Joe is back in the medical unit getting cleaned and stitched up after another brawl in the housing unit. Even though he has been relocated several times, he is not adjusting well to his cell assignment. Several young men ganged up on him after he, once again, wandered into another cell and started rooting through personal belongings. He said he was looking for his toothbrush. Joe is 55 years old but looks much older. He seems oriented and self-aware when the nurse asks him about the fight. What’s up with Joe? Should his nurse patch him up and send him back to his housing unit or is there something more to be done?

Joe is showing signs of early dementia, a growing concern in correctional settings. Besides the typical changes associated with aging, inmates also are exposed to many of the risk factors for this condition: traumatic brain injury (TBI) from a violent past, substance abuse, smoking, early dementia, hypertension, and diabetes. Mental changes can be subtle and appear as simple forgetfulness or purposeful rule infraction. Response from officers and other inmates can be punitive or harmful. In Joe’s case, the other men in his housing unit interpreted his boundary transgressions as an attempt to plunder personal property. In another situation, an early dementia inmate could be vulnerable to manipulation and victimization.

Assessing for Early Dementia

Correctional nurses can be vigilant for signs of dementia in patients that come through the medical unit. According to information from Correctional Mental Health Psychologists, several problems indicate a need for further evaluation:

- Difficulty expressing or understanding language (aphasia)
- Difficulty doing simple actions like hair combing or shoe tying (apraxia)
- Inability to recognize everyday objects (agnosia)
- Inability to plan, organize or think abstractly (impaired executive functioning)

Interventions for Early Dementia

Recently published recommendations for dementia management suggest a holistic multidisciplinary approach in the correctional setting. Correctional nurses can work with other healthcare and custody disciplines to create policies and protocols to guide dementia management. Here are a few suggestions:

Cognitive assessments during physical examinations, especially for inmates over 50
- Disclosure of the condition to the patient, once confirmed
- Education of health care staff, correctional officers, and inmates about dementia
- Tailored treatment based on the patient’s need and availability of environmental adaptations

Some correctional systems have been successful in creating dementia units that include an adapted environment and specially trained officer staff. Some units also have peer-inmate assistance. For instance, inmates convicted of murder at the California Men’s Colony take the time and patience to assist elderly inmates suffering from dementia with everyday tasks.

How are you dealing with dementia in your correctional facility? Share your tips in the comments section of this post.

Lorry Schoenly and Catherine Knox are experienced correctional nurses and authors of Essentials of Correctional Nursing, a comprehensive body of current, evidence-based knowledge about the best practices to deliver optimal nursing care to this population. Originally posted on