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A practice-based intervention to improve primary care for falls, urinary incontinence, and dementia


Wenger, Neil S., Roth, Carol P., Shekelle, Paul G., Young, Roy T., Solomon, David H., Kamberg, Caren J., Chang, John T., Louie, Rachel, Higashi, Takahiro, MacLean, Catherine H., Adams, John, Min, Lillian C., Ransohoff, Kurt, Hoffing, Marc, Reuben, David B.


Journal Of The American Geriatrics Society, Volume: 57, No.: 3, Pages.: 547-555

Year of Publication



Objectives: To determine whether a practice-based intervention can improve care for falls, urinary incontinence, and cognitive impairment.; Design: Controlled trial.; Setting: Two community medical groups.; Participants: Community-dwelling patients (357 at intervention sites and 287 at control sites) aged 75 and older identified as having difficulty with falls, incontinence, or cognitive impairment.; Intervention: Intervention and control practices received condition case-finding, but only intervention practices received a multicomponent practice-change intervention.; Measurements: Percentage of quality indicators satisfied measured using a 13-month medical record abstraction.; Results: Before the intervention, the quality of care was the same in intervention and control groups. Screening tripled the number of patients identified as needing care for falls, incontinence, or cognitive impairment. During the intervention, overall care for the three conditions was better in the intervention than the control group (41%, 95% confidence interval (CI)=35-46% vs 25%, 95% CI=20-30%, P<.001). Intervention group patients received better care for falls (44% vs 23%, P<.001) and incontinence (37% vs 22%, P<.001) but not for cognitive impairment (44% vs 41%, P=.67) than control group patients. The intervention was more effective for conditions identified by screening than for conditions identified through usual care.; Conclusion: A practice-based intervention integrated into usual clinical care can improve primary care for falls and urinary incontinence, although even with the intervention, less than half of the recommended care for these conditions was provided. More-intensive interventions, such as embedding intervention components into an electronic medical record, will be needed to adequately improve care for falls and incontinence.;

Bibtex Citation

@article{Wenger_2009, doi = {10.1111/j.1532-5415.2008.02128.x}, url = {}, year = 2009, month = {mar}, publisher = {Wiley-Blackwell}, volume = {57}, number = {3}, pages = {547--555}, author = {Neil S. Wenger and Carol P. Roth and Paul G. Shekelle and Roy T. Young and David H. Solomon and Caren J. Kamberg and John T. Chang and Rachel Louie and Takahiro Higashi and Catherine H. MacLean and John Adams and Lillian C. Min and Kurt Ransohoff and Marc Hoffing and David B. Reuben}, title = {A Practice-Based Intervention to Improve Primary Care for Falls, Urinary Incontinence, and Dementia}, journal = {Journal of the American Geriatrics Society} }


accidental falls, aged, aged, 80 and over, alzheimer disease, care, education, education medical continuing, efficiency, female, geriatrics, humans, los angeles, male, mass screening, of, patient satisfaction, prevention & control, primary health care, quality, quality assurance health care, quality indicators health care, standards, therapy, urinary incontinence

Countries of Study


Types of Dementia

Dementia (general / unspecified)

Types of Study

Non randomised controlled trial

Type of Outcomes


Type of Interventions

Treatment/prevention of co-morbidities or additional risks


Fall Prevention