Table 1 Main features of the included papers

(1) Research & review papers

1

Brooke et al, 2018, UK

Review

To identify how PLPWDs are cared for & supported

Systematic review

10 papers (UK = 3, USA = 3, Australia = 2, France = 1, Sweden = 1)

None reported

Need to find ways to identify need; lack of officer & legal professionals’ knowledge

2

Brooke & Jackson, 2019, UK

Qualitative

To understand staff & peer experiences of work with people with dementia

Interviews & focus groups

n = 29 (peer support = 5; MDT staff = 24). Male sex offender prison

n/a

Diversity in staff and peer supporters’ training & roles, and the prison regime. Need for training, and policy & guideline development

3

Brown, 2016, Australia

Qualitative

To investigate ‘effective’ programmes for prisoners with dementia

Interviews—staff, focus gp—prisoners

n = 24 (14 staff, 7 prisoners, 3 experts); 4 prisons: USA = 3, NZ = 1

Care programmes, peer support, environmental adaptations

Person-centredness, early identification, training, suitable care facilities in prison & community important, with policy needing to be developed

4

Cipriani et al., 2017, Italy

Review

To explore the ‘phenomenon’ of people with dementia in prison

Systematic search, quali-tative synthesis

50 papers

Unclear – papers not differentiated by intervention

Lack of data; prevalence hypothesised; system unprepared; treat prisoners with dignity, keep safe, adequate healthcare – need for guidelines

5

Dillon et al, 2019, UK

Qualitative

To study understandings & experience of dementia in prison

Semi-structured interviews

n = 30 (staff = 17, prisoners = 13); 2 male sex offender prisons

n/a

Need for training, environment change, balance independence & need, social interaction, programmes, information sharing & wide support

6

du Toit & Ng, 2022, Australia

Qualitative

To examine how external organisations support PLPWD

Group discussions

n = 27 (legal, health and social services); 55% female, 63% > 40 years

n/a

External organisations can support training, healthcare, & information sharing, Barriers: finance, infrastructure, care-custody conflicts

7

du Toit et al, 2019, Australia

Review

To review dementia care in prison, focused on models of best practice

Scoping review

35 papers: UK (n = 12), Australia (n = 10), USA (n = 7), Canada (n = 2), France (n = 1), Malaysia (n = 1), Switzerland (n = 1), the UN (n = 1)

n/a

Care pathways useful; mixed on specialised facilities. Voluntary agencies could be used more. Barriers: finance, and facilities in community

8

Forsyth et al, 2020, UK

Mixed methods

To (i) validate a screening tool, (ii) identify gaps in service provision, and (iii) develop a care pathway for PLPWD and mild cognitive impairment

Questionnaires, semi-structured interviews, ethnography

(i) 869 prisoners (273 female); (ii) & (iii) Questionnaires: 85 governors, 77 health managers; Interviews: n = 42, 5 prisons (14 prisoners – 9 PLPWDs)

Validation of 6CIT screening tool; description of developing care pathways

(i)unable to validate 6CIT for prison use; (ii) low numbers screen older people at reception, or had a care pathway; (iii) all > 50 screened on reception using MoCA, further assessment if needed. Care plans shared if consented. Locate on ‘normal’ or regional specialist wings; environments to be more dementia friendly, release locations related to risk

9

Jennings, 2009, USA

Qualitative

Investigate older prisoners’ experience of health & healthcare

Semi-structured interviews

n = 16 (4 prisoners, 3 family, 2 clergy, 4 staff, 3 volunteers)

n/a

Possible role for social workers liaising with families of people with dementia

10

King’s Fund, 2013, UK

Mixed methods

Evaluation of the Enhancing the Healing Environment (EHE) programme

Observations, workshops, routinely collected data

10 evaluation sites (no prisons, but implemented in around 30 prisons)

The EHE programme in prisons focused on: health centre, association areas & palliative care

No outcomes for prisons specifically. Overall programmes reportedly aided decision-making, reduced agitation & distress, increased interaction & independence, safe, value for money

11

Masters et al, 2016, USA

Survey

To evaluate a staff training programme focused on ageing prisoners

Facts on Aging Quiz; study-specific questionnaire

n = 69 healthcare & prison staff from across the Nebraska prison system

Dementia module: symptoms, progression, behaviour, impact, challenges, management

Pre-post-quiz results not significant. Non-medical staff—new information increased understanding of behaviours; medical staff understood more about what nonmedical staff want to know

12

Moll, 2013, UK

Qualitative

To identify good practice in the management & support of prisoners with dementia

Survey

Unknown. 14 prisons’ staff or volunteers (UK = 8, USA = 4, Japan = 1, Belgium = 1)

Various – regime & accommodation adaptation; structured programmes; hospices

Some increase in wellbeing for day centre users and specialist wing residents; positive on wing exercise, forums, peer support & training. Specialist units costly, staff cuts hamper work

13

Patterson et al, 2016, Australia

Qualitative

To develop tools & procedures to assess & manage prisoners with dementia

Policy Delphi surveys; focus groups

Surveys: n = 36 nurses; groups: n = 18, (13 nurses, 2 managers, 2 OTs, 1 geriatrician)

None – the research involved developing tools & procedures

Difficulties developing one-off screening tools, need a second-stage further assessment; 2 further algorithms detailed dementia assessment, and dementia management, in prison

14

Peacock et al, 2019, Canada

Review

To review and synthesise the literature on PLPWDs’ health and social care needs

Integrative review

Eight papers: Australia (n = 1), France (n = 1), UK (n = 3), USA (n = 3)

n/a

Need assessment framework, provision varies; need to adapt environments, early advanced directives. Barriers: time, lack of training, people being drunk/high at reception

15

Soones et al, 2014, USA

Mixed methods

To assess legal professionals understanding of age-related conditions

Survey; semi-structured interviews

Survey: n = 71; Interviews: n = 10 (5 lawyers, 3 social work, 2 judges)

n/a

Knowledge gaps: health, recognising cognitive impairment, assessing safety in prison, services on release. Recommend training & checklists

16

Treacy et al, 2019, UK

Mixed methods – one-year follow-up

To evaluate a dementia friendly communities initiative in two prisons

Study-specific questionnaires; interviews; focus groups

n = 68 (50 prisoners, 18 staff) in two male prisons (one sex offender, one local)

Dementia Friendly Community–information sessions, meeting with dementia charity, develop action plans

Info sessions reportedly increased knowledge; one prison created an action plan with some impact on awareness, environment & independence. Nos diagnosed with dementia & use of specialist units impacted dementia friendly practice

17

Turner, 2018, USA

Qualitative

To explore prisons’ dementia assessment practices & needs

Semi-structured interviews

n = 7 (4 psychologists & 1 assistant;1 psychiatr-ist, 1 nurse); 3 prisons

n/a

Identified a lack of training, use of screening tools & policies for the assessment of dementia

18

Williams et al, 2012, USA

Qualitative

To identify gaps in knowledge regarding older prisoners, and develop a policy agenda

Roundtable meeting of experts

n = 29 (doctors, psychologists, lawyers, a nurse, prisoner advocates)

None

9 priority areas for older prisoners inc: identifying & assessing dementia (plus: definition of older & functional impairment, training, women, accommodation, release, & palliative care)

(ii) Guidance & inspection documents

19

Alzheimer’s Society, 2018, UK

Guidance

To help officers understand & respond to prisoners with dementia

No methods information

n/a

None

Booklet for officers describing dementia & its impact, and tips for supporting people

20

Correctional Investigator, 2019, Canada

Inspection

To identify best prison policy & practice regarding older prisoners

Routinely collected data, interviews

n = 335 (280 prisoners & ex-prisoners; 55 staff & community staff)

None

Care to focus on dignity & human rights; resources should be allocated to community alternatives; need for national strategy

21

Dementia Action Allian-ce, 2017, UK

Guidance

To identify areas of need and solutions for prisoners with dementia

Roundtable discussion, but no methods

Unknown

None

Briefing note outlining challenge: diagnosis, care, routines, environment, training, & human rights

22

Department of Health, 2007, UK

Guidance

To help health & prison staff meet the needs of older prisoners

No methods information

n/a

Little dementia-focused: assessments to identify memory impairments; a dementia register should be developed, and care to be reviewed

23

Feczko, 2014, USA

Protocol

Overview of assessment, diagnosis & treatment issues for prisoners with dementia

No methods section

n/a

Clinical dementia protocol for healthcare: assessments, treatment & referral procedures

Challenge in prison to detect & treat dementia, esp with a lack of guidelines. Need collaboration across disciplines in prison, & for mainstream dementia research to include prisoners

24

Hamada, 2015, USA

Protocol

Presents an assessment and treatment protocol to be used by clinical psychologists (ATPEACE)

No methods information

n/a

Assessment & Treatment for Elders with Alzheimer’s in the Correctional Environment

Need to address lack of: dementia & risk factor awareness, diagnostic tests & evaluations, therapy & preventative strategy use, knowledge of services, cultural competence

25

Her Majesty's Inspectorate of Prisons, 2014, UK

Inspection criteria

Criteria for inspections for the treatment of women in prison

Consult staff, prisoners interest groups plus ministers

Not reported

Prison inspection with 4 tests of: safety, respect, purposeful activity & resettlement

Criteria include: healthcare staff to be dementia screening trained, & be able to recognise social care needs and dementia signs

26

Her Majesty's Inspectorate of Prisons, 2015, UK

Inspection

Inspection of HMP Isle of Wight

Observation, surveys, records

Surveys n = 371. Cat B prison, male, mostly sex offenders, 45.5% > 50 years

Inspected 4 tests: safety, respect, purposeful activity & resettlement

Good memory support services, regular visits by memory specialists, specialist memory-focused gym activities, & routine check-ups are booked for prisoners (such as dentist)

27

Her Majesty's Inspectorate of Prisons, 2016, UK

Inspection

Inspection of HMP Stafford

Observation, surveys, records

Surveys n = 196. Cat C male sex offender prison, 43.3% > 50 years

Inspected 4 tests: safety, respect, purposeful activity & resettlement

Balanced approach to disciplinary aided by clinicians & training – 20 prison staff studying for a dementia qualification (NVQ). No healthcare lead for older prisoners

28

Her Majesty's Inspectorate of Prisons, 2017a, UK

Inspection criteria

Criteria for inspections for the treatment of men in prison

No methods information

Not reported

Inspection with 4 tests: safety, respect, purposeful activity, rehabilitation & release planning

Criteria include: staff working with older prisoners to be able to recognise dementia signs; waiting times for access to memory or dementia services to be equivalent to community

29

Her Majesty's Inspectorate of Prisons, 2017b, UK

Inspection

Inspection of HMP Erlestoke

Observation, surveys, records

Surveys n = 149. Cat C male prison, 18.8% > 50 years

Inspected 4 tests: safety, respect, purposeful activity & resettlement

Two healthcare assistants provide an outreach service within the prison to monitor the vulnerable, including people with dementia

30

Her Majesty’s Prison Hull, 2015, UK

Prison action plan

The prisons’ plan for better outcomes for prisoners with dementia

No methods information

n/a

Improve standards via healthcare partners and staff & prisoner training

30 peer supporters trained by dementia organisation; staff demand exceeding places; staff shortages a challenge to implementation

31

Her Majesty’s Prison Littlehey, 2016, UK

Prison action plan

The prisons’ plan for better outcomes for prisoners with dementia

No methods information

n/a. Cat C prison, 2 units for men > 60 years & peer supporters

Raising awareness (staff-prisoners); environmental change; collaboration

Increased: understanding, peer support relation-ships with peers with dementia, staff- prisoner dialogue; environment: door colours, floors, seating; conference bringing groups together

32

Her Majesty’s Prison & Prob-ation Service, 2018, UK

Guidance

To present a toolkit or model of delivery, for Governors to meet needs of older prisoners

Review & case reports – no further information

n/a

Regime, environment & activity adaptation; family contact; training; peer support; palliative care;

Older prisoners a ‘specialist’ cohort. Recommend staff training; tailored regimes & inclusive activities with voluntary organisations, encourage family ties. No evidence for separate accommodations

33

Inspector of Custodial Services, 2015, Australia

Inspection

To understand current policy & practice in management & care of older prisoners

Interviews, focus groups, discussions; observations

Unknown. Interviews – managers; focus gps- staff/prisoners. 4 prisons (male + female)

n/a

Environments difficult; no needs assessments for placements; lack of structured recreational activity; staff relations positive but lack knowledge; healthcare needs not met; ad-hoc release planning

34

Ministry of Justice, 2013, UK

Guidance

To help officers manage & understand prisoners

No methods information

n/a

Guidance– case studies, signs, different diagnoses

Recommends officers refer people to healthcare if suspect dementia, or encourage self-referral

35

National Institute for Health and Care Excellence, 2017, UK

Guidance

Guidance on identifying & managing people with mental health problems in criminal justice system

Systematic reviews

n/a

Reviewed: training, assessment, intervention, and service delivery

Add cognitive question to screen; no evidence on case identification tools; no RCTs/reviews on prison rehab intervention – may need adaptation; need for staff training

36

Prisons and Probation Ombudsman, 2016, UK

Inspection

To investigate experience of prisoners with dementia, & challenges in supporting them

Fatal incident investigations – case studies

5 case studies, all male, aged 63–88

Learning lessons bulletin

Decision-making & capacity; social care responsibility; develop & share best practice; peer supporters trained & supported; risk assessments take a/c of dementia; family contact & inclusion

37

Public Health England, 2017a, UK

Guidance

Guidance for health & social care needs assess-ments for older prisoners

Consult health-justice staff & users

n/a

Guidance document

Case example of screening service; adapted cell

38

Public Health England, 2017b, UK

Guidance

Guidelines for physical health checks in prisons programmes

No methods information

n/a

Targets blood pressure, smoking, diet, alcohol, cholesterol, inactivity

Physical health check for 35–74 year olds serving > 2 years; dementia awareness raising for 65–74 year olds at this

39

Welsh Government and Ministry of Justice, 2011, UK

Guidance

To develop a care pathway for older prisoners

Consult prison-health staff, Government reps & public

Not known

Path phases: reception, 1^st night, assessment, re-assessment, care, transfer, release-resettlement

Dementia training for staff working with older prisoners; assessments to include dementia; access to memory clinics

40

Welsh Government, 2014, UK

Guidance

Guidance in implementing policy for mental health services for prisoners

Needs assess- ment, work- shops; consult prison service

Not known, but assessment & workshops facilitated by Public Health Wales

Implementation guidance document

Should be dementia screen, in-depth assessment, need referral routes to relevant services, staff training, importance of safeguarding

(iii) Discussion & description papers

41

Ahalt et al, 2017, USA

Discussion

To reduce the use & impact of solitary confinement

No methods section

n/a

Solitary confinement

Recommends prohibition of solitary confinement for prisoners with cognitive impairments

42

Baldwin & Leete, 2012, Australia

Discussion

Discuss challenges & solutions regarding prisoners with dementia

No methods section

n/a

Specialist accommo-dation & regimes, plus community alternative

Lack of progress in Australia. Need to research prisoners, training, environment, & wider debate about how to deal with dementia

43

Booth, 2016, Canada

Discussion

To discuss the assessment & treatment of older sex offenders

No methods information

n/a

General, and also offending behaviour groups specifically

Cognitive issues may affect attendance & engagement with groups = little progress; may be need for specialised work & risk considerations

44

Brooke & Rybacka, 2020, UK

Descriptive

To describe and conduct a dementia education workshop

Design relates to workshop development only

Health care (n = 33), substance misuse (n = 5), Offender Man-agers (n = 7), managers (n = 8), officers (n = 15); peer support (n = 76)

Workshop addressed barriers and problem-solving, current initiatives, aimed to improve knowledge and empower

Barriers: bullying by prisoners, regime, environment, lack of prison – health/social care staff communication. Peer supporters trained for > 50 years support; staff & peers need empowering

45

Brown, 2014, Australia

Discussion

To report approaches to meeting needs of prisoners with dementia

No methods section

n/a no detail

Various—specialist units, training, regimes, peer support & programmes

Need legislative change to protect people with dementia; support needs to be interdisciplinary & collaborative

46

Christodoulou, 2012, UK

Discussion

To identify prison enviro-nment factors that could increase risk of dementia

No methods information

n/a

Various measures to reduce dementia risks

Recommends health promotion activities re: smoking, diet, exercise, isolation, blood pressure; screen for dementia. Challenged by poor resources

47

du Toit & Mc- Grath, 2018, Australia

Discussion

To identify areas of dementia practice & research that need focus

No methods information

n/a

The role of occupational therapy

No research; recommend work with prisoners with dementia, on occupational participation, & prisons’ environmental adaptation

48

Fazel et al, 2002, UK

Discussion

To explore the ethical implications of imprison-ing people with dementia

Discussion of case studies

Presented 2 case vignettes

Prison purpose: deter, incapacitate, symbolic, rehabilitate, retributive

Holding prisoners with dementia largely does not fit prison purposes. Questions appropriateness & legality of detaining people with dementia

49

Garavito, 2020, USA

Discussion

Overview of issues linked to underdiagnosing dementia

No methods section

n/a

n/a

Prisons offer little/no assistance, need screening, check-ups & early intervention. Barriers: communities uncomfortable with early release, nursing homes hesitant to house ex-prisoners

50

Gaston, 2018, Australia

Discussion

To highlight need for early identification of dementia and support strategies

No methods section

n/a

n/a

Screen with appropriate tool, staff training, adapt environments, dementia friendly communities, partner with external groups, release plans, develop guidelines & strategy

51

Gaston & Axford, 2018, Australia

Discussion

To raise awareness of dementia, & review identification & support strategies for prisoners

No methods information

n/a

n/a

Strategies: screen, placement in safe space, activities, peer support, develop release policy; adopt WHO healthy prison standards; staff training & collaboration; environment adaptation

52

Goulding, 2013, Australia

Discussion

To present best prison practice for older prisoners

Field visits – no further information

10 prisons (USA = 8, New Zealand = 1, Germany = 1)

Various – regime & environment adaptation, care models, hospice

Low ‘compliance’ of staff with screening; easier to adapt regimes & environments in minimal security prisons; consider segregated units & custody-care framework, issues with release

53

Hodel & Sanchez, 2013, USA

Intervention description

To describe a psychosocial programme for prisoners with dementia—SNPID

No methods information

California Men’s Colony –houses prisoners with severe cognitive impairments

Special Needs Program for Inmate-Patients with Dementia: environment & activity adaptation, peer support

Person with dementia can function in prison; quality of life increases, behavioural problems reduce; work is rewarding for programme staff; important to adjust environment or have specific units

54

Mackay, 2015, Australia

Discussion

To analyse how prisons can comply with human rights legislation

No method section

n/a

Human rights legislation

4 principles: not forcing treatment; not denying treatment & treat in an appropriate environment; equivalence; treat people with humanity & respect

55

Maschi et al, 2012, USA

Discussion

To raise awareness, discussion, research & advocacy for prisoners with dementia

No method section

n/a

Environmental adaptation, care models

Should focus on advanced care planning, care across ‘spectrum of severity’, peer support, staff training, environment change & specialist units, family role & support needs, release low risk

56

Mistry & Muhammad, 2015, USA

Discussion

Discuss whether prisons are equipped to care for people with dementia

No method section

Use of 1 case study

Environmental adaptation – specialist units, peers supporters

Should be dementia assessment, & that determines placement, peer support, staff training, dementia programmes & units, early release

57

Moore & Burtonwood, 2019, UK

Discussion

To examine whether PLPWDs’ healthcare needs are being met

No methods section

n/a

n/a

Barriers: regime, mistrust staff, healthcare access, costs, loss of social contacts, consent. Solutions: specialised units; adapt environment, early release

58

Murray, 2004, UK

Discussion

To review the conditions and care of prisoners with dementia

No method section

n/a

Regime & environment adaptation

Need for screening, risk-care balance, training, environment change, meaningful activities, ambivalence re specialised units & early release

59

Pandey et al, 2021, India

Discussion

Discussion of prison care and support

No methods section

n/a

n/a

Barriers: regime, lack of staff, time, environment, fear of repercussion, finances. Solutions: early advanced directives, assess, train, improve environment & staff co-ordination

60

Patel & Bonner, 2016, UK

Prevalence—presentation

A description of a cognitive screening service in a female prison

No methods information

55 prisoners offered screen, 18 consented, 12 completed. Closed female prison

Cognitive screen – tool used not reported All prisoners > 55 screen

Provisional dementia diagnosis in 25% screened (n = 3); 75% (n = 9) had ‘significant vascular risk factors’. Need to appropriately identify, treat, train staff – dementia friendly prisons, plan release

61

Peacock et al, 2018, Canada

Discussion

To explore the needs of, and interventions for, prisoners with dementia

No methods section

One case report

Care models, peer support, environmental change, programmes – dementia friendly prisons

Few interventions evaluated. Need knowledgeable MDTs & external groups, a long-term care model & specialist wards; screen & diagnose early, peer support, environmental adaptation; early release

62

Sfera et al, 2014, USA

Discussion

To deal with fronto-temporal dementia behavioural variant

No methods information

n/a

n/a

Recommend screening all > 55 years; use of palliative care model when placing people with dementia

63

Sindano & Swapp, 2019, UK

Intervention description—presentation

To present support available & possible for prisoners with dementia

No methods section

n/a

Awareness sessions with prisoners & staff; attend prisoner & staff forums

Increased diagnoses & national dementia helpline contact; developed an assessment referral tool, and ‘Top Tips’ booklet for officers (see paper 16)

64

Tilsed, 2019, UK

Discussion—presentation

To highlight inequalities faced by people with dementia in seldom heard groups

No methods section

n/a

Dementia Action Alliance roundtable (paper 18), ‘top tips’ booklet for officers [paper 16)

Need for systematic care pathway through the prison system, collaborative working including community groups, awareness sessions for staff & prisoners, use of ‘top tips’ as a resource

65

Vogel, 2016, USA

Discussion

An ‘argument’ for additional training in dementia for prison staff

No methods section

n/a

Crisis Intervention: signs, stages, impact, risk, manage, communication

Need for staff training in dementia, possibly as part of wider mental health training

66

Williams, 2014, UK

Intervention description

Description of a prison Cognitive Stimulation Therapy group

No methods section

n/a –aimed at people with mild-moderate dementia –male prison

Cognitive Stimulation Therapy –to maintain cognitive functioning

Reportedly enjoyed by prisoners; staff report increased socialising; difficulties with staff buy-in–increased over time. Facilitators find it rewarding

67

Wilson & Barboza, 2010, USA

Discussion

Discussion of the challenges & needs of prisoners with dementia

No methods section

n/a

None reported

Need: better early detection, to disclose (as a process), adapt environment, train staff, develop & implement non-pharmacological interventions