Incarcerated Older Adults in the Coronavirus Disease 2019 Era: A Call for Advancing Health and Human Dignity.

The United States incarcerates more persons than any other country. Older adults constitute the fastest-growing demographic of prisoners (Figure 1). The geriatric threshold in correctional facilities is age 55 or, in some states, age 50 (Williams et al., 2012), and it is based on a theory of increased vulnerability and accelerated aging (Han et al., 2021; Leob et al., 2008). Compared with the current 10%, it is estimated that by 2030, adults aged 55 or older will make up one-third of the people incarcerated in the United States (Skarupski et al., 2018). The number will continue to rise, without serious effort to reform the criminal justice system (Obama 2017). Many of the older prisoners are serving long sentences imposed during the “tough on crime” and “War on Drugs” movements exemplified by the Anti-Drug Abuse Act of 1986. The laws underscored punishment rather than rehabilitation, resulting in mass incarceration, aptly described as a new Jim Crow era in the United States (Alexander, 2010). Moreover, two-thirds of incarcerated individuals are “persons of color.” Decades of systematic discrimination and a lack of proper access to mental health and social services, coupled with a rise in for-profit private prisons and an expensive bail system, resulted in disproportionate incarceration of already disadvantaged people (Han et al., 2021). The states with the least access to mental health care also have the highest rates of incarceration (Reinert et al., 2021). During his presidency, Barack Obama signed the Fair Sentencing Act into law, which helped ease the previous harsh sentencing guidelines. However, the new law is not retroactive and does not directly help those serving prior sentences. Though it was hoped the law would provide impetus to Governors, parole boards, and others with power to reduce existing sentences, there has been relatively little momentum in this regard. Aging in prisons remains a public health crisis.