Growing Old in Prison: Rising Numbers, Early Illness and Undiagnosed Dementia

Prisons are growing older. In England and Wales, the number of people in prison aged 70 and over rose by 78% between June 2015 and June 2026, while the prison population as a whole stayed about the same^[1]. In the United States, people aged 55 or older made up 16% of sentenced prisoners at the end of 2023^[2] and 63% of all deaths in state prisons in 2019^[3]. Studies from several countries find that older people in prison live with more illness and disability than people of the same age outside, and that dementia among them mostly goes unrecognised.

Growing old in prison means managing a heart condition, failing eyesight or the first signs of memory loss in a place built for young men, around stairs, bunk beds and fixed routines. It can mean leaving prison in your sixties or seventies with no home, no care in place and no one expecting you. None of this is part of the sentence a court hands down. It follows from prison, health and care systems that have not caught up with the people they now hold.

The older prison population is growing while the younger one shrinks

England and Wales publish one of the most detailed age breakdowns of any prison system. On 30 June 2015 there were 86,193 people in prison; on 30 June 2026 there were 85,858^[1]. Underneath that flat total, the number aged 21 to 29 fell by about 31%, from 28,027 to 19,440, while the number aged 60 to 69 rose by 65% (2,878 to 4,737) and the number aged 70 and over by 78% (1,231 to 2,197)^[1]. The number aged 80 or older nearly tripled, from 174 to 495, and in June 2026 there were 36 people in prison aged 90 or over^[1]. People aged 50 and over made up 13.9% of the prison population in 2015 and 18.8% in 2026.

Of the countries covered here, the United States holds by far the most older people in prison. At the end of 2023 there were 192,900 people aged 55 or older serving sentences of more than a year in state and federal prisons, up from 186,000 a year earlier^[2]. They made up 16% of all sentenced prisoners, and 4.6% were aged 65 or older^[2]. These figures cover people sentenced to more than a year only.

Elsewhere, the published data are thinner. Australia's national release headlines a median age of 36.6 years on 30 June 2025, with no count of older people in its summary^[5]. In Canada, a 2019 joint investigation by the Office of the Correctional Investigator and the Canadian Human Rights Commission found that 1 in 4 people in federal custody were serving a life sentence^[6]. A 2019 international review describes people aged 50 and over as the fastest-growing age group in prison^[7], but few systems publish figures that allow a like-for-like comparison.

The Canadian investigators pointed to an aging general population, a growing number of people serving life sentences, and more people being sentenced later in life, often for historical offences^[6]. Whatever the reason a person is in prison, the state that holds them becomes responsible for their health and care as they age.

Older people in prison live with the health of people a decade or more older

The most consistent finding in the research is that people in prison seem to age early. A US study compared 238 people aged 55 or older (average age 59) in an urban county jail with 6,871 people of similar age in the national Health and Retirement Study^[8]. Every geriatric condition measured, including functional, sensory and mobility impairment, was significantly more common among the people in jail, even compared with the poorest fifth of the community sample. For four of the six conditions, rates were similar to those of people aged 75 or older in the community^[8]. This is one reason prison research often treats 50 or 55, not 65, as “older”; one US team notes that the criminal justice system there defines “geriatric prisoners” as those aged 55 and older^[9].

In England and Wales, a study of 203 men aged 60 and over in 15 prisons, about one-fifth of all sentenced men in that age group, found that 85% had one or more major illnesses in their medical records^[10]. Their rates of illness were higher than those reported for younger prisoners and for the general population of a similar age^[10]. That study is now more than two decades old, but the international evidence since points the same way.

The largest pooled estimate comes from a 2019 meta-analysis of 26 studies covering 93,862 people aged 50 and over in prisons in 11 countries^[7]. It estimated that 39% had hypertension, 38% cardiovascular disease, 14% diabetes and 8% cancer. The studies differed a great deal, so these are broad estimates, but prevalence was often higher than among younger people in prison and among people of the same age in the community^[7].

A 2018 review of 21 US studies, all observational and cross-sectional, found that activities of daily living were challenging for up to one-fifth of older people in prison^[11]. In prison those activities include getting to meals on time, climbing to an upper bunk and walking long distances to healthcare or visits. Our study of older people who are homeless describes similar early aging.

Dementia in prison is common and mostly undiagnosed

The 2018 US review found no empirical data at all on cognition among older people in prison^[11]. That has started to change.

A 2025 study from England and Wales gives the clearest estimate yet. Researchers screened 869 people aged 50 and over (596 men and 273 women) in 10 women's prisons and a representative range of 11 men's prisons^[4]. Weighted for age and sex, 7.0% had likely dementia, rising to 11.8% among those aged 70 and older^[4].

What stands out most is how rarely dementia had been recognised. Of the people who screened positive, only two (3%) had a diagnosis of dementia in their prison healthcare notes^[4]. Among those who screened positive, 46% were assessed as being at high or very high risk of harm to themselves or others, and 35% had no friends they could talk to about private matters or call on for help. The authors estimate that about 1,020 older people in prison in England and Wales have symptoms of likely dementia, and conclude that service provision for this group is inadequate^[4].

Unrecognised dementia in prison is easily misread: a person who forgets the rules, misses a roll call or reacts to an instruction they did not understand may be treated as breaking discipline. A US study of 310 people aged 55 and over in an urban jail found that cognitive impairment was common and associated with worse health and criminal justice outcomes^[9]. Low diagnosis rates are a problem in the community too, as our study of dementia diagnosis rates shows, but in prison there is often no family member nearby to notice the change.

Mental health needs are high and often unmet

A 2018 systematic review of nine studies found that 38.4% of older people in prison had at least one psychiatric disorder, 28.3% depression, 22.9% a personality disorder and 14.2% an anxiety disorder^[12]. Compared with older people in the community, their relative risk was higher for every disorder studied except alcohol misuse and dementia; that review predates the England and Wales dementia study above^[12].

Depression is common and needs often unmet. Among 100 men aged 60 to 81 interviewed in nine prisons in the north of England, 56% showed clinical signs of depression^[13]. The most common unmet needs were information about their own condition and treatment (38%), psychological distress (34%), daytime activities (29%) and help with benefits (28%)^[13], needs a basic assessment on arrival could pick up. Our study of older people with serious mental illness covers overlapping gaps.

Social care in prison is patchy, and responsibility for it is unclear

Help with washing, dressing, moving around and taking medication is social care, and in prison it is often unclear who should provide it. A national study of prisons holding older men in England and Wales found that 44% of establishments had no older prisoner policy, and that health and social care were poorly integrated because responsibility for older prisoners' social care was ambiguous^[14].

The Canadian investigation found no legal or policy recognition that older people are a vulnerable population in prison, and that prison buildings did not adequately meet their needs^[6].

Where programmes exist, the evidence on what works is weak. A 2019 review found 29 papers, mostly about prison hospice programmes, and described the evidence base as “at an embryonic stage”^[15].

More people are growing old and dying in prison

As the prison population ages, more people die in custody, mostly of illness. In the United States, people aged 55 or older accounted for 34% of deaths in state prisons in 2001 and 63% in 2019, almost twice the share; the number of deaths in that age group rose from 972 to 2,441^[3]. From 2001 to 2019, almost 87% of the 65,027 people who died in state prisons died of illness^[3]. These shares reflect the growing number of older people held, not a rising risk for each person: the death rate among people aged 55 or older in state prisons fell from 2,032 to 1,580 per 100,000 over the period^[3]. The 2019 report was the last in this series.

A 2025 legal review from Germany concluded that, if possible, people should not have to die in prison, and that where release is not an option, conditions must allow a dignified death^[16]. The Canadian investigation put it plainly: “Prison is no place for a person who requires end-of-life care.”^[6] It also found that federal corrections lacked adequate, compassionate and responsive release options for older people who do not pose an undue risk to public safety^[6].

Leaving prison in later life often happens without a plan

The move from prison to the community is where health and care needs can fall through the gaps. The England and Wales study of health and social care services found that release planning for older prisoners was frequently non-existent^[14].

Among 360 people aged 55 or older within two years of release from US prisons, 79.1% reported a medical condition, 13.6% a serious mental illness and 1 in 12 a risk factor for homelessness^[17]. A 2025 interview study with 19 people released after the age of 50 found that housing problems were compounded by age-related barriers, stigma and weakened social support^[18].

The Canadian investigation found that many older, long-serving people were held well past their parole eligibility dates, and that community alternatives were lacking and not well resourced^[6]. Some older people, in other words, stay in prison because there is nowhere suitable for them to go. Australian researchers have argued for seeing older people in prison as “citizens in need of care” rather than “offenders to be secured”^[19].

What the evidence asks of us

The UN Nelson Mandela Rules (2015) say health care for prisoners is a state responsibility and that prisoners “should enjoy the same standards of health care that are available in the community”^[20]. They require reasonable accommodation and adjustments so that people with physical, mental or other disabilities have full and effective access to prison life^[20]. Against that standard, the evidence points to clear steps for governments, prison and health services, commissioners and funders:

• Count older people properly. Publish prison populations, deaths and releases by age consistently and in headline releases; Australia's summary, for example, reports age only as a median^[5].
• Assess needs on arrival. An older prisoner health and social care assessment and plan, developed and piloted by researchers in England and Wales, proved a feasible and acceptable way to identify and address needs^[14].
• Look for dementia. With likely dementia in about 7% of people aged 50 and over in prison in England and Wales and little of it diagnosed^[4], screening, staff training and a care pathway are needed.
• Settle who provides social care. Make responsibility for personal care in prison explicit and funded^[14].
• Adapt buildings and regimes. The Canadian investigators called for accessible facilities for older people who want them, staff training in age-related needs and a national strategy^[6].
• Plan release early. Link people to health care, social care and housing before they leave^[17], and review whether older people who pose little risk could be supported in the community^[6].
• Provide dignified end-of-life care in prison where release is not possible, and make release at the end of life a realistic option where it is^[16].
• Fund evaluation. The evidence on what works is at an early stage^[15].

Language: this piece says “older people” rather than “the elderly”, and “people in prison” or “older people in prison” rather than “inmates”, “offenders” or “elderly prisoners”, as many prison reform and prisoners' welfare organisations prefer. Where a source uses another term, such as “older prisoners” or “geriatric prisoners”, we keep it when quoting or naming that source.

Why we're publishing this

Older people in prison are among the least visible older people anywhere: rarely in national aging surveys, and cared for between prison, health and social care systems. The loss of liberty is the sentence; poor health care, unrecognised dementia and an unplanned release are not. We have brought together the best figures we could verify so that prisoners' welfare organisations, criminal justice charities, inspectors and commissioners can make the case for change with evidence they can cite.

How to read this data

Prison statistics differ in who they count and when. England and Wales figures are snapshots of everyone in prison on 30 June; US figures cover sentenced prisoners with sentences of more than a year at the end of 2023; Australia's are as at 30 June 2025. Countries define “older” differently (50, 55, 60 or 65), so figures are not directly comparable. Percentage changes and age-group totals for England and Wales are our own arithmetic from the Ministry of Justice tables.

The health evidence comes mostly from cross-sectional studies in a few prisons or a single jail, and from reviews whose studies vary widely. Dementia figures come from screening and assessment in a research sample, not health records. The US mortality figures are shares of deaths by age; the series ended in 2019. Evidence from low- and middle-income countries, and on older women in prison, is very thin.

Use this data

Free to cite with attribution to Understanding Aging. Criminal justice charities, prisoners' welfare organisations, campaigners and journalists are welcome to reuse these figures and charts. For the underlying figures as a spreadsheet, get in touch.

Important: This article summarises published research and statistics for general information. It is not medical, care, legal or financial advice and cannot be used to diagnose, treat or predict anything about an individual. If you have concerns about your own or someone else's memory or health, please speak to a GP or another qualified health professional.

Sources

1. Ministry of Justice. Offender management statistics quarterly: January to March 2026 (annual prison population tables, Tables 1.A.18 and 1.A.20). GOV.UK, 2026. gov.uk/government/statistics/offender-management-statistics-quarterly-january-to-march-2026
2. Bureau of Justice Statistics. Prisoners in 2023 – Statistical Tables. US Department of Justice, 2025. bjs.ojp.gov/library/publications/prisoners-2023-statistical-tables
3. Bureau of Justice Statistics. Mortality in State and Federal Prisons, 2001–2019 – Statistical Tables. US Department of Justice, 2021. bjs.ojp.gov/library/publications/mortality-state-and-federal-prisons-2001-2019-statistical-tables
4. Forsyth K, Malik B, Webb R, et al. Prevalence of dementia and mild cognitive impairment among the older prisoner population in England and Wales: a cross-sectional study. BMJ Open, 2025. europepmc.org/article/MED/40204308
5. Australian Bureau of Statistics. Prisoners in Australia, 2025. ABS, 2025. abs.gov.au/statistics/people/crime-and-justice/prisoners-australia/latest-release
6. Office of the Correctional Investigator and Canadian Human Rights Commission. Aging and Dying in Prison: An Investigation into the Experiences of Older Individuals in Federal Custody. Office of the Correctional Investigator, 2019. oci-bec.gc.ca/en/content/aging-and-dying-prison-investigation-experiences-older-individuals-federal-custody
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10. Fazel S, Hope T, O'Donnell I, Piper M, Jacoby R. Health of elderly male prisoners: worse than the general population, worse than younger prisoners. Age and Ageing, 2001. europepmc.org/article/MED/11709379
11. Skarupski KA, Gross A, Schrack JA, Deal JA, Eber GB. The health of America's aging prison population. Epidemiologic Reviews, 2018. europepmc.org/article/MED/29584869
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14. Senior J, Forsyth K, Walsh E, et al. Health and social care services for older male adults in prison: the identification of current service provision and piloting of an assessment and care planning model. NIHR Journals Library, Health Services and Delivery Research, 2013. europepmc.org/article/MED/25642504
15. Lee C, Treacy S, Haggith A, et al. A systematic integrative review of programmes addressing the social care needs of older prisoners. Health & Justice, 2019. europepmc.org/article/MED/31134392
16. Lindemann M, Verrel T. Aging and dying in prison [Altern und Sterben im Strafvollzug]. Bundesgesundheitsblatt – Gesundheitsforschung – Gesundheitsschutz, 2025. europepmc.org/article/MED/41123649
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20. United Nations. United Nations Standard Minimum Rules for the Treatment of Prisoners (the Nelson Mandela Rules), General Assembly resolution 70/175. UNODC, 2015. unodc.org/documents/justice-and-prison-reform/Nelson_Mandela_Rules-E-ebook.pdf