Factors including posttraumatic stress disorder (PTSD), traumatic brain injury (TBI), and depression are associated with an increased risk of developing cognitive impairment and Alzheimer?s Disease. Each of these factors is over-represented among persons who are incarcerated. Moreover, incarcerated older adults (age 50 and older) experience early onset chronic conditions and geriatric syndromes at younger ages than the general population (?accelerated aging?). Yet, while increasing numbers of older adults are released to the community following incarceration, knowledge regarding dementia in this population is essentially non-existent. Using a unique national cohort developed through the parent R01 (MH117604), ?Precursors of Suicide in Older Adults Transitioning from Prison to Community,? our objective in response to this Notice of Special Interest (NOT-AG- 008) is to characterize the burden of Alzheimer?s disease (AD) and Alzheimer?s disease-related dementias (ADRD) (hereafter also referred to as ?dementia?), and mild cognitive impairment (MCI) and related diseases (e.g., Parkinson?s) in older adults with a recent history of incarceration. We propose to determine the occurrence of dementia and MCI and related diseases in a national sample of veterans released from prison in later life (?older reentry veterans?), including descriptive epidemiology and examination of the clinical course (health care services use, suicide attempt, and mortality) in this vulnerable population. The overarching goals of the parent grant include (1) determining risk and precursors of suicide, death by unintentional injury, and suicide attempt after prison release; and (2) informing the prison-to-community transition by identifying health care use patterns related to outcomes in a highly vulnerable group. The proposed administrative supplement expands these goals specifically to reentry older adults who have AD/ADRD, MCI and related diseases. This research will generate hypotheses regarding unique aspects of the prison environment [e.g., chronic stress, sleep deprivation, sensory deprivation (among those exposed to solitary confinement)] that may contribute to the development of dementia, MCI and related diseases, and provide insight into unique aspects of the clinical course of dementia and related outcomes during the community reentry period?stimulating novel, and important inquiries for future funded research. We will achieve this by leveraging our (parent grant) national cohort of older reentry veterans and determine incidence and prevalence of AD/ADRD, MCI and related diseases overall and by sociodemographic and clinical factors (Aim 1). In addition, among older reentry veterans with AD/ADRD, MCI and related diseases, we will characterize medication and health services use patterns (Aim 2) and evaluate prognostic factors for predicting risk of suicide attempt and mortality, including death by suicide and unintentional injury (Aim 3). Findings from this project will cultivate future research directions and inform stakeholders involved in transition of care planning and suicide prevention in older adults returning from prison to community living with dementia.

Public Health Relevance

Very little is known about Alzheimer?s Disease and related dementias and diseases in older adults transitioning from prison to community (?older reentry adults?). This administrative supplement will characterize these disorders and elucidate the clinical course, including suicide risk, in a national sample of older reentry adults.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Multi-Year Funded Research Project Grant (RF1)
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Juliano-Bult, Denise M
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Northern California Institute Research & Education
San Francisco
United States
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