Why Do Older Adults Disengage From Routine Medical Care? Psychological Distress, Wealth Stratification, and Health System Disengagement in Later Life

Objective Many older adults stop seeing a doctor despite having insurance and significant health needs. This study asks whether psychological distress predicts disengagement from care, beyond structural barriers. Method Using three waves of the Health and Retirement Study ( N = 5,184 adults 65+), we model whether distress in one wave predicts no medical contact in the next, testing whether wealth weakens this link. Results Older adults with more psychological distress were significantly more likely to disengage from care, even accounting for demographics, resources, and health needs. This link was stronger among those with less wealth, suggesting money helps buffer the effects of psychological strain. The pattern held even when looking at change within the same person over time. Conclusion Psychological distress independently predicts disengagement from care, and this effect is stronger among financially disadvantaged older adults. Mental health screening in primary care could help reduce disengagement in this group.