Maintaining security: a grounded theory analysis of how correctional officers identify and respond to health- and age-related changes

The population of older adults in prison is rapidly growing. Incarcerated older adults have complex health profiles with high rates of chronic disease, geriatric syndromes, and disability. Additionally, incarcerated older adults are aging in a carceral system focused on security, rather than health. As such, correctional officers (COs) are central in the lives of incarcerated individuals. COs can be instrumental in timely observation and response to age- and health-related changes, yet their understanding of and responses to these changes is poorly understood. Using grounded theory, a systematic qualitative methodology, we conducted and analyzed 20 in-depth interviews with COs. Our analysis generated a grounded conceptual model which describes how COs perceive and respond to age- and health-related changes. COs primarily understand their work as maintaining security. When age- or health-related changes are observed, certain conditions, such as familiarity with the incarcerated person and personal characteristics of the CO, can lead COs to understand responding to these changes as part of their role. However, when COs do notice changes that may be attributable to health or aging, they are more likely to view the change as related to mental health. When COs perceive responding to health-related changes as falling within their role, they are more likely to engage active responses, such as contacting the prison health care team. Conversely, when responding to health-related changes is not viewed as part of the role of the CO, they are unlikely to report the change to prison health care teams. Understanding how COs observe and communicate changes in incarcerated older adults’ health status could close an important gap in our understanding of aging in prison. COs can and do identify health- and age-related changes, but multiple barriers prevent them from reporting these changes. This lack of communication could contribute to delays in care and contribute to negative health outcomes for the incarcerated person. There is an urgent need for public policy, prison systems, and research to develop and implement strategies to improve CO understanding of health and aging and develop effective systems of communication between COs and prison health care teams.