Factors Associated With Loss of Usual Source of Care Among Older Adults

Stephanie K. Nothelle, MD; Cynthia Boyd, MD, MPH; Orla Sheehan, MD, PhD; Jennifer L. Wolff, PhD


Ann Fam Med. 2018;16(6):538-545. 

In This Article

Abstract and Introduction


Purpose: Access to a usual source of care (USC) is associated with better preventive health and chronic disease treatment. Although most older adults have a USC, loss of USC, and factors associated with loss of USC, have not previously been examined.

Methods: We followed 7,609 participants of the National Health and Aging Trends Study annually for up to 6 years (2011–2016). Discrete time-to-event techniques and pooled logistic regression were used to identify demographic, clinical, and social factors associated with loss of USC.

Results: Ninety-five percent of older adults reported having a USC in 2011, of whom 5% subsequently did not. Odds of losing a USC were higher among older adults with unmet transportation needs (adjusted odds ratio [aOR] 1.67), who moved to a new residence (aOR 2.08), and who reported depressive symptoms (aOR 1.40). Odds of losing a USC were lower for those who had ≥4 chronic conditions (vs 0–1; aOR 0.42) and with supplemental (aOR 0.52) or Medicaid (aOR 0.67) insurance coverage.

Conclusions: We identified factors associated with older adults' loss of a USC. Potentially modifiable factors, such as access to transportation and supplemental insurance, deserve further investigation to potentially assist older adults with continuous access to care.