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Older People and Physical Health
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• As we age our physical health can deteriorate.
  The following slides contain
• information about
• Diabetes
• Dehydration
• Diet and Malnutrition
• Trips and Falls
• Hypertension (High Blood Pressure)
• Arthritis
• Strokes
• Urinary Incontinence
• For everyone, access to a healthy and active
  lifestyle will make significant improvements
• to the individuals health and well-being.
  Supporting people to engage in health, well
• being and education programmes in prison,
  regardless of age will make a significant
• difference.
• Ensure good management of medicines e.g. access
  to regular monitoring by healthcare
• and awareness of particular side effects from
  drug treatments.

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• Diabetes
• There are two main types of diabetes Type 1
  diabetesType 2 diabetes
• Treatment of Type 2 can be as simple as diet
  alone, may require tablet treatment and just
  occasionally by insulin injections
• Diabetes can accelerate hardening of the
  arteries causing heart attacks and strokes.
  Poorly treated diabetes can damage peoples feet
  and their vision so these should be regularly
  monitored by health staff
• Managing Diabetes in Prison
• Diet, not smoking and lifestyle are critically
  important to maintaining health for those with
  diabetes
• Those on insulin benefit from a strict regimen of
  activity and eating pattern built around their
  daily insulin injection schedule. If this is
  badly organised then there can be a risk of
  collapse and even loss of consciousness due to
  the blood sugar being too low

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• Dehydration
• Dehydration can be a problem in hospitals or
  prisons. Depression and Dementia are risk
  factors for dehydration. This can affect a
  prisoners ability to self care in general, e.g.
  after a stroke. They will need to rely on others
  for their food and drink. In a busy setting
  individuals can be missed and dehydration can
  quickly set in.
• Within prisons, prisoners likely to suffer with
  dehydration should be monitored to make sure they
  do have access to appropriate food and drink.
  This may mean providing additional time for them
  at mealtimes.
• It is not sufficient to assume that just because
  they have food and water they can automatically
  eat and drink it all in the time allotted.
• Healthcare teams can provide advice on care for
  prisoners likely to be at risk.

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• Malnutrition in prisoners
• A lack of nutrients in the body can be caused by
  a number of reasons. Malnutrition is most often
  a result of
• An inadequate diet
• Poor appetite can lead to lethargy and
  individuals could be more at risk of skin damage
  such as pressure ulcers
• Difficulties moving around can also prevent some
  people from feeding themselves properly
• Stomach conditions
• Alcoholism
• It is important to make sure people access a
  balanced diet in preventing malnutrition

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• Falls
• A fall can be an indicator of an on going health
  problem
• Falls cause the most deaths and long-term health
  problems amongst older people
• Falls can be caused by
• Weak muscles, sleepiness, confusion, poor
  eyesight,
• Medication - some drug treatments inadvertently
  (as a side-effect) increase the risk of a fall by
  causing blood pressure to drop on standing
• Trip hazards
• Postural changes, for example going from sitting
  to walking very quickly,
• Quick temperature changes, walking from a hot
  workshop to the cold outdoors
• Poorly fitted footwear
• Minimise Falls by
• Avoiding trip hazards, providing additional time
  for those likely to suffer from falls and by
  talking to healthcare about the care needs of the
  prisoner

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• Hypertension (High Blood Pressure)
• Hypertension can result in illnesses like stroke
  and heart attack
• Other common risk factors include smoking, poor
  diet,(high salt intake) obesity, sedentary
  lifestyle, diabetes could be familial. Therefore
  it is important to screen for raised blood
  pressure routinely alongside general measures to
  promote healthier lifestyles
• People known to have raised blood pressure should
  be encouraged to adopt a healthy lifestyle and to
  ensure their blood pressure treatment is
  monitored by a health professional

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• Arthritis
• There are many different types of joint
  inflammation (or Arthritis)
• This is very common, and affects all of us
  usually as we get older. It typically affects
  weight bearing joints such as the spine, hips and
  knees. Managing someone with Arthritis
• Active lifestyle and regular exercise are
  beneficial and simple painkillers such as
  paracetamol can help reduce pain. It is
  important that medication is given regularly
• People with arthritic conditions tend to need
  more time in the morning (washing, dressing etc)
• Help the prisoner engage with healthy living
  centres, health trainers or other health
  promotion activities that exist in your prison

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• Strokes
• A stroke is when the normal supply of blood to
  part of your brain is cut off
• Typically a person will suddenly lose the use of
  a limb, experience difficulty speaking or be
  unable to stand.
• More severe strokes
• Clearly a person in such a situation needs to be
  placed in the recovery position, intensely
  supervised whilst awaiting urgent medical
  assistance. Some strokes are relatively mild and
  do not require urgent medical help, however in
  all cases the person should be assessed by a
  health practitioner
• Managing someone who has had a stroke
• A person who has suffered a stroke may need a lot
  of practical support and encouragement to recover
  lost functions. Beyond these measures health
  practitioners may offer particular advice
  depending on the particular nature of the stroke
• Individuals may have difficulty getting up from
  and into a chair/toilet. If speech is affected
  different communication methods should be
  considered

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• Urinary Incontinence
• Urinary incontinence is passing urine when you
  dont mean to and it becomes more common as
  people get older but it does not only affect
  older people
• If you have incontinence, either the muscles or
  the nerve supply are not working properly to
  control your bladder. The two main types of
  urinary incontinence are stress incontinence (a
  small amount of urine leaks out during physical
  activity) and urge incontinence (the bladder
  empties completely)
• Social aspects are often overlooked and can cause
  great distress. Embarrassment, stigma, low
  expectation of help are all reasons for people
  not admitting they have a problem and not seeking
  advice
• Managing Urinary Incontinence
• Treatments range from practical pads, pants, to
  drug treatments to sophisticated surgery. The
  main message is that much can be done to help and
  this is an area where the health nurses in
  particular can advise
• An officer might arrange for extra
  clothing/bedding - managed in a discrete way

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• What can I do?
• Knowing our own work boundaries having training
  on Older People and Physical Health does not make
  us specialists
• Exploring our own attitudes and values around
  Older People and Physical Health and not
  projecting these on to others or by being
  judgemental
• Demonstrating good listening skills/ keeping a
  neutral tone of voice with open posture and good
  eye contact
• Acknowledging that Older People and Physical
  Health is an important issue for everyone and is
  difficult for most people to talk about

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• Scenario
• An 86 year old man with limited mobility is
  received in a local prison. He is able
• to walk slowly but it is a busy environment in a
  Victorian building with mostly
• younger men.  He mostly remains on the wing and
  is becoming less
• mobile. 
• What should you do?
•  
• Provide him with a wheelchair
• Provide him with a walking frame
• Encourage other prisoners to help him get around
• Agree a care plan that maximizes his mobility

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• Actual outcome
• In this scenario the old man was provided with a
  wheelchair which was used for
• convenience to move him round the prison.
  Younger prisoners enjoyed
• pushing him round the prison but he lost more
  mobility and became wheelchair
• dependant.
• Within the prison, and upon release, his care
  needs were much greater and
• more costly. He lost independence, dignity and
  self-worth.
• The best solution
• The correct answer was d this would have
  ensured continuing mobility,
• although under a simple care plan, all of the
  other factors could have been
• included, but in a way that supported his
  mobility rather than reducing it.

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• Further information can be found at
• http//www.olderpeoplesmentalhealth.csip.org.uk/le
  ts-respect.html
• http//www.ageconcern.org.uk/

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This information was developed by the Care
Services Improvement Partnership (CSIP) CSIP
seeks to reduce health and social care
inequalities for vulnerable groups For more
information visit www.csip.org.uk