"We're not patients. We're inmates": Older Black women's experience of aging, health and illness during and after incarceration.

BACKGROUND AND OBJECTIVES: The incarcerated population is growing older and by the year 2030, more than one-third of people incarcerated in the United States will be over the age of fifty-five. This population shift will have a profound impact on correctional healthcare systems as older incarcerated people often have multiple chronic illnesses and correctional institutions were not designed with aging and disability in mind. Black women experience greater burdens of comorbid conditions and are disproportionately represented among incarcerated women.

RESEARCH DESIGN AND METHODS: We utilized Black Feminist Epistemological Methodology to explore the intersection of aging, chronic illness, and mass incarceration via in-depth interviews with thirteen formerly incarcerated older Black women.

RESULTS: First, participants described needing to prove themselves to be trustworthy prior to becoming ill in order to be believed and granted access to care when they report symptoms. Next, participants report being treated, not as patients, but as "inmates." The punitive nature of prison healthcare disrupted the patient-provider relationship and complicated the ability of patients to maintain autonomy in healthcare interactions. Finally, we describe how carceral health extends beyond the walls of both the clinic and the institution.

DISCUSSION AND IMPLICATIONS: For older Black women, medical care and decision-making inside prisons occur with a punitive context which presents unique barriers when seeking care. Their experiences of health and illness while incarcerated may continue to influence if and how they seek care as they age in the community and thus must be interrogated when discussing aging in the Black community.