# Assessing Needs and Advancing Dignity-Conserving Care for Hospitalized, Incarcerated Older Adults: Clinical Data, Patient Experience, and Policy Evaluation

> **NIH NIH K76** · MAYO CLINIC ROCHESTER · 2024 · $243,000

## Abstract

The United States incarcerates more people per capita than any other developed democracy. Persons behind
bars retain a fundamental, Constitutionally-protected right to receive community-standard healthcare. A multitude
of factors prior to confinement, such as low educational attainment, exposure to violence, housing insecurity,
and history of childhood trauma, likely contribute to the poor health status of the U.S. prison population. As a
consequence of harsh sentencing practices of the 1980s and 90s, 1 in 7 adults in prison is serving a life sentence.
This means our prison population is aging at an unprecedented rate. Incarcerated people face earlier disease
onset and faster progression than community-dwelling, age-matched peers. This translates to an increasingly
frail and medically complex prison population, with high rates of cardiovascular disease, cancer, and dementia.
When an incarcerated person’s needs exceed the prison’s healthcare capabilities, they transfer to a hospital in
a neighboring community. Yet vanishingly little is known about these encounters. Multimorbidity, high prevalence
of familial estrangement, poor advance directive completion, shackling, correctional officer presence, stigma,
and heterogeneous correctional policies all contribute to these ethically fraught hospitalizations.
The proposed work will address key knowledge gaps about the clinical, geriatric, ethical dimensions of need for
hospitalized incarcerated older adults. Aim 1 will leverage a unique dataset from a 5-state hospital network,
spanning 25 years and thousands of hospital admissions to define prevalence and temporal trends in factors
such as age, delirium and advance directive completion. Aim 2 will apply state-of-the-art qualitative methods to
characterize the experience of hospitalization for an incarcerated older adult from multiple vantage points:
patient, family, correctional officer and bedside nurse. Aim 3 will apply a sophisticated analytic lens to evaluate
prevalence and contents of state and federal policies pertinent to the hospital care of older adults.
The candidate, Dr. Erin Sullivan DeMartino, is clinician-ethicist in Mayo Clinic’s Division of Pulmonary and Critical
Care Medicine with a track record of high-impact original research publications and a GEMSSTAR award from
NIA. She has engaged a world-class mentorship and advisory team. Her primary mentor, Dr. Jon Tilburt, is a
visible and established empirical bioethics investigator committed to the development of junior colleagues. Dr.
DeMartino has recruited a team of internationally recognized co-mentors and advisors with diverse backgrounds,
offering expertise in geriatrics, correctional health, ethics, and qualitative and quantitative methods both for the
aims and the career development plan. Dr. DeMartino has outlined a rigorous training plan, drawing upon the
vast resources of Mayo Clinic and national methodologic, geriatric, and leadership development opportunities.
Mayo Clinic’s Kogo...

## Key facts

- **NIH application ID:** 10954369
- **Project number:** 1K76AG088403-01
- **Recipient organization:** MAYO CLINIC ROCHESTER
- **Principal Investigator:** Erin S DeMartino
- **Activity code:** K76 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $243,000
- **Award type:** 1
- **Project period:** 2024-08-15 → 2029-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10954369

## Citation

> US National Institutes of Health, RePORTER application 10954369, Assessing Needs and Advancing Dignity-Conserving Care for Hospitalized, Incarcerated Older Adults: Clinical Data, Patient Experience, and Policy Evaluation (1K76AG088403-01). Retrieved via AI Analytics 2026-06-13 from https://api.ai-analytics.org/grant/nih/10954369. Licensed CC0.

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