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2023 HSR&D/QUERI National Conference Abstract

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1116 — Challenges Faced by Older Veterans and Their Caregivers During the COVID Pandemic: Results from a Prospective Multi-site Survey

Lead/Presenter: Stuti Dang
All Authors: Dang S (Miami GRECC VAMC, University of Miami Miller School of Medicine, Elizabeth Dole Center of Excellence in Veteran and Caregiver Research), Garcia-Davis 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, Miami, FL) Valencia W (Medical University of South Carolina, Summerville, SC) Hansen J (George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT, University of Utah School of Medicine, Salt Lake City, UT) Brintz B (University of Utah, Salt Lake City, UT) Ruiz D (Miami Veterans Affairs Healthcare System) Pugh MJ (University of Utah, Salt Lake City, UT, Salt Lake City VA Medical Center, Salt Lake City, UT) Rupper R (University of Utah, Salt Lake City, UT, Salt Lake City VA Medical Center, Salt Lake City, UT) Bouldin E (University of Utah, Salt Lake City, UT, Salt Lake City VA Medical Center, Salt Lake City, UT) Trivedi R (Palo Alto VA Medical Center, Palo Alto, CA) Penney L (South Texas Veterans Health Care System, San Antonio, TX) Kinosian B (Philadelphia Veterans Affairs Medical Center, Philadelphia, PA) Intrator O (GECDAC (Geriatrics & Extended Care Data & Analysis Center), Canandaigua VA Medical Center, Canandaigua, NY, University of Rochester School of Medicine and Dentistry, Rochester, NY) Leykum L (UT Health Science Center at San Antonio, San Antonio, TX) Elizabeth Dole Center of Excellence in Veteran and Caregiver Research Group

We aimed to understand the biopsychosocial impacts of COVID-19 on older Veterans and their caregivers.

We conducted a multi-site survey of 20,000 community-dwelling Veterans aged 65 years and older and their caregivers from July-December 2021. Veterans and caregivers were asked to report the impact of COVID-19 using “increased’, “decreased”, “no change”, or “not applicable” for a set of 20 items encompassing the following domains: social (e.g., time spent with family / friends, communication with family / friends), emotional (e.g., feeling lonely or isolated, anxious, angry, depressed, difficulty sleeping, alcohol use), and healthcare access (e.g., ability to receive routine care, home care, medications). An open-ended question asked caregivers to share how “your caregiving experience has been affected by the COVID-19 pandemic”. We calculated the proportion of Veterans and caregivers reporting a worsening experience in each domain due to COVID. Racial/ethnic differences between Non-Hispanic White (NHW), Non-Hispanic Black (NHB), and Hispanic participants were examined using chi-square tests and pairwise comparisons.

Veteran respondents (n = 8,056) were 80.3 (SD: 9.8) years-old on average, mostly NHW (77.3%), and men (94.0%). Caregiver respondents (n = 3,579) were 71.1 (SD: 13.1) years-old on average, mostly NHW (71.9%), women (75.1%), and spousal caregivers (57.1%). Among Veterans, 21.5% reported a decrease in healthcare access; Hispanics were more likely to report this (25.3%) compared to NHWs (21.48%; p = 0.02) and NHBs (18.4%; p < 0.01). Worse emotional health was common (39.7%); racial/ethnic differences were observed for Hispanics (48.1%) compared to NHWs (38.6%; p < 0.01), NHBs (40.6%; p < 0.01). 30.6% of Veterans reported increased social isolation; no racial/ethnic differences were observed. Among caregivers, 15.9% reported a decrease in their own healthcare access; no racial/ethnic differences were observed. 37.7% of caregivers reported worse emotional health; racial/ethnic differences were observed for NHBs (28.9%), compared to NHWs (39.3%; p < 0.01); Hispanics (34.7%; p = 0.1). 40.2% of caregivers reported increased social isolation; racial/ethnic differences were evident for NHBs (32.1%) compared to, NHWs (41.5%; p < 0.01) and Hispanics (39.5%; p = 0.04). Caregivers’ qualitative responses highlighted additional themes, including increase in caregiving responsibilities, multigenerational caregiving responsibilities, limited resources/personnel available, not knowing what really happened in doctor's appointment with Veteran, and inability to visit loved ones in an institution during COVID-19. Challenges with masking, social isolation, and difficult behaviors were exacerbated in patients with dementia or PTSD. Some lauded VA’s great job in handle care during the pandemic.

Veterans and caregivers described complex challenges during COVID which spanned social, emotional, and healthcare access domains. While pandemic-related challenges were common, Hispanic Veterans were particularly likely to report greater decreases in healthcare access and emotional health, while NHW caregivers experienced particularly common negative changes in emotional health and social isolation.

Our results provide insights into the pandemic’s biopsychosocial impacts, including racial/ethnic differences. The VA could leverage available programs to proactively identify and provide services for mental health and social isolation to support those Veterans and informal caregivers most at risk during the COVID-19 pandemic and in future crises. Enhanced communication strategies are crucial to keep caregivers apprised of Veterans’ care, especially for Veterans with dementia and mental illnesses.