoners constitute the fastest growing segment of the prisoner population worldwide - representing over 13% of the incarcerated population. This relative increase is due to causes such as population ageing, convictions for historical crimes, and changes to laws such as mandatory sentencing. This shift brings various age-related conditions to an environment built around much younger offenders. Older prisoners often have greater health care needs than younger inmates (mental health, frailty, brain health) but without direct inquiry or health screening these may go undetected and untreated. Financial constraints leading to resource limitations (e.g., insufficient trained staff to perform assessments in prison), compounded by a lack of appropriate assessment tools (e.g., accounting for the low education and English literacy levels of many prisoners), contribute to a current crisis of ignorance.

As Dr Adrienne Withall puts it, “We simply to not have adequate data on the health of older inmates in our prisons. In this research, we will use technological innovation to develop and validate a novel screening tool to facilitate the collection of important health, medical and cognitive data, thus bypassing the roadblock created by resource limitations in prisons.”

This study will: 1) take advantage of 20-year-old technology – the Audio Computer-Assisted Self-Interview (ACASI) – in a new way to facilitate the collection of health data from older offenders who often have low levels of education and English; 2) design a cognitive battery using an innovative ‘serious game’ approach to facilitate the measurement of cognitive data from older offenders; and (3) establish whether these components are both valid and acceptable. ‘Serious games’ are a potentially transformative approach to assessment, using the guise of entertainment to assess cognitive skills that have traditionally been tested with pen and paper neuropsychological tests.

Long term gains

The Audio app-delivered Screening for Cognition and Age-related health in PrisonErs (ASCAPE) app will facilitate the early identification of healthcare needs so that they can be supported both in prison and post-release, with the potential to reduce future health care costs and re-offending for this group. Longer-term benefits of this research include more equitable access to cognitive testing. Neuropsychological and medicolegal assessments are expensive and not usually accessible to lower socioeconomic status clients who access Legal Aid or even self-represent in court. ASCAPE may help to facilitate broader and more equitable access to testing for all clients.

“At the end of this study we hope to have a package that, should it be shown to be valid and acceptable, can be implemented widely and scaled up rapidly with minimal costs and maximum screening accuracy,” Dr Withall concludes.