Structural, cultural and personal barriers to healthcare for older adults in prison: insights from a qualitative study in New South Wales, Australia

Background The increasing number of older incarcerated adults and their complex health needs require concerted efforts to overcome barriers to providing proper access to high-quality healthcare. Studies investigating the complex nature of such barriers have been limited despite their identification being an important first step in addressing this challenge. The purpose of this study was to provide an in-depth exploration of the barriers to healthcare for older adults in prison. Methods We conducted interviews with 23 prison staff and 14 older incarcerated adults in 3 prisons in NSW, Australia. Thematic analysis was used to analyse the data. Results The study identified three main themes—structural, cultural, and personal—along with nine sub-themes of barriers: competing priorities of custody and health , resources and capacity , prison bureaucracy , relational coordination , power relationships , punitive practices , perceived stigma , fear of retribution , and deprived autonomy . These barriers impact service timeliness, choice and control, care seeking, risk of harm/discomfort, and the reach and scope of healthcare for older incarcerated adults. Conclusions The findings revealed a diverse and interrelated set of barriers indicating the considerable influence of custody on the delivery of prison healthcare to older incarcerated adults. Addressing these barriers requires working through custody and health policies, enhancing relational coordination, empowering older incarcerated adults and implementing efficient approaches to offset the rising cost of delivering health services to the cohort.