In struggling prison systems already overwhelmed by the sheer number of prisoners they are housing, there is a quickly growing problem that many are not equipped to handle. Prisoners, many of them violent criminals, are now facing one of the most serious problems in the aging population, dementia, including Alzheimer's disease. Elderly prisoners, defined by the prison system as those over the age of fifty, currently make up a quickly growing number of the prison population. Life sentences account for nearly ten percent of all inmates while another eleven percent are sent to prison for at least twenty years. Prisoners in that age category are increasing as well. In 2010, more than two times as many people age fifty five or older were sent to prisons around the US as were sent there in 1995.

There have been no official counts for how many inmates are dealing with dementia or cognitive impairment. For one, there are not enough trained staff to make those determinations. In addition, some of the most common symptoms of some forms of dementia may be mistaken for just plain behavioral issues which are all too normal within the prison system. Experts estimate that because of the increased number of risk factors for these conditions, dementia affects more inmates than the general public.

The medical cost of caring for the aging prisoner can increase as much as three to nine times more than to house a younger, healthy inmate. Because of some of the factors of dementia, including paranoia and confusion, these prisoners must often be protected from others who may attack or take advantage of them. In addition, the increased paranoia and the noise and confusion of prison life may lead to an increased risk of attacks on prison guards, other prisoners and visitors like mental health evaluators. In some cases, the prisons have suggested paroling these prisoners and sending them to nursing homes. Nursing homes are not happy to take these prisoners, especially those with violent histories.

New York has created a separate unit for these inmates, bringing in professional caregivers but the cost is more than twice the yearly cost of what is spent on the general population. Two other states, Louisiana and California are training their prisoners to take care of some of the more minor duties for the cognitively impaired prisoners. In California, those prisoners are called the "Gold Coats". They earn fifty dollars each month for shaving, bathing, feeding and other duties for the most seriously impaired prisoners. In addition, because of their training, they are often the first to notice potential warning signs that may warn of ongoing dementia problems.