Behind Bars with No Idea Why: 200K U.S. Prisoners May Have Dementia Within a Decade

As the United States population ages, so is the prison population. Many prisoners either enter the criminal justice system already having dementia or develop it after several years in prison. And some, as might be expected, are held their even when they forget what they’ve done wrong.

In the 1980s and 1990s, “tough on crime” policies like three-strike laws and mandatory life sentences without parole created a spike in the number of new prisoners, especially those who were condemned to spend the rest of their lives in prison. Now, 30 to 40 years later, we’re still seeing the effects of those policies, which have filled our prisons to bursting.

Prison officials across the country are getting ready for a massive influx in the number of criminals who suffer from dementia and other ailments that tend to plague the elderly. By the end of the decade, almost one-third of prisoners, or 400,000 people, will be people over the age of 55. This is about double the number of elderly people currently residing in U.S. prisons. As many as 200,000 prisoners in the U.S. are expected to suffer from dementia.

An aging prison population poses several issues for correctional facilities, including an increased need for medical care and increased vulnerability of elderly prisoners. But perhaps one of the most concerning issues is that many of these prisoners will have no idea why they’re being held behind bars.

There has been some debate recently about the moral implications of keeping an elderly person with dementia in prison. It seems that holding a person accountable for crimes they don’t even remember committing may go against the U.S. Constitution’s prohibition of cruel and unusual punishment.

The eighth amendment also requires that, in order for a crime to be punishable, the punishment in question must have a purpose, such as retribution, rehabilitation, or deterrence. It stands to reason that none of these goals can be reasonably expected to be outcomes of imprisonment for a criminal who does not remember his crimes.

In February of 2019, the court case Madison v. Alabama set a precedent when the court found that a prisoner who had suffered severe strokes and dementia did not deserve his proposed punishment. It was determined that it was unconstitutional to execute someone who cannot rationally understand the death penalty or what he did to deserve it. Although most prisoners with dementia are not facing the death penalty, many of them are destined to die in prison. It seems immoral to imprison these people who cannot understand what’s going on or why.

Prisons around the nation are already overburdened, and the increase in the number of elderly prisoners will only add to this stress. This is a problem not only in terms of financial and logistical nightmares that the country must attempt to resolve but also in terms of the potential cost to human dignity for elderly persons that may go along with it.

However, what other choice is available? Many prisoners with dementia have been in prison for years and have no one to care for them in the outside world. Prison is all they have known for a long time. And how can we determine where the line is for who stays in prison and who is allowed to go free because their memory has faded enough?

Some prisons already have entire wings or units dedicated to the care of prisoners with dementia and other illnesses or disabilities. Many of the people they assist are no longer able to perform even routine self-care activities and require round-the-clock supervision and care.

We can only hope that we’re doing enough to meet the impending uptick in the number of future prisoners with dementia. And that we’re being fair in our decisions about whether or not to keep an incarcerated person in prison after they’ve been diagnosed with dementia. Where do you think the line should be?