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2023 HSR&D/QUERI National Conference Abstract

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1107 — Prospective Survey to Identify Unmet Needs of High-Need High-Risk Older Veterans and their Caregivers

Lead/Presenter: Stuti Dang
All Authors: Dang S (Elizabeth Dole Center of Excellence in Veteran and Caregiver Research, Miami VA Healthcare System, University of Miami Miller School of Medicine), Garcia S (University of Miami, Miller school of Medicine) Desir M (Miami Veterans Affairs Healthcare System, University of Miami, Miller school of Medicine) Munoz, R (Florida International University, Robert Stempel College of Public Health & Social Work) Valencia W (Medical University of South Carolina) Hansen J (George E. Wahlen Department of Veterans Affairs Medical Center, University of Utah School of Medicine) Brintz B (University of Utah) Ruiz D (Miami Veterans Affairs Healthcare System) Pugh M (University of Utah) Rupper R (Salt Lake City VA Medical Center) Bouldin E (University of Utah) Trivedi R (Palo Alto VA Medical Center) Penney L (South Texas Veterans Health Care System) Kinosian B (Philadelphia Veterans Affairs Medical Center) Intrator O (GECDAC (Geriatrics & Extended Care Data & Analysis Center), Canandaigua VA Medical Center, University of Rochester School of Medicine and Dentistry) Leykum, L (UT Health Science Center at San Antonio)

Objectives:
Empowering Veterans to age in place is a Department of Veterans Affairs (VA) priority. Informal caregivers play a crucial role supporting Veterans with functional and cognitive impairments through direct provision of care for Veterans as well as arrangement of formal home and community-based services (HCBS). Delaying long term institutionalization (LTI) depends on identifying and supporting each Veteran’s needs. We aim to understand the unmet needs of older Veterans and the roles of their caregivers. We conducted a survey of 20,000 Veterans and their caregivers. We oversampled Veterans with a higher predicted two-year risk of LTI. We mailed Veteran and caregiver surveys to Veterans with instructions for them to complete the Veteran survey by mail or electronically and to have their caregiver complete the caregiver surveys (if applicable). The surveys assessed demographic, physical, psychological, and social domains, unmet needs, and experience with HCBS and caregiver support programs.

Methods:
To reflect LTI risk, we sampled Veterans and their caregivers from San Antonio, Palo Alto, Miami, Salt Lake City, and VISN Network 8 living in the community and not in hospice care. Veterans and caregivers completed surveys by mail or electronically.

Results:
Forty percent (8,056) of Veterans responded to the survey between July-December 2021. Respondents were 80.3 (SD: 9.8) years-old on average, mostly White (82.6%), and men (94.0%). Caregivers (n = 3,579) were 71.1 (SD: 13.1) years-old on average, mostly White (80.5%), and women (75.1%); most were spousal caregivers (57.1%). Unmet needs were defined as having insufficient help (needing a little or a lot more help). Veterans reported unmet needs in ADLs (15.7%), IADLs (26.0%), nursing tasks (7.9%), pain management (15.1%), communicating with the healthcare team (18.2%), and social needs such as legal or housing (12.1%). The most common IADL unmet needs were medication management (55.4%), housework (55.4%) and preparing meals (53.7%). Caregivers averaged 7.3 hours of daily care (SD: 5.5 hours); and helped with ADLs (42.5%), IADLs (57.2%), communicating with the healthcare team (52.4%), and social needs (36.4%). Caregiver preparedness when assisting Veterans with tasks varied; 62% of caregivers felt very prepared, 35% somewhat prepared, and 3% not at all prepared to perform tasks. Caregivers reported having a second helper (34%), a third (13%), and a fourth helper (6%) for caregiving tasks. When asked about use of different VA-specific caregiver resources, only 11% of caregivers reported using any programs or resources, while 46.9% had not used them, and 42.1% were not aware of them.

Implications:
Both Veterans and caregivers describe complex unmet needs in medical, psychological, and social domains. Unmet IADL needs were most common. Barriers to accessing caregiver support programs may include lack of awareness of VA and non-VA programs.

Impacts:
VA operational partners will use survey results to inform HCBS policy to support aging Veterans and their caregivers. Identifying unmet needs can inform program development and resource allocation to better meet aging Veterans’ needs while aging in place. The VA may benefit from ensuring that Veterans, caregivers, and clinicians are aware of appropriate programs, and developing strategies (e.g., peer navigators) to match caregivers with appropriate services.