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


Older adults are a growing segment of the population.[1] As older adults disproportionately experience chronic conditions[2,3] and frequently utilize health care services, access to a usual source of medical care (USC), is particularly important in effective management of their care.[4] A robust evidence base demonstrates that persons with a USC are more likely to receive appropriate chronic disease treatment[5–8] and have better disease control.[9–12] Having a USC has also been linked to increased receipt of preventive health services,[13–16] fewer emergency department visits,[17] and fewer unmet medical needs such as inability to renew needed medications.[18]

The overwhelming majority of Medicare beneficiaries (95.6%) report having a USC.[19] Older adults without a USC tend to be younger (aged 65–74 years vs ≥75 years), male, nonwhite, Hispanic, have lower income, less educational attainment, and tend to be healthier such that they are less likely to have functional limitations or depressive symptoms.[20,21] Medicare beneficiaries without supplemental insurance (17%) coverage are more than 3 times as likely to lack a USC compared with those having individually purchased (4.5%) or employee-sponsored supplemental plans (2.8%).[19]

Although the cross-sectional characteristics of those with and without a USC are well described, few studies have examined USC stability, especially among older adults. More than 1 in 20 older adults with a USC report having had it for less than a year,[19] suggesting that instability may not be a rare occurrence. To our knowledge, the 2 studies which have examined the factors associated with loss or gain of USC have been conducted among working-age adults (aged 39–46 years)[22] and children (aged <18 years).[23] Both studies found that those who experienced a loss or gain of USC over the previous year were more likely to report unmet health needs. Adults with an unstable USC were more likely to be female, have lower self-rated health, and lower income.[22] We are not aware of any prior studies that examined loss or gain of USC among older adults.

Older adults face circumstances that may make maintaining a relationship with a USC difficult such as declining functional status,[24] transportation limitations,[25] or fixed income. Therefore, we were particularly interested in factors associated with loss of a USC. The primary objective of this study is to describe the factors associated with a loss and failure to regain a USC in the previous 12 months among older adults.