title: Pain behind bars: the epidemiology of pain in older jail inmates in a county jail.
abstract: BACKGROUND
  The number of older jail inmates in poor health is increasing rapidly. Among older adults, pain is common and leads to greater acute care use. In jail, pain management is complicated by concerns about misuse and diversion. A lack of data about the prevalence and management of pain in older jail inmates limits our ability to develop optimal palliative care strategies for this population.
  
  
  OBJECTIVE
  To describe the prevalence of and factors associated with pain and analgesic use in a population of older jail inmates.
  
  
  METHODS
  Cross-sectional study. χ(2) tests assessed association between characteristics, pain, and analgesic use.
  
  
  METHODS
  Two hundred ten jail inmates age 55 or older.
  
  
  METHODS
  "Severe frequent pain" defined as "severe or very severe" pain experienced "frequently or constantly" using the validated Memorial Symptom Assessment Scale. Medical conditions, substance use, and analgesic treatment determined through self-report and jail medical records.
  
  
  RESULTS
  Participants' mean age was 59 years; 69% had multimorbidity; 75% reported any pain; 39% reported severe frequent pain. Report of severe frequent pain was associated with multimorbidity, functional impairment, and pre-jail acute care use (p<0.05), but not with substance use (57% versus 56%, p=0.89). Within a week of their interview, most participants with severe frequent pain had received an analgesic (87%) and many received an opioid (70%).
  
  
  CONCLUSIONS
  High rates of pain in a rapidly growing population of older jail inmates with multimorbidity and functional impairment suggest that jails are an important site for assessing symptom burden and developing appropriate palliative care interventions.
authors.affiliation: 1 Division of Geriatrics, University of California , San Francisco, San Francisco, California.
authors.forename: Brie A
authors.initials: BA
authors.lastname: Williams
authors.forename: Cyrus
authors.initials: C
authors.lastname: Ahalt
authors.forename: Irena
authors.initials: I
authors.lastname: Stijacic-Cenzer
authors.forename: Alexander K
authors.initials: AK
authors.lastname: Smith
authors.forename: Joe
authors.initials: J
authors.lastname: Goldenson
authors.forename: Christine S
authors.initials: CS
authors.lastname: Ritchie
mesh_terms: D000700:Analgesics / Q000627:therapeutic use; D002140:California / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy / Q000453:epidemiology*; D010166:Palliative Care; D015995:Prevalence; D011329:Prisoners; D057566:Self Report
chemical_list: D000700:Analgesics