A concept evolution inspired by Delphi: The quest for a fair and dignified model for ageing in prison

As prison populations age, correctional systems face mounting challenges in meeting the complex needs of older people in custody. This study co-produced a conceptual model for prison-based aged care through a Delphi-inspired, multi-stakeholder process. Building on a prior systematic review, we proposed a baseline model comprising three foundational pillars - People (relational care), Purpose (meaning), and Place (safe environment). Through five iterative focus group discussions with a total of 17 participants involving family members, aged care professionals, advocates, and mental health workers, the model was refined to reflect lived realities, systemic gaps, and transformative possibilities. Participants identified widespread ageism and neglect in current practices, such as inadequate health provision and age-appropriate care, isolation, poor staff training, and the absence of meaningful activity or rehabilitative support. However, they also envisioned alternatives, including peer-led care, secure aged care units, and trauma-informed workforce strategies. The resulting model offers a rights-based, relational, and rehabilitative framework to guide policy and practice, centring dignity, wellbeing, and purpose in the experience of ageing in prison.