title: Medication prescribing practices for older prisoners in the Texas prison system.
abstract: OBJECTIVE
  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 > or = 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% (> or = 55 years) and 17% (> or = 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.
authors.affiliation: Department of Medicine, University of California, San Francisco, CA, USA. brie.williams@ucsf.edu
authors.forename: Brie A
authors.initials: BA
authors.lastname: Williams
authors.forename: Jacques G
authors.initials: JG
authors.lastname: Baillargeon
authors.forename: Karla
authors.initials: K
authors.lastname: Lindquist
authors.forename: Louise C
authors.initials: LC
authors.lastname: Walter
authors.forename: Kenneth E
authors.initials: KE
authors.lastname: Covinsky
authors.forename: Heather E
authors.initials: HE
authors.lastname: Whitson
authors.forename: Michael A
authors.initials: MA
authors.lastname: Steinman
mesh_terms: D000367:Age Factors; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D005260:Female; D005765:Gastrointestinal Agents / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011329:Prisoners / Q000706:statistics & numerical data*; D011330:Prisons / Q000592:standards / Q000706:statistics & numerical data; D013781:Texas
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D000959:Antihypertensive Agents; D005765:Gastrointestinal Agents