摘要：Objectives. We sought to assess appropriateness of medication prescribing for older Texas prisoners. Methods. In this 12-month cross-sectional study of 13 117 prisoners (aged ≥ 55 years), we assessed medication use with Zhan criteria and compared our results to prior studies of community prescribing. We assessed use of indicated medications with 6 Assessing Care of Vulnerable Elders indicators. Results. Inappropriate medications were prescribed to a third of older prisoners; half of inappropriate use was attributable to over-the-counter antihistamines. When these antihistamines were excluded, inappropriate use dropped to 14% (≥ 55 years) and 17% (≥ 65 years), equivalent to rates in a Department of Veterans Affairs study (17%) and lower than rates in a health maintenance organization study (26%). Median rate of indicated medication use for the 6 indicators was 80% (range = 12%–95%); gastrointestinal prophylaxis for patients on nonsteroidal anti-inflammatories at high risk for gastrointestinal bleed constituted the lowest rate. Conclusions . Medication prescribing for older prisoners in Texas was similar to that for older community adults. However, overuse of antihistamines and underuse of gastrointestinal prophylaxis suggests a need for education of prison health care providers in appropriate prescribing practices for older adults. More than 1 in 100 Americans are incarcerated in a US prison or jail 1 and older prisoners are among the most rapidly growing correctional populations. 1 – 4 With high rates of chronic disease, 5 – 7 older prisoners cost on average 2 to 3 times more than younger prisoners to incarcerate. 1 , 8 Yet prisons are often ill-equipped to care for older prisoners with complex medical problems, such as functional or cognitive impairments. 9 – 12 This is largely because older adults have substantively different health care needs than younger adults who have traditionally been the focus of prison health care. 12 Despite the increasing numbers and cost of older prisoners, research about the quality of geriatric care in prisons is sparse. One important difference in the care of younger and older adults is medication prescribing. 13 , 14 Older adults often require medications for multiple chronic diseases, whereas younger adults typically require short-term medications for acute injuries or infection. Although older patients are at increased risk for medication-related adverse events leading to morbidity, mortality, and high costs, 15 , 16 underuse of indicated medications can deny older adults improved quality and length of life. 15 Despite the safety concerns and high cost associated with inappropriate medication use in older adults, little is known about medication prescribing practices for older prisoners. We assessed medication prescribing practices among older prisoners in the Texas Department of Criminal Justice (TDCJ)—one of the nation's largest state prison systems. Since 1994, when the TDCJ implemented an academic-based managed care system run by the University of Texas Medical Branch, it has reported substantial improvements in health care and has been proposed as a nationwide model. 17 , 18 It is unknown if this improved quality has extended to elements of care of the older prisoners, such as medication prescribing quality.
