Dementia and Cognitive Impairment in the Older Prison Population of England and Wales: Identifying Individual Need and Developing a skilled, Multi-Agency Workforce to Deliver Targeted and Responsive Services

Award Number
Award Type
HS&DR Researcher Led
Health and Social Care Delivery Research
Status / Stage
2 July 2016 -
1 July 2019
Duration (calculated)
02 years 11 months
Funding Amount
Funder/Grant study page
Contracted Centre
The University of Manchester
Contracted Centre Webpage
Principal Investigator
Professor Jenny Shaw
WHO Catergories
Methodologies and approaches for risk reduction research
Models across the continuum of care
Disease Type
Dementia (Unspecified)

CPEC Review Info
Reference ID151
ResearcherReside Team


Award Number14/197/65
Status / StageCompleted
Start Date20160702
End Date20190701
Duration (calculated) 02 years 11 months
Funder/Grant study pageNIHR
Contracted CentreThe University of Manchester
Contracted Centre Webpage
Funding Amount£595,841.82


What pathways of care, service provision and staff training packages should be provided to appropriately support older prisoners, aged 50+, with cognitive impairment, including dementia, in England and Wales? Enhance care pathways for older prisoners with cognitive impairment by understanding individual and service needs and designing a responsive staff training package. Objectives: In England and Wales: 1) Estimate prevalence of cognitive impairment amongst the older prisoner population; 2) Validate the Six Item Cognitive Impairment Test (6CIT) [1] for prisoners 50+; 3) Identify service needs and appropriate care pathways for older prisoners with cognitive impairment throughout custody and on discharge to the community; 4) Establish prison and healthcare staff training needs for identifying, assessing and supporting cognitively impaired older prisoners; 5) Develop an appropriate training support pack. Part 1: Stage 1: 860 older prisoners will be screened for cognitive impairment/dementia using the 6CIT [1] and Montreal Cognitive Assessment (MoCA) [2]. Stage 2: Participants testing positive on the MoCA will be interviewed using the Addenbrookes’ Cognitive Evaluation (ACE3) [3] and standardised assessments to establish risk of violence; activities of daily living needs; mental health needs; brain injury; and social networks. Stage 3: We will estimate current and future prevalence of dementia/cognitive impairment in the prison population to inform the planning and costing of services. Part 2: A questionnaire distributed to healthcare managers of all adult prisons in England and Wales (n = 107) will ascertain current service provision for prisoners with cognitive impairment and identify staff training needs. Part 3: Case studies will be used to explore the support needs of older prisoners with mild, moderate and severe cognitive impairment. Approximately 10 individual prisoner case studies will be identified and ethnographic observations of these cases will be conducted. Semi-structured interviews will take place with a range of staff members, other prisoners, family members/carers, as well as those experiencing cognitive impairment. Part 4: Data from Part 1 will be categorised into a range of representative case types and case vignettes presented to a panel of experts in order to design pathways of care for prisoners with different degrees of cognitive impairment severity. The costs of these packages of care will be estimated and aggregated in relation to prevalence data. The panel will also be asked to contribute to the development of a training pack for the identification of cognitive impairment for staff working in prison, undertaking critical review of consecutive drafts. Analysis: We will estimate the prevalence of cognitive impairment by calculating percentages and 95% Confidence Intervals (CIs) using the MoCA [2] as a ‘gold standard’ measure. Qualitative data will be analysed using framework method. Outcomes: The research will validate a screening tool for cognitive impairment for routine use in prisons; identify service needs and the required pathways of care; and develop a staff training package. Benefits and impact: Older prisoners with cognitive impairment/dementia will have their needs detected earlier and more accurately and appropriate services will be in place to support them. This will reduce costs as efficient preventative services develop.


Enhance care pathways for older prisoners with cognitive impairment by understanding individual and service needs and designing a responsive staff training package.