{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T01:13:30Z","timestamp":1787015610503,"version":"build-2736575974"},"reference-count":50,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2023,5,5]],"date-time":"2023-05-05T00:00:00Z","timestamp":1683244800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["agsjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J American Geriatrics Society"],"published-print":{"date-parts":[[2023,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Little is known about determinants of access to community\u2010based geriatricians. The Geriatric 5Ms\u2122 describe geriatricians' core competencies and inform referrals to specialists for older adults with complex needs. We explored the association of the Geriatric 5Ms\u2122 and other characteristics with outpatient access to geriatricians by home care (HC) clients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This was a population\u2010based, retrospective cohort study of frail community\u2010dwelling HC clients (\u226560\u2009years) with complex needs (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009196,444). Health assessment information was linked to health services data in Ontario, Canada, 2012\u20132015. Multivariable generalized estimating equations were used to identify characteristics associated with geriatrician contact (\u22651 visit in 90\u2009days post\u2010HC admission), including derived Geriatric 5Ms\u2122 score, and predisposing, enabling, and need factors obtained from clinical assessments.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Only 5.2% of the cohort had outpatient geriatrician contact in Ontario, Canada. Derived Geriatric 5Ms\u2122 score was associated with higher odds of contact, but the model had modest discriminatory power (\n                      <jats:italic>c<\/jats:italic>\n                      \u2010statistic\u2009=\u20090.67). In the broader multivariable model, based on empirically included factors and adjusted for regional differences, age, worsening of decision\u2010making, dementia, hallucinations, Parkinsonism, osteoporosis, and caregiver distress\/institutionalization risk were associated with higher odds of geriatrician contact. Female sex, difficulties accessing home, impaired locomotion, recovery potential, hemiplegia\/hemiparesis, and cancer, were associated with lower odds of contact. This model had good discriminatory power (\n                      <jats:italic>c<\/jats:italic>\n                      \u2010statistic\u2009=\u20090.77).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Few frail, community\u2010dwelling older adults receiving HC had any outpatient geriatrician contact. While the derived Geriatric 5Ms\u2122 score was associated with contact, a broader empirical model performed better than the Geriatric 5Ms\u2122 in predicting contact with an outpatient geriatrician. Contact was mainly driven by conditions common in older adults, but evidence suggests that geriatricians are not evaluating the most medically complex and unstable older adults in the community. These findings suggest a need to re\u2010examine the referral process for geriatricians and the allocation of limited specialized resources.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jgs.18382","type":"journal-article","created":{"date-parts":[[2023,5,5]],"date-time":"2023-05-05T03:20:09Z","timestamp":1683256809000},"page":"2810-2821","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Determinants of access of frail, community\u2010residing older adults to geriatricians in Ontario"],"prefix":"10.1111","volume":"71","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6641-5773","authenticated-orcid":false,"given":"Sophie","family":"Hogeveen","sequence":"first","affiliation":[{"name":"McMaster Institute for Research on Aging McMaster University  Hamilton Ontario Canada"},{"name":"Centre for Integrated Care St. Joseph's Health System  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John P.","family":"Hirdes","sequence":"additional","affiliation":[{"name":"School of Public Health Sciences University of Waterloo  Waterloo Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George","family":"Heckman","sequence":"additional","affiliation":[{"name":"School of Public Health Sciences University of Waterloo  Waterloo Ontario Canada"},{"name":"Schlegel\u2010UW Research Institute for Aging  Waterloo Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heather","family":"Keller","sequence":"additional","affiliation":[{"name":"School of Public Health Sciences University of Waterloo  Waterloo Ontario Canada"},{"name":"Schlegel\u2010UW Research Institute for Aging  Waterloo Ontario Canada"},{"name":"Kinesiology and Health Sciences University of Waterloo  Waterloo Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,5,5]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1447-0594.2004.00257.x"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532\u20105415.2008.01942.x"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12877\u2010020\u201001782\u20107"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD012705.pub2"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.archger.2004.03.009"},{"key":"e_1_2_10_7_1","unstructured":"American Geriatrics Society.State of the Geriatrician Workforce.2018. 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