In a bid to improve end-of-life care for incarcerated individuals in the California prison system, UC San Francisco researchers have found a way to predict who is most likely to die within two years and should be considered for palliative care or compassionate early release.
The mortality prediction model, which was developed with physicians who work in the state’s prisons, considers age, mobility, and medical conditions — such as cancer, end-stage liver disease, and kidney disease — as well as whether someone is already living in a specialized health facility.
This population tends to die younger than the general population, with a 2012 study of New York state parolees showing that each additional year in prison is associated with a two-year reduction in life expectancy.
Identifying those at higher risk of death enables prison staff to have conversations with them about appointing a health care power of attorney and documenting preferences for life-sustaining treatment, including do-not-resuscitate orders.
“Geriatric conditions like frailty, functional decline, and cognitive impairment may occur several years earlier in incarcerated individuals,” said W. James Deardorff, MD, an assistant professor of Medicine in the Division of Geriatrics and the co-first author of the paper, which published this month in the Journal of General Internal Medicine.
The model was based on data from 90,000 people in prisons and was highly reliable at predicting who would die within two years.
“If someone has stage 4 metastatic cancer, it’s clear that they are at high risk of death, but many people in prison have multiple non-life-threatening conditions that cumulatively threaten their lives,” said Alexander K. Smith, MD, MPH, a professor of Medicine in the Division of Geriatrics and co-senior author of the paper.
The researchers hope that the model will open the door for more terminally ill incarcerated individuals to gain compassionate early release, which has been historically underutilized. “By the time it’s obvious that someone is eligible, and the request has been reviewed by prison staff and the court, a year may have passed,” said Sei Lee, MD, MAS, a professor of Medicine in the Division of Geriatrics and co-senior author of the paper. “By then, they may have died.”
Other Authors: Alexandra K. Lee, PhD, MSPH, is co-first author. Co-authors are Kaiwei Lu, MS, Bocheng Jing, MS, W. John Boscardin, PhD, Brie A. Williams, MD, MS, of UCSF; and Michele DiTomas, MD, MS, and John Dunlap, DO, of the California Dept. of Corrections and Rehabilitation.
Funding: National Institute on Aging, National Center for Advancing Translational Sciences, Office of the Federal Receiver in California, and the California Prison Health Receivership Corporation. For disclosures, please see the paper.
About UCSF: The University of California, San Francisco (UCSF) is exclusively focused on the health sciences and is dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care. UCSF Health, which serves as UCSF’s primary academic medical center, includes top-ranked specialty hospitals and other clinical programs, and has affiliations throughout the Bay Area. UCSF School of Medicine also has a regional campus in Fresno. Learn more at https://ucsf.edu or see our Fact Sheet.
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Journal of General Internal Medicine