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Age Sensitivity Training for Corrections Personnel.

Elderly inmates are the fastest-growing segment of the Texas prison population (Martinez et al., 1999). In addition to aging in place, elderly offenders are being incarcerated at higher rates than in the past and with longer sentences than those in other age groups (see Table 1). The elderly traditionally are defined by demographers as the segment of the population over the age of 65 and are characterized by declines in physiologic functions, an increasing vulnerability to environmental changes and a loss of homeostasis. However, due to lifestyle choices and high-risk factors, 55-year-old members of this distinct prison cultural subgroup more closely resemble typical 65-year-olds in the outside world (Watson, 1995; Martinez et al., 1999; Schreiber, 1999). In 1998, there were 4,779 inmates 55 and older in Texas prisons (Groom, 1999). It is projected that this population will exceed 10,500 by 2008 (see Figure 1), representing 8.2 percent of the total Texas prison population (Martinez et al., 1999). Currently, there are approximately 60,000 inmates between the ages of 36 and 54, serving an average sentence of 24 years (Schreiber, 1999).

Table 1: Texas Prison Population by Age Group

Age Number of Percentage of Average Length of
Group Offenders Prison Population Sentence in Years

25 and under 25,862 18.5% 7.61
26 to 35 47,996 37.1% 7.86
36to 54 52,548 40.7% 9.56
55 and over 4,779 3.7% 11.63

Note: Data from "Elderly Offenders in Texas Prisons," by P. Martinez et al., 1999, p. 2 and 6.

The mission of the Texas Department of Criminal Justice (TDCJ) includes promoting positive changes in offender behavior and reintegrating offenders into society. To fulfill this mission, interventions should include educational training for correctional staff concerning physiological changes associated with normal aging, psychological ramifications of incarceration for the elderly and age-specific developmental changes. The purpose of this age sensitivity program was to provide training to enhance age sensitivity, expand knowledge and awareness, and improve the skills of TDCJ personnel.

Needs Assessment

In the February 1999 final subcommittee reports of TDCJ's Aging of the Offender Population Action Team, several issues, facts and recommendations were presented to TDCJ concerning elderly offenders in Texas prisons. The Training Subcommittee reported the following:
 Issue: Staff working with elderly offenders need training to understand the
 special needs and problems of the elderly population.

 Facts: TDCJ's experience in providing services to special needs populations
 (mentally ill, mentally retarded, physically handicapped, terminally ill
 and elderly inmates) indicates that unit operations suffer when staff are
 not prepared for the unique characteristics of special needs inmates.

 Options: Preservice and in-service training for all TDCJ employees raises
 the level of awareness of the existence of special needs offenders and
 their needs. Units designed to house large numbers of offenders should
 receive training prior to the assignment of the special needs population
 and should continue to receive ongoing in-service training.

All correctional officers are in need of age-specific, special needs education. Elderly offenders may only represent a small, albeit growing, percentage of the Texas prison population (see Table 1), but correctional officers at the Estelle Unit, an age-specific sheltered geriatric housing facility, require age sensitivity training because they are full-time custodians of older offenders. There currently are 60 elderly, infirm inmates housed in the Estelle Unit in Navasota and 108 inmates termed "geriatric" in the Pack 1 Unit in Huntsville (Groom, 1999). The Pack 1 Unit is one of 14 designated TDCJ units that houses elderly offenders, but it is not a specialized unit. Inmates assigned to Pack 1 generally are healthy, while those assigned to the Estelle Unit usually require specialty services (i.e., physical therapy, hearing/visually impaired services, etc.). Staff report that the clustering of older inmates tends to make them act even older and more inactive. Forty-seven percent of the over-55 age group are housed in 14 units and mainstreamed with the general population, while the remainder are scattered systemwide. There is no designated unit for geriatric female inmates (Groom, 1999). Based on its findings, the TDCJ Identification and Housing Subcommittee recommended the establishment of a formal training program for staff.

Communication deficits rank highest among the elderly, the most common of which is hearing impairment (Burnside and Schmidt, 1994). Approximately one-third of people older than 65 and one-half of those 85 or older are hearing-impaired. It is the third most common chronic condition of older people and is associated with decreased quality of life, depression, isolation and dementia (Keller et al., 1999). Additionally, one in three elderly people suffer a vision-reducing disease by age 65 (Quillen, 1999). Visual impairment is related to increased morbidity because there is an increased risk for falls, hip fractures, physical disability and depression (Keller et al., 1999).

Overall for the elderly, there is a decline in all areas of sensory perception -- visual, tactile, auditory, gustatory and olfactory (Eliopoulos, 1997). Sensory loss can lead to an increase in physical complaints, isolation, boredom, withdrawal and an overactive imagination. Behaviors change as a result of sensory deprivation. Further, sensory impairment is predictive of subsequent functional impairment of older adults (Reuben et al., 1999). Sensitivity to these changes can help TDCJ personnel better understand the aged inmate. It is to the advantage of prison staff to understand the impact of aging on inmates and the importance of lifestyle in the' aging process (Morton, 1992). To fulfill TDCJ's-missions of promoting positive changes in offender behavior as well as, to assist in the reintegration of the older offender into free-world society, prison staff first must understand the aging process and the functional level and capacity of each individual inmate.

The final comment of the five TDCJ Aging Action Team Subcommittee Reports stated: "The focus on this issue, brought about by the work of the TDCJ committee, the Criminal Justice Policy Council, the CMHCAC and the Legislative Board Budget clearly indicates a consensus on the need to move forward in a deliberate manner in making offender management decisions related to this population."

From a health care perspective, the justification for such training stems from the increased demand for services for elderly inmates and the accompanying need to provide adequate resources to respond to that increased demand.

Literature Review

Elderly inmates represent a small minority of the U.S. prison population. However, a marked population increase in both state and federal facilities has been observed and correspondingly, there has been an increase in the number of articles appearing in the correctional, nursing and lay literature (see Table 2). Analysts are warning prison officials. to prepare for an explosion in the elderly inmate population (Watson, 1995).
Table 2: Lay Literature Headlines

 Date Media Headline

 "State faces graying prison
10/06/97 Newspaper (article) population: Geriatric care
 a need"

 "Prison's senior class: State
01/17/99 Newspaper (article) experiencing increase in
 geriatric prisoners"

 "Aging inmates present problems:
06/21/99 Online Prison population grays with

 "Cellblock seniors: They have
06/21/99 Magazine grown old and frail in prison.
 Must they still be locked up?"

06/29/99 Online "Prison to be used for inmates
 who need assisted living care"

 "Ill and Elderly prisoners:
08/23/99 Radio (NPR) Should they be in jail, in care
 facilities or released back
 into society?"

09/20/99 Newspaper (editorial) "Keeping old prisoners jailed is
 punishing taxpayers"

A report on older offenders in Iowa prisons (Colsher et al., 1992) noted that 42 percent (n = 119) had gross physical functional impairments. Of those ages 50 to 59 (n = 37), 33.3 percent reported difficulty hearing normal voices, 55.6 percent believed they had hearing loss and 16.2 percent reported wearing hearing aids. A survey completed in three medium-security prisons in British Columbia (Gallagher, 1990) compared social, emotional and physical characteristics of older and younger inmates and noted that physical health differences resulted primarily from the vision and hearing loss problems of the older offenders. Several recommendations resulted from this study, including the introduction of education for correctional officers and case, managers about the normal aging process. In a report describing the health status of elderly inmates, Smyer, Gragert and LaMere (1997) noted this population poses special problems for the correctional system due to the physical decrements of the aging process. Further, their report concluded that educational training for correctional staff on the aging process is necessary.

LaMere, Smyer and Gragert (1996) noted substantial assistance for the aged inmate must be accompanied by staff awareness of the losses inherent from the cumulative effects of living and aging in prison. Education is the key to increasing staff awareness. Rubenstein (1982) described the elderly inmate as insecure, fearful and sedated. Additionally, Smyer, Gragert and LaMere (1997) identified violence and the threat of violence as stressors that add to the physical deterioration of elderly inmates and recommended educational training for correctional staff about age-specific developmental changes. However, Schreiber (1999) stated some experts say extra training for staff may not be enough.

In a comprehensive report for the National Institute of Corrections (NIC) on older inmates, Morton (1992) recommended special units be assigned to house older inmates who are unable to function in the general population, provisions for medical care designed to meet the special needs of the elderly and special training for staff specifically designed to deal with the unique needs of this group. In a report of a two-year study of elderly offenders in the United Kingdom (Yorston, 1999), older offenders suffered much higher levels of mental illness than the general population and the development of more services to help older inmates was recommended.

The Coalition for Federal Sentencing Reform currently is building a coalition of concerned organizations and citizens to deal with the growing crisis of the elderly in prisons. The October 1998 Elderly Prison Initiative Forum was the first in a series of forums to address the plight of elderly inmates. In January 1999, the Criminal Justice Policy Council released a report titled Elderly Offenders in Texas Prisons (Martinez et al., 1999), which examined factors that have accelerated the growth of the aged offenders in Texas prisons in relation to future management plans of this population and related health care costs.

Other states have reported similar findings into this growing problem (Watson, 1995; Morton, 1992). In a 1997 report on special needs populations prepared by the Longmont, Colo., information center of the National Institute of Corrections (NIC), only 16 of 50 state departments of correction provided special training on working with chronically ill, terminally ill and/or elderly inmates. The elderly inmate population was not identified as an individual special needs population, therefore, the states providing training specifically for working with the elderly could not be culled from this data. At Ohio's correctional training academy, courses in cultural diversity are offered, including seminars on aging (Wilkinson and Unwin, 1999). Further, as a result of the 1990 passage of the Americans With Disabilities Act, South Carolina developed a program in 1993 to prepare staff to work with special needs offenders, including older inmates with significant physical impairments (Morton, 1993). However, there was no age-specific sensitivity training at the preservice level for all correctional officers in any state.

Clearly, the problem of aging inmates has been identified as a growing concern of correctional facilities, health care providers and the general public. Awareness of the physiological, psychological and developmental changes associated with aging is the first step in the process of managing the health, housing and supervision of the elderly inmate.

Theoretical Framework

The theory of innovation diffusion has been incorporated into a number of disciplines, from agriculture to marketing (Surry, 1997). Diffusion is defined as transmission by contact (Merriam-Webster, 1995). Rogers (1983) expands the definition to include a process by which an innovation is adopted and gains acceptance by members of a certain community. The adoption of the program by TDCJ administration represented acceptance by the state based on an internal needs assessment. Adoption by personnel required a change agent. The advanced practice nurse student program presenter acted in the role of change agent. Change agents act in deliberate ways to initiate and accomplish change (Hansen, 1995).

There are four major factors identifiable in every diffusion study, campaign or program that influence the process of change. They are:

* The innovation itself;

* Communication through certain channels;

* Communication over time; and

* Communication among the members of the social system (Rogers, 1983).

The age sensitivity program was the innovation (Factor 1). It was a new concept being introduced into TDCJ and preservice training. The normal aging process may have represented new knowledge to TDCJ personnel. However, the newness of the innovation may not involve just new knowledge, (Rogers, 1983). The innovation attempted to persuade personnel to adopt new attitudes and behaviors toward a distinct segment of the prison population.

The innovation was communicated through a familiar channel (Factor 2): requisite preservice training. However, it was communicated by an outside agent -- a registered nurse not affiliated with the training academy. The TDCJ training centers' military-titled instructors represent a chain-of-command relationship that influenced the communication process. Trainees were required to listen and not talk during the presentation and to demonstrate respect for the speaker.

The nature of any information exchange relationship determines the conditions under which a source will transmit the innovation to the receivers, as well as the effect of the transfer (Rogers, 1983). In the training program, the outside agent was the source and the receivers were the officer trainees. The effect of the transfer may have been determined by the interpersonal link of the presentation. Volunteers were invited to join in the presentation and questions were welcomed. The content was relevant to to the trainees' personal experiences with the elderly. Rogers (1983) contends interpersonal channels are most effective in persuading individuals to adopt new ideas.

Time (Factor 3) has been identified as the most important element in the diffusion process. It involves passage from first knowledge of the innovation to adoption or rejection and usually is measured by respondent recall (Rogers, 1983). There are five steps in the innovation-decision process:

* knowledge/awareness;

* persuasion;

* decision;

* implementation; and

* confirmation.

The process of change involves time in the sense that these five steps occur in a time-ordered sequence (Rogers, 1983).

Knowledge/awareness was the only time factor applicable to this project from the perspective of the correctional officers. At the end of the presentation, immediate recall of knowledge was measured by a test. Persuasion, decision to adopt, implementation and confirmation are long-term goals for program participants. However, from an administrative standpoint, knowledge/awareness of the need for age sensitivity training, persuasion of the appropriate training personnel and the decision to adopt a program already was accomplished. Implementation as a permanent part of the training curriculum and confirmation of this implementation are long-term project goals.

For the purposes of this program, the social system (Factor 4) was the criminal justice system. The subsystem was the correctional service provider staff, most notably, correctional officers. The structure of the social system can impede or facilitate the diffusion of the innovation into the system (Rogers, 1983). The acceptance and response of the initial trainees will have an impact on the decision to adopt. By including five trainees in a hands-on demonstration and in teaching through modeling (Knowles, 1984), the teacher demonstrated behaviors for the learners to imitate. The purpose of modeling is to increase participants' knowledge about the desired process, product or behavior by showing examples (Welch and Berman, 1992). In this case, the instructor used different training aids during the presentation. Based on Bandura's system of social learning, Knowles (1984) noted social learning could be applied for positive educational purposes as the development of attitudes, beliefs and performance skills. The sensitivity training innovation involved the adoption of behaviors based on attitude adjustments. This attitude change would directly and indirectly benefit older inmates. By dispelling stereotypical thinking about working with this group, officers will be less likely to overlook health care needs, emotional and mental status, and levels of learning (Morton, 1992} and will encourage adequate, independent functioning by the offender when he or she is released back into the free world.

Description of the Training Program

The goal of the program was to educate correctional officer trainees in order to raise their level of awareness and enhance their sensitivity to the older-adult environment. Didactic and experiential, the program's content, learning strategies and evaluations are detailed in a partial teaching plan in Table 3. Upon completion of this program, it was hoped participants would be able to:

* Discuss the concept of the aging of America;

* Identify who is old in our prisons and why;

* Identify the normal physiological changes associated with aging;

* List common sensory disease processes associated with the aging population;

* Discuss the sensory losses of hearing, vision and movement that create barriers to communication and effects on behavior;

* Discuss characteristics of functional decline in older adults; and

* Identify and describe the characteristics of confusion in older adults.
Table 3: Teaching Plan Example

 Objectives Content

 Oral presentation of
Identify the normal physio- research-based, age-
logical changes of aging related physiological
 changes associated with
 the aging process

 Audio demonstration of
Discuss the sensory losses normal, mild and moderate
of hearing and vison that hearing loss
create barriers to
communication Visual simulation of
 glaucoma, macular
 degeneration, cataracts,
 hemianopsia and yel-
 lowing of the lenses

 Content Method of Time

Oral presentation of
research-based, age-
related physiological Didactic presentation 10 minutes
changes associated with
the aging process

Audio demonstration of
normal, mild and mod- Audiotape 10 minutes
erate hearing loss

Visual simulation of
glaucoma, macular
degeneration, cataracts, Visual simulation 15 minutes
hemianopsia and yel-
lowing of the lenses

 Content Resource

Oral presentation of
research-based, age- Written/Visual material:
related physiological Overhead transparencies
changes associated with handouts
the aging process

Audio demonstration of
normal, mild and mod- Audio/Visual materials simu-
erate hearing loss lating hearing loss

Visual simulation of
glaucoma, macular Interactive media: simulation
degeneration, cataracts, kit - 5 pairs of glasses to wear
hemianopsia and yel- and walk around
lowing of the lenses

 Content Method of Evaluation

Oral presentation of
research-based, age-
related physiological Q-and-A pretest/posttest
changes associated with
the aging process

Audio demonstration of
normal, mild and mod- Oral self-report
erate hearing loss

Visual simulation of
glaucoma, macular Direct observation; Oral self-
degeneration, cataracts, report
hemianopsia and yel-
lowing of the lenses

After a brief introduction, the program began with the administration of the 15-question, true or false, "What Is Your Aging IQ?" pretest. The participants were instructed to number the quiz with the last four digits of their social security numbers in order to facilitate matching with the posttest at the end of the presentation.

A 15-minute didactic presentation on the "graying of America," the aging Texas prison population and general information on normal aging process immediately followed the pretest. Charts and graphs depicting the shifting demographics of America's aging population and how this change is reflected in the prison population were presented on overhead slides, as well as a definition and description for normal aging and the older offender. Stereotypical aging myths were presented and debunked.

Sensory losses associated with aging started the next phase of the presentation. Hearing, vision, smell, taste and tactile changes were discussed. Following the content on common signs and symptoms of hearing loss, a videotape was played that simulated mild and moderate hearing loss associated with the aging process. While looking at a scale indicating normal, mild and moderate hearing loss on the projection screen, the participants experienced the sensory perceptual change of a normal speaking voice. The presentation continued with interventions to compensate for hearing loss and a discussion of common changes in vision. Five volunteers then joined the speaker on the stage to don glasses that simulated common eye diseases of the elderly: macular degeneration, glaucoma, cataracts, hemianopsia (blindness in part of the field of vision, common after a stroke), as well as yellowing of the lenses. Each volunteer described the experience to his or her peers and walked around the stage to describe compensating mechanisms to cope with the vision changes. The presentation concluded with a discussion of further physiological changes associated with aging, recognizing confusion in the elderly and functional decline. The posttest, the same "What Is Your Aging IQ?" quiz, was administered immediately following the presentation.

A complete training manual, a copy of a training video and one vision loss simulation kit were left at the correctional training center in Beeville, Texas. The training manual contained the planning session, including rationale; goals and objectives; lecture notes; experiential activities; the training seminar presentation, including transparencies; a PowerPoint presentation on a floppy disk; a copy of the quiz; and a seminar evaluation form. The program took place from 8:30 a.m. to 10 a.m. at the training academy auditorium, Jan. 19, 2000. There were 288 correctional officer trainees in the class. The program was added to the curriculum of the 180 hours of preservice training hours required for the trainees. The director of training provided copies of all handouts, pretests and posttests, use of the auditorium, VCR, overhead projector and staff assistance.


The objectives of this project were twofold: The education, increased knowledge-awareness and enhanced age sensitivity of the trainees and adoption, implementation and incorporation of the program into the permanent curriculum by TDCJ.

The first objective was measured by the change in scores, comparing pre- and posttest participant results. A paired samples t-test was performed comparing the number of incorrect answers on the pretest to the number of incorrect answers on the posttest. The mean difference (N = 288) was +3.05 points; t (287) = 2.42, p [is less than] .02. The data suggest there was a significant difference in the test scores after participating in the age sensitivity program. The decrease in incorrect answers further suggests an increase in knowledge. Knowledge-awareness is the first step in the innovation-decision process and occurs when a subject is exposed to the innovation's existence and gains some understanding of how it functions (Rogers, 1983). The long-term adoption of the innovation by trainees is a long-range objective and outside the scope of this project. The rate of knowledge-awareness is more rapid than the rate of adoption (Rogers, 1983).

In addition, 30 evaluation forms were distributed randomly to participants. Presented as optional, the first 30 participants who chose to evaluate the educational program completed forms. The evaluation, consisting of questions concerning quality of content, organization and format, was a nine-item likert scale wherein 5 = strongly agree, 4 = agree, 3 = disagree, 2 = strongly disagree and 1 = no opinion.

More than 80 percent of respondents agreed or strongly agreed that the program met its objectives and presented content appropriate for TDCJ's special needs training. The permanent curriculum objective is long-term and will be monitored by continued communication with training academy administration. Bozarth strongly recommended that the program be included in preservice curriculum or in-service training (at a minimum). However, the entire correctional officer curriculum for TDCJ currently is under review.


Experts warn there will be a marked increase in elderly inmates in Texas prisons. The need for age-specific training for correctional officers has been well-documented in various reports presented by TDCJ. In general, this pilot program was well-received and improved test scores of participants indicated an increase in knowledge-awareness. Although different from traditional Texas correctional training, it was a positive step in providing sensitivity training for this special needs population. By increasing officers' skills, tools and knowledge, debunking stereotypical myths about aging, reviewing the normal aging process and presenting the elderly as a heterogeneous group, correctional officers partaking in the class have the tools to encourage positive lifestyle changes and promote independence in older adults. Further, by providing this behavioral benefit to the prison population, TDCJ's mission to promote positive change in offender behavior and to reintegrate offenders successfully into society will be greatly enhanced.


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Mary Lou Heater, RN, MSN, recently received a master of science degree in nursing from the University of Texas Health Science Center at Houston, specializing in psychiatry/mental health and gerontology.
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Author:Heater, Mary Lou
Publication:Corrections Compendium
Article Type:Statistical Data Included
Geographic Code:1U7TX
Date:Jun 1, 2000
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