Assessing Needs and Advancing Dignity-Conserving Care for Hospitalized, Incarcerated Older Adults: Clinical Data, Patient Experience, and Policy Evaluation

The United States incarcerates more people per capita than any other developed democracy. Persons behind bars retain a fundamental, Constitutionally-protected right to receive community-standard healthcare. A multitude of factors prior to confinement, such as low educational attainment, exposure to violence, housing insecurity,

and history of childhood trauma, likely contribute to the poor health status of the U.S. prison population. As a consequence of harsh sentencing practices of the 1980s and 90s, 1 in 7 adults in prison is serving a life sentence. This means our prison population is aging at an unprecedented rate. Incarcerated people face earlier disease

onset and faster progression than community-dwelling, age-matched peers. This translates to an increasingly frail and medically complex prison population, with high rates of cardiovascular disease, cancer, and dementia. When an incarcerated person’s needs exceed the prison’s healthcare capabilities, they transfer to a hospital in

a neighboring community. Yet vanishingly little is known about these encounters. Multimorbidity, high prevalence of familial estrangement, poor advance directive completion, shackling, correctional officer presence, stigma, and heterogeneous correctional policies all contribute to these ethically fraught hospitalizations.

The proposed work will address key knowledge gaps about the clinical, geriatric, ethical dimensions of need for hospitalized incarcerated older adults. Aim 1 will leverage a unique dataset from a 5-state hospital network, spanning 25-years and thousands of hospital admissions to define prevalence and temporal trends in factors

such as age, delirium and advance directive completion. Aim 2 will apply state-of-the-art qualitative methods to characterize the experience of hospitalization for an incarcerated older adult from multiple vantage points: patient, family, correctional officer and bedside nurse. Aim 3 will apply a sophisticated analytic lens to evaluate

prevalence and contents of state and federal policies pertinent to the hospital care of older adults. The candidate, Dr. Erin Sullivan DeMartino, is clinician-ethicist in Mayo Clinic’s Division of Pulmonary and Critical Care Medicine with a track record of high-impact original research publications and a GEMSSTAR award from

NIA. She has engaged a world-class mentorship and advisory team. Her primary mentor, Dr. Jon Tilburt, is a visible and established empirical bioethics investigator committed to the development of junior colleagues. Dr. DeMartino has recruited a team of internationally recognized co-mentors and advisors with diverse backgrounds,

offering expertise in geriatrics, correctional health, ethics, and qualitative and quantitative methods both for the aims and the career development plan. Dr. DeMartino has outlined a rigorous training plan, drawing upon the vast resources of Mayo Clinic and national methodologic, geriatric, and leadership development opportunities.

Mayo Clinic’s Kogod Center on Aging and Biomedical Ethics Research Program provide an unparalleled setting for execution of the proposed research and development activities and for Dr. DeMartino’s emergence as an independent investigator at the forefront of aging and policy research centered on vulnerable populations.