Older adults experiencing social marginalization may face inequitable access to publicly funded home care services. In Ontario, Canada, the Ontario Marginalization Index (ON-Marg) provides a multidimensional measure of area-level marginalization. This study examined whether ON-Marg dimensions were associated with access to publicly funded home care among community-dwelling adults aged 75 years and older. We conducted a population-based retrospective cohort study using linked administrative health data from Ontario, Canada, for the year 2019. The cohort included individuals aged 75 + residing in the community (excluding those in long-term care). Home care access was stratified by ON-Marg dimensions: residential instability, material deprivation, dependency, and ethnic concentration. The primary outcomes were receipt of long-stay (≥ 90 days) and short-stay (< 90 days) home care aggregated at the community level (Aggregated Dissemination Areas -ADAs). Multivariable regression models adjusted for age, sex, hospitalization, and health complexity. Among 1,071,899 older adults, 14

BACKGROUND:Given long-standing deficits of medical expertise to care for a growing population of older adults, it is important to understand the geriatric medical workforce. We aimed to describe and compare the scopes of practice of the 3 geriatric-focused physician providers in Canada (i.e., family physicians with certification in Care of the Elderly [FM-COE], geriatricians and geriatric psychiatrists).METHODS:We conducted a qualitative study to compare competencies across geriatric-focused physician provider types in Canada, using a directed content analysis approach. We identified and obtained relevant publicly available documents that described the competencies required for certification by searching the websites of The College of Family Physicians of Canada and the Royal College of Physicians and Surgeons of Canada between June 2 and July 31, 2020. An inductive content analysis was used to compare content within each CanMEDS Role according to the CanMEDS Framework.RESULTS:We identified and obtained 4 relevant publicly available documents describing the competencies required for geriatric-focused certification for the 3 geriatric-focused physician provider types. We found substantial overlaps in the expected medical expertise of FM-COE and geriatricians. The few substantive differences across providers may result from different priorities about which competencies were made explicit for providers. The focused nature of mental health care is apparent in several competencies unique to geriatric psychiatry.INTERPRETATION:This work highlights substantial overlaps in the scopes of practice for FM-COE and geriatricians. Our findings may encourage efforts to develop more robust delineations between the scopes of practice of these related professionals to facilitate inter-specialty collaboration to lead to more equitable and accessible medical care for older adults.

Objectives: To determine which nursing home (NH) resident-level admission characteristics are associated with potentially preventable emergency department (PPED) transfers. Design: We conducted a population-level retrospective cohort study on NH resident data collected using the Resident Assessment Instrument-Minimum Data Set Version 2.0 and linked to the National Ambulatory Care Reporting System for ED transfers. Setting: We used all NH resident admission assessments from January 1, 2017, to December 31, 2018, in Ontario. Participants: The cohort included the admission assessment of 56,433 NH residents. Methods: PPED transfers were defined based on the International Classification of Disease, Version 10 (Canadian) We used logistic regression with 10-fold cross-validation and computed average marginal effects to identify the association between resident characteristics at NH admission and PPED transfers within 92 days after admission. Results: Overall, 6.2% of residents had at least 1 PPED transfer within 92 days of NH admission. After adjustment, variables that had a prevalence of 10% or more that were associated with a 1% or more absolute increase in the risk of a PPED transfer included polypharmacy [of cohort (OC) 84.4%, risk difference (RD) 2.0%], congestive heart failure (OC 29.0%, RD 3.0%), and renal failure (OC 11.6%, RD 1.2%). Female sex (OC 63.2%, RD -1.3%), a do not hospitalize directive (OC 24.4%, RD -2.6%), change in mood (OC 66.9%, RD -1.2%), and Alzheimer's or dementia (OC 62.1%, RD -1.2%) were more than 10% prevalent and associated with a 1% or more absolute decrease in the risk of a PPED. Conclusions and Implications: Though many routinely collected resident characteristics were associated with a PPED transfer, the absence of sufficiently discriminating characteristics suggests that emergency department visits by NH residents are multifactorial and difficult to predict. Future studies should assess the clinical utility of risk factor identification to prevent transfers. (C) 2021 AMDA - The Society for Post-Acute and Long-Term Care Medicine.

Prompted by Varpio et al.'s exploration of sex‐related experiences in medical education, Cavanagh et al. intertwine race‐based ideology to offer an intersectional lens on the problem.