High Rates of Functional Limitations and Unmet Long-Term Care Needs in Older Veterans

Over half of older veterans receiving Veterans Health Administration (VHA) care experience limitations with activities of daily living (ADLs) or instrumental activities of daily living (IADLs), with nearly one-third reporting unmet needs for help, according to a study published in the Journal of Clinical Medicine.

“The objectives of this study were to (1) characterize Veterans across levels of hierarchy of ADL and IADL problems, (2) compare Veterans across the degree of need for help, and (3) identify the types and prevalence of ADL and IADL combination patterns,” wrote Sandra Garcia-Davis, Miami VA Healthcare System, Geriatric Research, Education & Clinical Center GRECC and Department of Public Health Sciences, University of Miami in Miami, and coauthors.

In the cross-sectional study, the researchers analyzed 7424 veterans aged 65 years and older from the 2021 HERO CARE survey. They found that 47.5% had no ADL or IADL problems, 13.2% reported only IADL problems, 5.6% reported only ADL problems, and 33.7% had both ADL and IADL problems. Veterans with combined ADL and IADL limitations were more likely to face food insecurity (29.8%), missed medical appointments due to transportation (17.2%), low health literacy (54.7%), dementia (9.0%), depression (31.1%), and homebound status (19.9%) compared with those with fewer limitations. They were also more likely to have a caregiver (65.3%).

When examining the degree of need, 32.3% of veterans with any ADL or IADL limitation reported unmet needs, 31.6% received sufficient help, and 36.1% managed on their own. Veterans with unmet needs had higher rates of food insecurity (36.1%), transportation-related missed appointments (28.3%), dementia (13.1%), depression (38.1%), anxiety (29.2%), homebound status (23.7%), and 100% service-connected disability ratings (16.0%). The severity of limitations corresponded with the degree of help needed. Those with unmet needs averaged 4.47 ADL problems and 5.10 IADL problems, compared with 2.71 and 2.61, respectively, among those who could self-manage.

Detailed analysis revealed that nearly a quarter of veterans with ADL limitations had difficulty with all 8 measured ADLs, most commonly bathing, dressing, eating, transferring, and toileting. Similarly, 31.3% of veterans with IADL limitations reported difficulty with all 7 measured IADLs, with preparing meals and washing dishes among the most frequent challenges.

“These data are aligned with both VA and non-VA research priorities, and the results may help advance health equity by identifying health disparities in unmet needs,” concluded the study authors.

Reference

Garcia-Davis S, Hlaing WM, Vidot DC, et al. The epidemiology of the long-term care needs and unmet needs of older Veterans in the United States. J Clin Med. 2025;14(12):4219. doi:10.3390/jcm14124219