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In Canada, population over the age of 65 account for 17% of the country’s population in 2016, and for the first time the older adult population has surpassed that of children (0-14 years). The rapidly increasing older adult population creates a critical demand for health and social services tailored to their needs. The emphasis on “aging in place” in Canada and inadequate government funding of institutional long–term care beds have led to increased dependence on primary care and community services, such as adult day programs, to maintain their health and well-being. The study explores the geographic accessibility of older adults to primary care physicians (PCPs) and adult day programs (ADPs) within the Toronto Census Metropolitan Area, Canada’s largest urban centre. The study uses various methods including the two-step floating catchment area (2SFCA) accessibility model and location quotient to examine the spatial mismatch between the supply of and demand for PCPs and ADPs. A diverse range of data are used, including the 2016 geo-referenced Canadian census, location of PCPs and ADPs and road network. Multiple travel thresholds from 1 kilometre to 10 kilometres are used to calculate geographic accessibility for older adults with a low mobility (no access to a vehicle) and a higher mobility (with access to a personal vehicle). The results indicate that the City of Toronto consistently has high accessibility scores for all travel thresholds; accessibility is high in suburban areas along the fringes of the Toronto CMA when travelling up to 10 kilometres to reach a service location. Thematic mapping shows that ADPs are generally in close proximity to PCPs. The paper provides implications for identifying service shortage areas, developing programmes and health promotion strategies and enhancing the delivery of primary care and community service relevant for older adults. *Correspondence to: Lu Wang, Department of Geography and Environmental Studies, Ryerson University, 350 Victoria Street, Toronto, Ontario, Canada, Tel: 416-979-5000 x 2689; Fax: 416-979-5362; E-mail: luwang@ryerson.ca Received: June 04, 2018; Accepted: June 22, 2018; Published: June 25, 2018 Introduction As demographic transition progresses in Canada, a large number of aging baby boomers have accelerated the shift in the age and sex structure of the population. From 1982 to 2012 the population aged 65 and over had doubled, while the number of children has only grown by 2.5% [1]. This trend continued until 2015 when older adults finally outnumbered those aged 0 to 14 [2]. In 2017, one out of six Canadians were at least 65 years of age at 16.9% of the population, compared to those aged 0 to 14 comprising 16.0% [3]. The Canadian healthcare system faces many challenges to meet the growing healthcare demand among older adults. These challenges include a general shortage of physicians in Canada, the longer life expectancy, decreased funding on healthcare including long-term healthcare, and increased health complications among older adults [47]. Since Canada’s birth rate has remained steady for about 20 years, the increase in proportion of older adults has caused the dependency ratio (number of individuals aged 0 to 14 and 65 or older per 100 people aged 15 to 64) to increase and will continue to do so in the upcoming years. Advances in technology, the field of medicine and institutions addressing global health care access has allowed for individuals to live longer and treat their ailments, especially in developed nations. However, wait times in the Canadian health care system have become longer while hospitals discharge patients faster [8,9]. When it comes to older adults who are more vulnerable and use health care services more often, their access has been cut even further. The Canadian Institute for Health Information reported 143,219 individuals in hospital continuing care and private residential care beds in the province of Ontario, most of whom are 65 or older [10]. Statistics Canada reported about 2,251,000 individuals aged 65 or older in Ontario [11]. The monitoring and treatment of chronic conditions for over two million older adults are now mainly the onus of primary care physicians (PCPs) and community-based services, without intervention from specialists or treatment through in-hospital services [12]. Adult day services, also referred to as adult day programs, are very effective community-based services utilized by older adults across North America. They have been shown to increase the overall wellbeing of participants and play a role in chronic disease management [13-15]. Good geographic access to healthcare and social program provide a benefit to older adults in maintaining health and well-being. However, the intersection of these two types of supplementary services that critical to the wellbeing of older adults has rarely been investigated. The study explores the geographic accessibility of older adults to primary care physicians (PCPs) and adult day programs (ADPs) within the Toronto Census Metropolitan Area (CMA), Canada’s largest urban centre. It uses various methods including the two-step floating catchment area (2SFCA) accessibility model and location quotient to examine the spatial mismatch between the supply of and demand for PCPs and ADPs. A diverse range of data are used, including the 2016 geo-referenced Canadian census, location of PCPs and ADPs and road network. Multiple travel thresholds from 1 kilometre to 10 kilometres Wang L (2018) Measuring spatial accessibility of older adults to primary care physicians and adult day programs in the Toronto CMA Volume 3(3): 2-8 Nurs Palliat Care, 2018 doi: 10.15761/NPC.1000186 are used to calculate geographic accessibility for older adults with a low mobility (no access to a vehicle) and a higher mobility (with access to a personal vehicle). The study yields provide implications for identifying service shortage areas, developing programmes and health promotion strategies and enhancing the delivery of primary care and community service relevant for older adults. Background and scholarly context In Canada, the emphasis on “aging in place” and inadequate funding of long-term-care beds have led to increased dependence on primary care, delivered mainly by family physicians to older adults living in private and community settings. Primary care physicians play a pivotal role in delivering primary healthcare to the older population in the Canadian healthcare system. They are also gate keepers to specialists [16]. Older adults have a higher risk of developing chronic conditions such as adult onset diabetes, lung disease, high blood pressure, heart disease, and mental illness. They are also large users of medical services and their use and population will only continue to grow [17]. As children become adults, the younger cohorts of the population move out of their family homes and the older cohort is referred to as empty nesters. Aging in place, which refers to older adults who choose or are forced to continue living independently in their private dwellings, becomes more difficult when there is less support and more responsibility placed on parents or grandparents to be self-reliant at an age when they are more fragile and more likely to have health complications. Those who do not have a partner or spouse to age alongside are even more vulnerable, especially older women since they have longer life expectancies than men. As mobility decreases this creates great implications when it comes to accessing primary care physician on a regular basis. Problems also arise when older adults find it difficult to maintain themselves and their household while dealing with a decline in health [18,19]. Adult day programs have offered opportunities for these vulnerable populations to gain access to a range of services. The first ADP to open in Canada was Baycrest Day Centre in 1959. ADPs offer counseling, support, social activities, health promotion, disease prevention, creative arts, meals, and education to older adults with different needs. Programming ranges from providing help to those who suffer from Alzheimer’s or Dementia to organizing social activities for older individuals to participate. Studies show that being social and amongst others contributes to the well-being of an individual and can accelerate their health recovery [20-22]. Social services work as a medium between primary care accessibility and aging in place to improve and maintain the overall well-being of the older population. Noninstitutionalized individuals who age in place alone or with family caregivers benefit from ADPs that offer opportunity for older adults to interact with others when they would otherwise be isolated in their homes [13]. Previous research has investigated the relationship between health care utilization and distance traveled by individuals. A distance decay trend is evident, whereby health care use and disease burden increase as distance between home to primary care physician increases [23-28]. Geographic access is considered a critical factor of accessing healthcare in Canada where the healthcare system is publically funded, and therefore, older adults in Canada face a less daunting barrier to care related to insurance, compared to counterparts in a private healthcare system [17,29]. Geographic, or spatial, accessibility refers to the relative ease with which individuals from one location can reach other specified zones or point locations and can be measured by geographical models such as the two-step floating catchment area (2SFCA) model and its variations [30-36]. The 2SFCA model integrates supply and competition for demand, while considering the number of service providers at each location, the population that falls within their catchment area and transportation pathways that allow individuals to travel to service locations. Spatial inequalities in accessing healthcare services are found between urban and non-urban ar