The effect of disability on personal quality of primary care received by older adults

Purpose. To quantify the association between disability and patient-rated personal quality of primary care among older adults. Methods. Participants were community-dwelling Medicare beneficiaries aged ≥65 enrolled in traditional Medicare or a Medicare health maintenance organisations. Functional status was evaluated twice (1998 and 1999) using nine activities of daily living (ADLs) and instrumental ADLs. Respondents were classified as having no, persistent, incident or previous disability based on the combination of their functional statuses at the two measurements. Self-reported personal quality of primary care was assessed using the Primary Care Assessment Survey in five domains. Results. Compared to those with no disability, respondents with previous disability reported lower quality of care by 0.497 (p = 0.001) of a standard deviation, whereas persistent or incident disability was not associated with a difference in personal quality of care. Conclusions. Previous disability appears to have a negative effect on the personal quality of care while incident and persistent disability do not. Findings for previous and incident disability may suggest a lag in the perception of quality of care. A 'response shift' phenomenon may explain the lack of an observed association between persistent disability and personal quality of care.