Inmates in U.S. prisons are older and sicker than ever before, presenting multiple chronic health concerns. Although prison officials and politicians are becoming more aware of and responsive to the special needs of aging inmates, barriers continue to impair States' ability to respond effectively to an aging prison population. Most States are faced with the rising costs of medical care coupled with general prison overcrowding. There is some public support for special treatment or separate facilities for older inmates, but others argue that this is likely to make programming for the general inmate population less accessible to older inmates. Further, there is disagreement about the ethical and legal obligation of prisons to provide inmates with such acute care as heart bypass surgery or kidney transplants, given that many people in the Nation's general population cannot afford the same level of care. Professional staff specifically trained to work with older inmates is essential. Assessment that provides early and accurate information on the complex needs of older inmates is critical for case management. Good communication between custody staff and healthcare providers is also important, and researchers should continue to examine prison conditions and programs in terms of their appropriateness and effectiveness for older inmates. This will ensure that planning and policy development will be based in research findings. 45 references