COVID-19 and incarcerated older adults: a commentary on risk, care and early release in Australia.

PURPOSE The purpose of this commentary is to draw upon available literature and practices related to COVID-19 and management of older incarcerated adults in Australia to highlight key matters for better risk management and care of this population during this and future infectious disease pan/epidemics. DESIGN/METHODOLOGY/APPROACH The present commentary draws on current policies, practices and literature regarding the health, needs and management of older incarcerated adults in Australia to discuss risk, care and early release for this population during the COVID-19 pandemic. FINDINGS Incarcerated persons experience poorer health and accelerated age-related decline compared to those in the general community. The present situation offers the opportunity to fill knowledge and practice gaps, including policies for staff training, identification of dementia and cognitive decline, assessment of mobility issues, addressing barriers to health-seeking, possibilities of medical or compassionate release, risk assessment and release protocols and post-release needs. PRACTICAL IMPLICATIONS While Australian prisons have acknowledged the vulnerability of older persons, more focused adaptation of COVID-19-related policies to consider adults as young as 45 years are needed. Appropriate ethical identification and management of cases in this population is needed, as is discussion on issues of decarceration and medical release. Re-conceptualisation of incarcerated adults as "citizens in need of care", rather than as "offenders to be secured", will be beneficial. Robust, local evidence is needed to assist decision-making. ORIGINALITY/VALUE This is a comprehensive, focused review of relevant evidence, policies and practices for a growing subpopulation of prisoners worldwide with complex needs and particular vulnerability to the COVID-19.