As Ontario expands access to team-based primary care, an important question is emerging: what does meaningful attachment look like for older adults living with frailty, dementia, mental health concerns and other complex health needs?
That question was at the centre of PGLO’s presentation,“Attachment in the Aging Era: Preparing Primary Care Teams Through Training and Integrated Design,” at the 2026 AFHTO Power of Primary Care Summit in October. The session, presented by Kelly Kay of PGLO and Meghan Peters of City of Lakes Family Health Team, drew a full room and strong engagement from primary care teams (download full presentation below).
Attachment needs to be supported by capacity
For many older adults, becoming re-attached to primary care (perhaps following the retirement of a previous provider) occurs at a point in life when their needs may already span multiple domains: medical conditions, medications, mobility and function, cognition, mental health, caregiver needs and social circumstances. The central message of the presentation was straightforward: attachment alone is not enough.
When primary care teams do not have the time, knowledge, tools or connections needed to respond to complexity, attachment can simply relocate pressure rather than resolve it. Needs may continue to show up through repeated visits, emergency care, hospitalization, specialist referrals and challenges maintaining independence at home. This is not because older adults with complex health concerns are the problem. Rather, conventional care processes may not always be designed around their needs.
Two things need to evolve together
PGLO proposed a simple framework for strengthening primary care for an aging population:
Workforce preparation + integrated care design = more sustainable attachment for older adults living with complexity.
Neither component is sufficient on its own. Primary care teams need knowledge and confidence in areas such as recognizing frailty, dementia care, mental health in later life, medication optimization, engaging care partners, managing risk and navigating community resources. At the same time, primary care needs practical ways to connect with geriatric expertise when greater complexity emerges.
Building confidence and competence
One example is PGLO’s Provincial Common Orientation to the Care of Older Adults, an interprofessional learning program that combines self-directed learning with facilitated application to practice. Among the primary care participants highlighted in the AFHTO presentation, 70 interprofessional team members from more than 35 primary care practices had completed the training. Ninety-two per cent reported improvements in care, and increased knowledge across 27 topic areas.
But knowledge gains are only part of the story. Participants described changes in what they actually do, including more holistic assessment, earlier recognition of frailty and cognitive or mental health concerns, stronger team discussions and referrals, and more person-centred language and care planning.
Bringing geriatric expertise closer to primary care
The second part of the equation is designing care so that geriatric expertise is easier for primary care teams to access and use and linking to elements of health service design specific to the needs of older adults. There is no single model that will work in every Ontario community. PGLO highlighted a range of possibilities: screening and frailty pathways, geriatric assessors embedded in primary care, interprofessional geriatric clinics, shared-care arrangements, rapid consultation and eConsult, case conferencing, navigation, and ongoing coaching and mentorship.
The structures may differ, but the objective remains consistent: bring expertise closer to where older adults already receive their care. The session also brought this concept to life through the experience of award-winning City of Lakes Family Health Team and its collaboration with the North East Specialized Geriatric Centre. The model integrates geriatric assessment and specialist expertise with primary care, providing a practical example of how regional specialized services and local primary care can work together.
Design without dogma
One of the strongest lessons from this work is that integration should not mean imposing a single model everywhere. Team composition, geography, available resources and how frequently geriatric specialists participate may legitimately vary. What should remain consistent are clear access pathways, defined roles and accountability, timely communication, interprofessional collaboration, partnership with older adults and care partners, and connections across sectors. In other words, adapt the model to local circumstances while preserving the functions that make integrated care work.
An opportunity for primary care transformation
The enthusiasm at AFHTO was encouraging. PGLO’s session was filled, and participants actively discussed how primary care can better support an aging population. That interest points to a larger opportunity.
Ontario’s work to improve primary care attachment can do more than connect people with a provider. It can create a stronger primary care home for older adults, one capable of recognizing complexity earlier, drawing specialized expertise closer to primary care and helping people remain well and independent in their communities.
The goal should not simply be attachment. It should be attachment with the capacity, connections and expertise needed to make that relationship meaningful.
View the full presentation here