Geriatric carcerality: The prison and the aging crisis

Abstract

We contend there exists an aging crisis in Canada's federal prison system. This aging crisis calls us to reconsider the broader socio-carceral context of what we term the geriatric carcerality of prison as an institution. We argue the intent of confinement now is to punish prisoners through the aging process, while the detriment of confinement (alongside the inadequate health care inside the prison) exacerbates the aging process, inevitably punishing prisoners beyond their sentences. We endeavour to demonstrate the multiplicity of carceral conditions at work within the modern iteration of the prison's now geriatric context, with specific focus on the current state of Canada's federal prison system. We draw upon a range of scholarship, government reports, and policy, suggesting the geriatric identity of the prison has shifted to resituate its intent, detriment and spatiality around the old age prisoner. In effect, the prison's objectives of punishment and/or rehabilitation and the purpose of prison at large must be called into question.

Keywords

Prisons Canada old age aging.

Introduction

There exists an aging crisis in Canada's federal correctional system. The number of older persons in custody (OPiC) is rising (OCI and CHRC, 2019). As this prison population ages, the care and health services required for them rise as well (McCleod and Elwood, 2018). Multiple challenges face an aging prison population, such as chronic physical and mental illnesses, higher rates of disease and infectious conditions (Novisky et al., 2022). There is increasing functional decline, coupled with the need for palliative and end-of-life care services in prison (Iftene, 2019; Iftene and Downie, 2020; Gacek et al., 2026). Correctional Services Canada (CSC),¹ the federal organization responsible for the care, custody and control of federally sentenced prisoners, has suggested in previous reporting OPiC are now in worse health than their respective community counterparts, despite variations in age, sex, sentence type and socioeconomic factors (CSC, 2018; see also OCI and CHRC, 2019 for discussion). Reducing health disparities have become paramount, especially as public and prison health have become so interdigitated the boundaries between the pair blur beyond historical standards (McCleod and Elwood, 2018). Not only has this become a hallmark of the current carceral age we find ourselves (Gacek, 2022) but begs several of the following questions: If the modern iteration of the prison as an institution now receives (and retains) more people, and those people age, but health care services have not kept apace, what does this say then about the prison system? What purpose does the prison as an institution now serve in its modern iteration? If we believe (and do so) there exists an aging crisis in the prison system, are we truly past the point of no return in resolving the crisis?

This aging crisis calls us to reconsider the broader socio-carceral context of what we term the geriatric carcerality of prison as an institution. We coin this term to demonstrate how the intent of confinement seemingly punishes prisoners through the aging process, especially as it appears now the process is the punishment itself (see Feeley's [1992] discussion on the punishing process of legal courts). This simultaneously takes place while the detriment of confinement (outdated, geriatric infrastructure, alongside the inadequate health care inside the prison) exacerbates the aging process, inevitably punishing prisoners beyond their sentences. In theorizing the modern iteration of the prison, we suggest there are the multiple carceral conditions at work within the prison's now geriatric identity and context. While we draw upon national and international literatures and reports, we specifically examine federal prisons in Canada to make our case. To do this, we draw upon Moran et al.’s (2018) conditions of carcerality—intent, detriment and spatiality—to rationalize the scope and extent of the aging process within the prison system. We then connect this work to our current focus, exploring how the prison system has been both influenced by and infused with geriatric contexts fuel the aging crisis we see presently. We suggest the identity of the prison has shifted to resituate its intent, detriment, and spatiality around the old age prisoner, now a rapidly growing and prominent subject within federal corrections. Of course, all persons are aging at all times and in different ways, so we remain cognizant how geriatric carcerality can be applied to all persons living and working in the prison space, not just those held in custody. Nevertheless, and given the increasing rates of OPiC, our examination queries the prison's objectives of punishment and/or rehabilitation and the purpose of prison at large. We suggest while ‘fixing’ federal prison health care services may be easier said than achieved, now is the time to meaningfully engage in discussion of doing so, lest we allow these services to deteriorate further, and OPiC along with them.

Considering the carceral conditions

We take our cues from Moran et al.'s (2018) rich interpretation of the ‘carceral’ as they suggest there are conditions which ‘bear on the nature and quality of carcerality’ (Moran et al., 2018: 677). The authors contend it would be a challenging endeavour to precisely define the carceral, as doing so could produce an illusory binary categorization process of ‘carceral-or-not’ (Moran et al., 2018: 677). Rather, carceral conditions should recognize the scope and extent of carcerality as it relates to the necessary and subjective experiences found with spaces of incarceration, detention, and captivity. As Jefferson (2014: 49) reminds us, understanding confinement writ large requires us to ‘look not only at institutions and sites but at practices and meanings, or more crucially at the relations between sites, practices, social relations and subjectivities’. An enriched discussion of (geriatric) carcerality draws upon Moran et al.'s (2018) three conditions of carcerality: (1) detriment, (2) intention and (3) spatiality. It also highlights the challenges OPiC face in making sense of and reconstructing meaning in their lives, especially those grappling with a prison environment haunted by and plagued with loss (for discussion, see Neimeyer, 2001, 2016).

First, detriment focuses upon the lived experience of harm by those who suffer from it (Moran et al., 2018). This condition refers to how detriment is experienced, instead of whether detriment was intended. While Moran et al. (2018) recognize detriment may be intentionally aligned with punishment, unintentionality may also occur too. Notwithstanding, they suggest the primacy here is to those incarcerated with experiences of detrimental loss. Indeed, detriment can encompass a range of emotional, psychological or physical pain and suffering, but it can also encompass relatively mild inconveniences, and every experience ranging in between.

Second, the carceral condition of intention focuses upon the state agent(s) and their intentions of detrimentally impacting those incarcerated through operations involving carceral spaces, practices and/or policies. Yet Moran et al. (2018: 678) readily recognize intention as problematic, specifically due to ‘the decision-making of calculative governance[.]’. For instance, many state policies are rationalized as benefitting the public, or are pragmatic in their implementation – even when they have punitive effects (cf. Hamlin and Speer, 2018). There is also the matter of public perception and associated will, such as whether the public—however broadly one defines ‘public’ – intends punishment and carcerality upon prisoners themselves (Sparks and Gacek, 2019). Time is certainly an issue to consider here; the detriment felt by those incarcerated, who experienced the intention to harm when it began at the inception of a prison sentence, can still feel incarceration ‘long after actual incarceration has ceased’ (Gacek, 2022: 23). Time, much like public perception, is something we also take up below, as they are pertinent to our discussion as well. Notwithstanding, Moran et al. (2018) indicate both formal and informal structures and/or organizations which intend to administer punishment – or do so already – are necessary for carcerality. While a formal period of imprisonment within an institution of one person or group is a clear instance of this, we must also remain attuned to the informal structures behind intention, such as the norms, motivations and informal expectations of behaviour manifesting within and beyond intention.

Finally, Moran et al. (2018) contend the carceral is achieved by and through spatiality, the third condition of carcerality. Confinement within carceral space, then, becomes a unique opportunity to (intentionally) keep in and (detrimentally) contain many types of people, concomitantly while also purposefully keeping other things and people out. While carceral spatiality ‘is related but distinct from the first two carceral conditions, there is more to it than simply observing the carceral is spatial’ (Gacek, 2022: 24). Certainly, there are aspects to spatial containment which are necessary (as all activities happen within space) but we must be cognizant of the spatial practices, policies and otherwise relationships through and between them; correctional practices and policies, for example, deliver intention, while relationships within carceral spaces where correctional practices and policies operate suggest how one experiences detriment through said practices and policies (Moran et al., 2018).

Taken together, the three carceral conditions enable the existence of carceral space (Moran et al., 2018). Detriment and intention are demarcated through spatiality by literally enclosing practices and policies within socio-institutional boundaries, yet these conditions also set the stage for spatial experiences and relationships to materialize and take place in form and function, within and beyond the carceral institution itself. We contend these carceral conditions benefit our discussion of geriatric carcerality; before we explore the term further, we must demonstrate how we construct age and aging, particularly as it relates the aging crisis unfolding in the Canadian context. This discussion we turn to next.

Constructing age and the aging crisis

While aging is not a uniform process, prisoners over the age of 50 years old ‘are deemed as ageing prisoners in light of their poorer health status when compared to persons of similar age in the general populations’ (Wangmo et al., 2017: 675–676). CSC (2018) also affirms ‘old age’ at 50 years old and older.² We align with the definition presented by Wangmo et al. (2017), and agree with Fitch and colleagues where they suggest scholarly efforts to understand multidimensional aspects of age and aging, insofar as we ‘should incorporate all of the domains of aging: chronological, biological, psychological, and social’ (Fitch et al., 2024: 574). We recognize how chronological age is defined as ‘the period elapsed since an individual's birth’ (Mathur et al., 2024: 1) while biological age focuses upon ‘the molecular damage the body accumulates over time […] [capturing] genetic, metabolic, and environmental changes experienced by an individual’ (Mathur et al., 2024: 1). Moreover, and considering their increasing numbers, Wangmo and colleagues identify three broad groups of incarcerated older persons: ‘(a) those who entered prison at a young age and have aged there; (b) those who entered prison in old age and will further age and die there; and (c) those moving in and out of the prison system’ (2017: 676; see also Crawley and Sparks, 2006) Notwithstanding, there are necessary implications ‘for […] the allocation of resources for care’ (Fitch et al., 2024: 574) as well as redressing if not resolving the aging crisis in the prison system.

In our discussion of the prison aging crisis, we are cognizant how crises ‘play out in peoples’ lives in layered and intersecting ways’ yet it seems how ‘media can only treat one crisis at a time, as if crises existed within a vacuum or [come] in succession’ (Maier et al., 2021: 16). Post-Covid-19 pandemic, we continue to live in unprecedented times, to the point one could suggest we are inundated with crises across many diverse yet interrelated fronts (political, economic, health, justice and so forth; see Maier et al., 2021 for a discussion). In a similar vein, and speaking in regard to older prisoners in the United Kingdom, Crawley and Sparks contend,

[w]ithout wishing to resort too readily to the overworked notion of ‘crisis’ (a term, ironically, prisons seem to attract routinely) it seems clear that, on any sober projection of current tendencies, the number of older prisoners will continue to accumulate for the foreseeable future. This presages a multiplication of needs and demands for which little in the way of planning or provision or, less obviously, cultural re-adjustment, is yet evident. (2005: 345, italics in original)

In the Canadian context, the ‘greying’ of the federal correctional population has become increasingly noticeable, with scholarly (Iftene, 2019; Iftene and Downie, 2020), federal agency (CSC, 2018) and joint organizational efforts (OCI and CHRC, 2019) attempting to better understand this trend. In fact, those incarcerated face poorer health outcomes and a shorter life expectancy (Novisky et al., 2022; OCI, 2015).³ Therefore, we believe the notion of crisis then is warranted, given CSC's alleged lack of planning for OPiC, and equal lack in shifting institutional culture to expand OPiC care otherwise (see, for example, OCI & CHRC, 2019). This is where geriatric carcerality begins to come into view; given how CSC (2018) found OPiC 65 years and older had higher rates of chronic disease than those of similar age within the wider Canadian population, geriatric and medicalized needs of incarcerated persons are important, but must be coupled with a greater nuance of older, outdated – geriatric – identity and purpose the carceral space of the prison still holds for us in society. We say this not to homogenize incarcerated older persons or to reduce the concept of geriatric to healthcare needs alone, but to clarify our frame of reference when we speak about outdated carceral infrastructure, identity and purpose which structures the (un)intentional consequences placed upon older persons and their lives. Bringing geriatric and carcerality together through our conceptual design reveals the connections between carceral and geriatric institutions where older persons are increasingly finding themselves and fuels the need for resolution within and across these spaces.

The prison: Where old idea(l)s meet new?

We contend punishing prisoners through the aging process has become a significant institutional feature of imprisonment, especially when one considers the geriatric carcerality of the prison as a modern institution. Yet we realize there are multiple interpretations of what an ‘institution’ could be in a carceral context. For example, Goffman's (1961) examination of the ‘total institution’ remains a significant understanding of the totalizing effects incarceration can have upon the behaviours and perceptions of those living within institutional spaces. Relatedly, Foucault (1977) explores how the prison has shifted over time in its form and functioning of deploying punishment upon prisoners; this is coupled with observing how the shifting discourse of power and discipline over time are (re)enacted within institutional spaces. These are not the only interpretations, however; more recent scholarship has examined the prison as a ‘porous institution’ (Ellis, 2019), and as a ‘reinventive institution’ (Crewe and Ievins, 2020). In each instance, scholars attempt to highlight the human experiences of confinement within unique spaces of incarceration, respectively, but they also highlight how prisons can be sites of spiritual, religious and/or narrative rebirth (Ellis, 2019; Crewe and Ievins, 2020). Indeed, as Crewe and Ievins indicate, connecting ‘institutional functions – what the prison does generically – […] [to] the particular relationship between the institution and the individual’ matters (2020: 572, emphasis in original), especially those ‘whose subjectivity is shaped by social circumstances and life experiences’ (2020: 572). Yet this raises the question of whether geriatric carcerality, for the purposes of our discussion, is solely a modern aspect of the prison. While prisons can be prominently connected to spaces of separation, confinement, constraint and socio-moral denunication, can we determine whether age-related effects of incarceration have always been part of the modus operandi of the prison-as-institution?

Historical accounts of prisons suggest the purpose of prisons demonstrate a balancing act between punishing the prisoner and correcting them (Sellin, 1931; Schneider, 1979). Of course, in either case, ‘punishment’ or ‘correction’ are socially constructed and contextual. Yet, Sellin's account highlights how through much of ancient, mediaeval, and modern times the prison exacts punishment upon those ‘to intimidate the criminal, inflict suffering upon him [sic], deter him and others from crime, and protect society’ (1931: 1). Despite the varying methods of punishment existing – lashing, branding and/or maiming the criminal was frequently employed – it is the prison where the aim of correction becomes a central focus (see also Foucault, 1977). Despite the respective evolutions of prison reform in the West,⁴ the question of how best to correct prisoners (for themselves, and for the safety and security of the community) equally becomes a central aim of the prison-as-institution. How best to correct? Will labour, prayer or solitary confinement deliver correction (Sellin, 1931; Schneider, 1979), or something else?

The idea of correction – or even rehabilitation – is not new; as Schneider reminds us ‘prison as a rehabilitative device goes back at least to Plato’ (1979: 708). And scores of literature already demonstrate prison as a place of rehabilitation, too numerous to discuss here. Yet, we contend age always was treated as a byproduct to the rehabilitative ideal; if prisons are meant to correct prisoners so most can be released back into the community at some point in the future (subject to the severity of the crime), then punishment through prisoners aging was never the prison institution's intention – until now. Even Sellin (1931: 5) remarks how, at the time of writing, prison populations in the United States and Europe were decreasing, due to ‘the increased use of probation, fines, and other non-institutional forms of treatment’. If rehabilitative ideals are best served through a variety of punitive methods (and not relying solely upon the prison), then logic follows a prisoner's rehabilitation would not jeopardize their age. What makes our current reality different than these historical antecedents?

It appears, among other considerations like the sentence imposed upon the prisoner, jeopardizing age has become an important punishment in the modern iteration of prison. Prison policies and practices intend to keep people locked in prison, and the relationship between the incarcerated and the carceral space itself serves to keep them away from society, to the detriment of the age of the incarcerated. If we are correct to assert that historically, aging has never factored into punishment, but was merely a byproduct of prisoners spending time in the prison institution itself (regardless of how bored or idle they appeared, or how much ‘correction’ they required), then where does this leave us? Given the pervasive culture of control (Garland, 2002; Sparks and Gacek, 2019) and expanding carceral age (Gacek, 2022), has a punitive ideal of the prison institution overtaken a rehabilitative one? If it is true ‘the goal of rehabilitation (and humanitarianism) significantly motivated the people who built [prisons]’ (Schneider, 1979: 743) then this also begs the question of, as Schneider contends, ‘why societies adopt the institutions they do, and about the closeness of the fit between the structure of society and the institutions it uses’ (1979: 745). Prison, we believe, provides the opportunity to punish through one's aging process; while not its original raison d’etre, its identity can be shifted to accommodate a new and now modern form of punishment to the disadvantage of the aging prisoner. Recognizing how societies are getting older and living longer (Gilbert et al., 2024; Van Vloten, 2025), we must now interrogate, among other things, the age-effects of separating people from society through the prison, and incarcerating them for long(er) periods of time. This also speaks to more expansive and diffuse ways to enact carcerality beyond the anchorage to the prison institution, something we consider next.

Geriatric carcerality: From the prison to other forms of geriatric confinement

As Moran and colleagues contend, ‘the scales of deployment of carceral techniques and infrastructures demands critical attention’ (2018: 668; our emphasis). Infrastructure becomes central to the housing and incarcerating of OPiC, but also to their continued punishment within prison and post-release. In their discussion of conceptualizing the carceral, the authors examine Foucault's (1977) distinction between ‘compact’ and ‘diffuse’ methods of expanding the carceral throughout society. In making the distinction, Moran and colleagues (2018: 668) state:

Foucault identified colonies for the poor, almshouses, institutions for abandoned children and factory-convents flowing out from, and adopting aspects of, the ‘compact’, institutional, carceral model. Moving ‘still further away from penality in its strictest sense’, he argued, ‘the carceral circles widen and the form of the prison slowly diminishes and finally disappears altogether’ (Foucault, 1977: 298). Beyond the ‘compact’ institutions, then, lay the more ‘diffuse’ carceral models, such as charitable organizations, housing associations and moral improvement societies, which used ‘carceral methods’ that assisted but also surveilled. And beyond these still lay the ‘great carceral network’ that ‘reaches all the disciplinary mechanisms that function throughout society’ (Foucault, 1977: 298).

It is this carceral ubiquity we find fascinating, especially in light of our discussion of geriatric carcerality. Importantly, our concept differs from existing work in carceral geography, prison health and biopolitical aging because it recognizes the diffusion of carcerality within the prison (as compact institution), but also beyond the prison through diffuse carceral techniques and methods of maintaining dominance and control over current and former OPiC, as well as law-abiding and/or civilian geriatric populations in society. Discussions of old age challenges exist in carceral geography and biopolitical aging discourse (see Repo, 2018, 2024), and taking into consideration ‘austere custodial physical infrastructure’ (Novisky et al., 2021: 1632) it has been argued in prison health literature how incarceration is a ‘potent structural driver of health inequalities’ (Novisky et al., 2021: 1630). Yet there has been no discussion of bridging these perspectives in a way which acknowledges how the institutional infrastructure – the buildings, policies, structural procedures, intentional logics, cultures, etc. – for older people in society are also bound to an older, outdated (geriatric) identity and purpose of the carceral space itself. Especially in the Canadian context, compact institutions and diffuse carceral models have not kept up with the needs older people have and the increasing health services they require. While there are examples of compassion and concern for older persons in Canadian federal prison environments (OCI and CHRC, 2019), the politics and funding connected to these carceral spaces (Turner et al., 2023) make the care and services inside them questionable. Given the expanding size and increasing age of the prison population, if the detriment of confinement worsens prisoners’ ages, then the intent of confinement (and perhaps the identity of the prison-as-institution) seems to punish prisoners through the aging process (Feeley, 1992), which ultimately fuels the current aging crisis. As we examine below, in different ways, and by (intentionally) keeping in and (detrimentally) containing OPiC, the prison now excludes and isolates OPiC from the outside, while also restricting access to care and health services they need.

Correctional and institutional spaces are not all the same, and jurisdictional differences and socio-cultural experiences will vary; yet the ‘greying’ trend in Canadian prisons (OCI and CHRC, 2019) and Canadian society (Van Vloten, 2025) suggests a developing crisis of care and health services may be unfolding. This requires us to formulate a concept like geriatric carcerality which recognizes the current state of institutional affair in the correctional context, but also connects them to socio-institutional geriatric contexts beyond the anchorage to the prison. For example, are there similarities and/or differences between prisons and other institutions of geriatric confinement broadly defined? Is geriatric carcerality an institutional feature affecting non-geriatric carceral populations? To answer these questions, we draw upon aspects of Vannier's (2025) categorizations to demonstrate how our focus upon geriatric carcerality connects to the prison in its modern form, function and identity. Vannier (2025) outlines the ‘quality of pains’ criminological research presents as distinctive, categorizing the qualities in terms of (1) deteriorating and dying bodies; (2) carceral bodies as objects of medical analysis and (3) deteriorating bodies and the inadequacy of carceral environments. We expand Vannier's categories to consider other geriatric carceral institutions beyond the prison, and the diffusion, costs and consequences of geriatric carcerality upon non-carceral geriatric populations. Our categories are as follows: (1) the inadequacies of prisons and long-term care homes as geriatric carceral institutions; and (2) the imbalance between geriatric carceral care and control. We outline each in turn.

The inadequacies of prisons and long-term care homes as geriatric carceral institutions

The prison remains ‘an anchorage point within which one may imbue meanings, experiences, and relationships with spatiality [in mind]’ (Gacek, 2022: 58). Yet the geriatric bodies residing within it, coupled with the tethering of these bodies to practices and policies not conducive to geriatric bodies, suggests the prison as a ‘modern’ institution (if we can call this arguably archaic structure that) has shifted its form to reconsider geriatric contexts, but not its function. What we see then is an institutionalization of geriatric issues related to OPiC, but scant concern with how OPiC function within the prisons themselves.

We call into question how and in what ways the prison connects to other forms of geriatric confinement, arguably witnessed in nursing and long-term care (LTC) homes. Research demonstrates the power prisons exude over people residing and working within them (Sykes, 1958; Foucault, 1977; Moran et al., 2016; Turner et al., 2023). As Turner et al. (2023: 2) highlight, ‘[r]egardless of where on the scale between extreme punitiveness and progressive exceptionalism they exist, prisons are deliberate societal constructions designed and manifested in ways enforcing spatial restriction, securitization, and loss of liberty upon the persons incarcerated within them’. Moreover, as Ben-Moshe (2020: 15) contends, ‘incarceration is not just a space or locale but a logic of state coercion and segregation of differences’. Below we outline our thoughts on how we design and segregate difference within modern institutions, particularly in prisons and LTC homes. In doing so, we suggest there exists an inherent assumption within prison and LTC design about the lives and lived experiences residing in these institutions.

Of course, we acknowledge LTC are not prisons; though they may exist and parallel carceral institutions like prisons, LTCs are traditionally embedded in the discourse of public and/or private care rather than punishment (Koncul et al., 2023). Moreover, institutions like hospitals traditionally have been intended as spaces to ‘cure’ the ‘unwell’ so reintroduction into mainstream social spaces occurs (Repo, 2018). In Repo's (2018: 234) view, however,

[t]here is a different end goal in nursing homes. The main purpose of nursing homes is not to cure but to be the final homes of elderly people and to take care of them until the end of their lives. Such practices of care also involve different actors variously giving up, and taking control of, many basic, quotidian processes.

Repo's (2018: 233) work explores how the nursing home can take on carceral logics and become a quasi-carceral environment sitting ‘uneasily on the continuum between care and control’. Their research on Finnish nursing homes found ‘spatial design and use of institutional care settings, often overlooked in […] elderly care, are […] major determinant[s] of residents’ well-being’ (Repo, 2018: 234). Indeed, the determinant of design, coupled with the detriment several residents remarked in Repo's (2018) interviews, suggests an intertwining of (quasi-)carceral logics at work. In our view, LTCs and prisons work on ‘parallel tracks and logics’ (Ben-Moshe, 2020: 65), of which requires further investigation. Unfortunately, as Milligan (2009: 21) notes, ‘[i]nstitutional care has been seen to represent a spatial solution to particular ‘problems’ usually arising as a consequence of frailty and age’. While some may recognize segregation ‘as part of the LTC experience and accept the situation’ (Koncul et al., 2023: 312; see also Nakram et al., 2012), others ‘might be coerced or forced to move to an LTC and lawfully deprived of their liberty as part of their care’ (Koncul et al., 2023: 312; see also Dwyer, 2010: 1515). People in LTCs have reportedly expressed feeling frustrated by a ‘lack of freedom to leave’ (Shiells et al., 2020: 1563, as cited in Koncul et al., 2023: 312) with some LTC residents suggesting they are living in ‘prison-camps’ to describe their living situations (for discussion see Wiersma and Pedlar, 2008). Repo's (2018) work highlights the spatial control and mistreatment experienced by nursing home residents, coupled with feelings of being ‘locked up’. Others have also likened the LTC experience to incarceration: ‘like a prison without bars’ (Heggestad et al., 2013, cited in Koncul et al., 2023: 312). Certainly, ageist institutional cultures and staff attitudes reinforce invisibility and neglect for OPiC and their community counterparts. Notwithstanding, we believe it necessary to query ‘all forms of enclosure and confinement, including those found in social and health care, and the logic that motivates them’ (Koncul et al., 2023: 312).

For example, techniques and practices of control and restraint particularly viewed in prisons and LTC suggests there is a carceral logic infused within and across both geriatric institutions. Increasingly, ‘the restraints that keep people confined are not merely social, nor environmental, but often also material (such as belts, straps, locked wards, physical walls), or chemical, involving antipsychotics and other psychotropic medications that can alter [LTC] residents’ perceptions and experiences of time and space’ (Koncul et al., 2023: 312). Moreover, and within the socio-spatial organization ‘of everyday life in long-term care, residents who resist dominant interpretations and routines may be labelled as challenging and/or disordered’ (Koncul et al., 2023: 312). Therefore, LTCs resonate with carceral spaces and logic, as they are ‘typically and social organized to stratify residents through spatial partitions that construct and reinforce status hierarchies within the home’ (Koncul et al., 2023: 312). Importantly and relatedly, prison staff are neither equipped nor adequately trained to provide care for OPiC, as staff are meant ‘to run prisons, not old-age homes’ (Aday, 1994: 53). However, recently work has been done regarding staff training in the intricacies of older adulthood, cognitive impairment and palliative/hospice care (Bronstein and Wright, 2007; Myers et al., 2022; Sundt et al., 2024). Certainly, lack of staff training and resources (OCI and CHRC, 2019) fuel the federal prison aging crisis we witness at present.

Furthermore, we must also recognize how the physical conditions of a correctional facility significantly impacts those inside (Bierie, 2012; Ricciardelli, 2019). As Turner et al. (2023: 7) contend, ‘outdated building infrastructure, poor ventilation and plumbing systems all factor into the health of a prison itself and to those who work and are incarcerated inside of it’. In their research on correctional officer health and well-being, Turner et al. (2023: 15) found ‘the relationship between prison infrastructure and the lived experience of prison space is integral to the health and wellness of people living and working in prisons’. Although, we acknowledge infrastructural conditions in the Canadian federal context remain due to a historical lack of investment in carceral space, political will, public opinion, culture and contemporary budget restraints (Turner et al., 2023; see also Gacek and Sparks, 2019 for supplementary discussion). Our conversation of geriatric carcerality exists in a Canadian sociopolitical climate ‘where prison investment continues to be combated by calls for decarceration and prison abolition’ (Turner et al., 2023: 18). A tension arises here, where investing in better health care in prison may mean overall investments in federal corrections which, in Canada, is met with political and public backlash. Despite the recognition, for example, ‘a reduction in the prison population may actually enhance the operational budget’ of prisons (Turner et al., 2023), raising an important conundrum for potential prison investments and policy reform which might remedy prison aging challenges (i.e., infrastructure, OPiC and otherwise).

In connecting with the previous section, Koncul et al. (2023: 312) contends

The carceral ethos of LTCs can be traced back to the 19th century, when older people […] were routinely confined to institutions. Institutions were ‘asylums and workhouses’, and residents were expected to adhere to harsh institutional norms such as compliance and silence (Andrews, 2018). People […] did not fare well, as neither the condition nor a person's needs were understood.

If we fail to recognize the carceral ethos of both prisons and LTCs, three challenges arise. First, we doom ourselves to tolerating instead of casting off pernicious carceral policies and practices. Second, we also make it more difficult for us to contain – if not extinguish – the aging crisis in federal prisons. Third and final, we jeopardize the scales of balancing care and control within these modern institutions, a significant point we discuss below.

The imbalance between geriatric carceral care and control

It is legally and legislatively necessary for CSC to uphold care of federal prisoners, older or otherwise. While scholarship has questioned the nature, scope and delivery of this care (Iftene, 2019; Iftene and Downie, 2020), we supplement this with a reconsideration of how the prison as a modern institution does not provide substantive care to its residents, and whether the balance of care and custody has shifted to favour the latter, superseding the former.

Parr (2003: 213) indicates traditional ‘care’ in health care has been understood in medicalized terms, including but not limited to the ‘use of drugs, surgery … and medical expertise of various sort’. However, ‘attitudes towards care are gradually changing so that it is not seen as only satisfying residents’ basic needs, but as also including arranging activities and social interaction’ (Repo, 2018: 234–235). Care ultimately becomes quite complicated in geriatric carceral institutions; to the extent care is even adequately accessed and provided, this begs the question of the staff training and/or compassion to deliver care comprehensively.

Carceral space and risk are intertwined. First, ‘carceral spaces are usually established for those who are seen as a risk to themselves, to others or to society. What can be considered as risk varies at different times and in different areas’ (Repo, 2020: 124). In their research of Canadian federal prisons, wellness and wellbeing, Turner and colleagues (2023: 6) contend:

Overcrowded prisons, in part due to double-bunking and lack of physical distancing opportunities, represent a risk of contagion in environments that are confined. Incarcerated persons housed in an overcrowded environment are at a higher risk of contracting upper respiratory tract infections associated with exposure to airborne pathogens such as pneumonia, influenza, and TB [tuberculosis] and, as was most recently and acutely recognized, the COVID-19 pandemic is evidence of this risk.

Of course, Repo reminds us ‘[t]he possibility of harm is not seen as equal for all people, but depends on various aspects, such as age, gender and geographical location’ (2020: 123). Such spaces, especially as we examined in the previous section, ‘both employ multiple risk assessment methods and practices to, for example, decrease violent behaviour […] and use various therapeutic measures and techniques in challenging situations’ (Repo, 2020: 124). It is noteworthy how care within these carceral and geriatric institutional spaces is ‘at particular risk of giving way to “careless” control’ (Repo, 2018: 235). As Repo (2018: 235) contends, ‘[t]he idea of “care without caring” can be seen as a route to control, particularly in terms of the use of space. It is seen overtly in those cases of spatial mistreatment when everything that is not included in the mandatory regime or paid for is excluded/omitted or when residents are left alone for protracted periods of time’.

The apparent lack of a penal element suggests nursing homes can, at most, be called quasi-carceral settings. However, as Repo reminds us:

These settings are not carceral ‘by design’, but can be experienced as such. The contradictory nature of care and control in institutional elderly care shows how the built environment and infrastructure as well as relational factors need to be considered to address this pressing contemporary problem. In light of new developments and increasing automatised care, an understanding of the effects of lack of interaction and human touch in this fragile balance of care and control in ‘care environments’ is needed. (Repo, 2018: 239; italics emphasized)

One could argue if the intent of prison design now is to punish aging persons then it is surely succeeding. A lack of public investment in carceral space, especially in the Canadian context (Turner et al., 2023), intentionally detriments OPiC to the point where prisoners – now housed for longer periods of time in older, prison institutions—are punished, symbolically and substantively, through the aging process. In terms of the former, we see how the prison serves as a historic and modern symbolic site of punishment, and so symbolically those who are locked up in prison and those who age in prison become one in the same. In terms of the latter, we see how a lack of continuous care services, coupled with aging infrastructure, suggests the modern intention of ensuring the health and well-being of prisoners does not improve compared to what substantive care services they might receive in the community (of course, systems-level challenges remain for community care services; see Poulin et al., 2023; Colibaba et al., 2023). CSC (2018) and the joint report authored by the Office of the Correctional Investigator and Canadian Human Rights Commission (OCI and CHRC, 2019) remark, in varying ways, more could be done to increase the care towards OPiC and meet their comprehensive needs; the challenge, though, now lies in determining whether there is enough political and public will to alter current federal prison infrastructure and patient services to keep pace with increased care. Intentionality becomes a culmination of not only prison design, but also politico-institutional austerity and inertia, alongside inadequate infrastructure (Turner et al., 2023), aspects which straddle both LTCs and incarceration (for discussion see Boucher et al., 2021; Gilbert et al., 2024). Indeed, for older persons the intentionality can feel punishing for them (Feeley, 1992). When ‘care environments’ (to which we argue the prison now exists in this category with LTC spaces) swings the pendulum too far towards control, care gets left behind, to the detriment of those locked up and away from society.

The pain quotient: Time as punishment

Of course, we must ask: How does time function as a tool of punishment? And do similar patterns emerge in LTCs? To explore these questions, we turn to Humblet (2025), who builds on Farber's (1944) discussion of the relationship between time and punishment. Farber (1944) demonstrates that perceptions of time shift across the life course, shaping how imprisonment is experienced. Younger prisoners view time with hope – ‘life is still ahead’ – whereas middle-aged individuals lament lost potential, believing ‘the best years of their lives are spent in prison’ (Farber, 1944: 175, cited in Humblet, 2025: 675). For older inmates, the passage of time signals a stark finality: ‘life is already lived’ (Farber, 1944: 175, cited in Humblet, 2025: 675).

This relationship between time and suffering is not unique to prisons. LTCs, too, impose a distinct temporal experience on their residents. In both institutions, time is paradoxically endless and stagnant – ‘nothing distinguishes one hour from the next’ (Serge, 1970: 30, as cited in Meisenhelder, 1985: 45). For older persons, whether in prison or elder care facilities, this sense of temporal monotony poses a significant challenge to meaning-making. (Re)constructing meaning in one's life is a universal human need (cf. Neimeyer, 2001, 2016), yet the subjective nature of meaning renders it particularly vulnerable to institutional deprivation. The past, for these individuals, is a repository of memories defining their identity, while the present is shaped by the limited remaining future. However, the few remaining avenues for meaning are constrained by institutional structures limiting autonomy and reinforce a sense of invisibility.

A key aspect of this temporal suffering is what O’Donnell (2014: 202, as cited in Humblet, 2025: 678) calls the pain quotient (PQ) – the ratio between ‘time to be served’ and ‘time to be lived’. For younger prisoners, the PQ is relatively low; they can anticipate a future beyond the carceral space. For aging inmates and nursing home residents, however, the PQ is significantly higher. With life expectancy diminished, the likelihood of experiencing a meaningful existence outside institutional confinement is minimal, making their punishment – whether imprisonment or institutionalization – even more severe.

In both institutional settings and through their respective operating processes, older persons confront a disorienting reality. Entry into prison or elder care facilities disrupts their sense of identity, while the prospect of release – if it even exists – can be equally destabilizing. The challenge of rebuilding a life after long-term incarceration is particularly daunting for older adults, many of whom have lost crucial sources of meaning, such as careers, relationships and a defined life purpose (Humblet, 2025: 680). Furthermore, older inmates experience what Humblet (2025) describes as the spatial restrictions of the prison compounded by the physical limitations of aging bodies. This confinement, coupled with ageist institutional practices, fosters internalized self-devaluation, rendering older prisoners persona non grata and further eroding their ability to find meaning.

Adding complexity to the discussion of the pain quotient is the role of gender. Older women in both prisons and LTC may experience a disproportionately high level of suffering (see, for example, Wahidin, 2002). Beyond the existential struggle of a limited future, incarcerated women must also navigate the additional trauma of separation from their children (Welch, 1991). The intersection of age, gender and carceral suffering thus amplifies the punitive nature of time in these institutional settings.

An inherent paradox underlies our discussion: improving healthcare in prisons could lead to longer life spans for incarcerated individuals, thereby extending their sentences. However, research on healthcare access in carceral spaces – especially during the COVID-19 pandemic – suggests better healthcare can only be achieved through decarceration. Wang et al. (2020: 2257) highlight the stark differences between prisons and other institutional settings, noting:

Despite being a focal point of the pandemic and past respiratory outbreaks, correctional facilities have not consistently been included in pandemic planning or guidance. Unlike in nursing homes and other long-term care facilities, which were also sources of outbreaks, healthcare in prisons and jails has no mandatory independent quality oversight nor is it integrated with community health systems.

Given these structural deficiencies, we must consider alternative models for addressing the needs of aging incarcerated populations. As OCI & CHRC (2019: 3) aptly state, ‘[p]risons were never intended to be nursing homes, hospices or long-term care facilities. Yet increasingly in Canada, they are being required to fulfil those functions’. To mitigate the profound suffering imposed by institutional time, policymakers must explore alternatives acknowledging the unique needs of aging populations. What can we do to ensure incarceration does not become a de facto death sentence for those who have already served a lifetime of punishment?

Social, legal and policy implications

If we were to create a Venn diagram of LTC and incarceration, we would suspect to see an increasingly single circle. Understanding the similarities between carceral settings and elder care facilities in shaping the lived experiences of older individuals reveals a shared need for a greater humanitarian approach. For older Canadians in these spaces, finding meaning in later life is often out of reach due to the ageist structures of these institutions and the tendency to render older individuals invisible. This invisibility, in turn, leads to negative treatment by prison staff (Humblet, 2025) or care staff in elder care facilities. Despite these challenges, older individuals in both settings find meaning through two key pathways. First, offering mentorship and guidance to younger individuals serves as a vital source of fulfilment. Intergenerational interactions – whether mentoring younger inmates (Humblet, 2025) or engaging with visiting youth in elder care facilities – foster a sense of purpose across institutions. These opportunities not only provide immediate meaning but also create a foundation for continued engagement in meaningful activities or projects. Second, meaning making at the individual level (Neimeyer, 2001, 2016) must be addressed for both OPiC and community dwelling older adults. How we make sense of meaning through loss, loneliness and isolation matter to how we move through grief and bereavement to envision a renewed meaning and sense of love and purpose (Neimeyer, 2001, 2016). Given these insights, policy development should prioritize the role of life-meaning in these environments and establish structured opportunities for older individuals to participate.

We also highlight efforts to better understand ‘successful aging’ (e.g. see Avieli, 2022; Kenkmann and Ghanem, 2024) alongside efforts to balance structural critique of inadequate infrastructures with recognition of personal agency, identity and development (Avieli, 2022). While the interest in older populations and their lives grows, so too do initiatives and multidimensional models to assist them navigating ‘health concerns, social relations and everyday activities’ while they deal with the uncertainty in their futures (Kenkman and Ghanem, 2024: 72). Policies and practices which improve custodial and community living arrangements for this group would be a step in the right direction (Kerbs and Jolley, 2009, OCI and CHRC, 2019), but also social reform in policies which better support making cities and communities more ‘age friendly’ (Codd, 2020). This would increase older individuals’ chances of community reintegration and rehabilitation, and lead us upon a better path towards cultural, if not societal readjustment (Crawley and Sparks, 2005). Doing so can help mitigate the effects of geriatric carcerality, ensuring aging populations in both carceral and care settings maintain a sense of dignity and purpose.

Finally, and with a sensitivity towards legal complexities, we underscore necessity for nuanced approaches to navigate prison aging in terms of expanding federal prison palliative care and compassionate release, respectively (Iftene, 2019; Iftene and Downie, 2020; Gacek et al., 2026). Given the continued debate of age segregation in prison (Kerbs and Jolley, 2009; Wangmo et al., 2017), better accommodations or release options need to be considered, as current prison healthcare system challenges encourage us to rethink the very purpose of incarceration and the principles of justice it upholds. Clearly, reforms for adequate care and humane treatment demonstrate how the rights of older persons are fundamentally tied to our collective responsibility as a society (Crawley and Sparks, 2005; Wangmo et al., 2017).

Concluding thoughts

In our efforts to coin and develop geriatric carcerality, we provide a way to reframe concerns regarding the ongoing nexus between OPiC and the process of incarceration in Canada. As Crawley and Sparks contend,

in the case of older prisoners, what is at stake is, amongst other things, a chronic incapacity both specifically vis-à-vis physical or mental abilities and, more generally, a structured inability to protest or register complaint in an effective manner. For these reasons, our conceptual and analytic terms of art may need to be significantly rethought in order to deal with particularly powerless fractions of the prison population. Older prisoners have repeatedly made us, as researchers, aware of otherwise un-voiced objections to the legitimacy of aspects of their treatment. Nevertheless […] these conditions generally falls below the horizon of attention both of their custodians and of the wider research and policy communities. (2005: 355; italics emphasized)

We leave on the choice term ‘chronic incapacity’; while similar to our pertinent discussion of geriatric carcerality, the term mentioned in Crawley and Sparks’ (2005) work is fascinating for two reasons – as descriptive of the continuous challenges facing OPiC medically on the one hand, but also a reminder of the longstanding question surrounding the purpose and identity of prison as a modern institution on the other. Continuous challenges are faced by OPiC and they remain principally silenced when enduring abuse and neglect (Arias et al., 2023). As our conceptual and analytical term of art, geriatric carcerality spurs us to reevaluate the ethical imperatives of providing empathy, compassion and care towards older persons, whether in custody or society at large. Recognizing the vulnerabilities OPiC experience in Canadian society, we believe our concept and subsequent efforts to reconsider the prison in its now geriatric context helps reconsider the chronic carceral age we currently occupy (Gacek, 2022). In addition, such recognition also services to aid and supplement those voices who call for evoking change in the prison system, and interrogate the extent to which carcerality chronically leaches out into other forms of confinement, spaces and practices as experienced by and through geriatric populations. Given the expansion and diffusion of geriatric carcerality, this should give us pause. Now is the time to recentre resistance against increased carcerality and to shed light upon the legitimacy of geriatric institutional environments intertwining care and incapacitation.

Footnotes

ORCID iD

James Gacek

Funding

The authors received no financial support for the research, authorship and/or publication of this article.

Declaration of conflicting interests

The authors declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Notes

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