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


A total of 7,609 participants at round 1 responded to the interview, of whom 383 (5%) reported no USC and were excluded. Those who did and did not report a USC were significantly different in several regards (Supplemental Table 1, available at http://www.annfammed.org/content/16/6/538/suppl/DC1/). Older adults without a USC were more likely to be male, younger, unmarried, and to have lower income. Those without a USC also reported better health, were less likely to have 1 or more chronic conditions, and tended to lack self-care help.

Loss of USC

Among the 7,226 participants who reported a USC at baseline, a total of 469 reported loss of USC. Details by round are shown in Figure 1. Those who did and did not lose a USC during the study had different baseline characteristics (Table 1). Most of the individuals who reported loss of a USC in round 2 re-gained a USC by the next round (60%); however, with subsequent rounds individuals who remained without a USC were more likely to continue to report no USC (Figure 2).

Figure 2.

Population estimates for longitudinal follow-up of individuals who lost a USC in round 2.
USC = usual source of care.
aPercentages at each round represent the number of people in each category (deceased, still no USC, gained a USC, missing) in that round divided by the number of people who reported a loss of USC in the previous round.

The odds of loosing a USC (in adjusted analyses) (Table 2) during the study period were significantly greater for older adults of Hispanic ethnicity (adjusted odds ratio [aOR] 1.96), who were male (aOR 1.45), reported living in a residential care facility (aOR 1.94) or nursing home (aOR 6.41), had moved to a new residence since the previous interview (aOR 2.08), reported having depressive symptoms (aOR 1.40) or a transportation barrier (aOR 1.67). The likelihood of losing a USC was significantly lower for older adults who had 4 or more chronic conditions (vs 0–1; aOR 0.42) or reported a fall (aOR 0.77). Odds of losing a USC were also lower for those in the highest income quartile (vs quartile 1; aOR 0.66), who had supplemental (aOR 0.52) or Medicaid (aOR 0.67) coverage in addition to Medicare. Results were largely unchanged in our sensitivity analysis, which excluded participants who were residents of a nursing home or residential care facility at any point in the study (n = 819) (Supplemental Table 2, available at http://www.annfammed.org/content/16/6/538/suppl/DC1/).