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Abstract
Aging Veterans face complex needs across multiple domains. However, the needs of older female Veterans and the degree to which unmet needs differ by sex are unknown. We analyzed responses to the HERO CARE survey from 7,955 Veterans aged 55 years and older (weighted N = 490,148), 93.9% males and 6.1% females. We evaluated needs and unmet needs across the following domains: activities of daily living (ADLs), instrumental ADLs (IADLs), health management, and social. We calculated weighted estimates and compared sex differences using age-adjusted prevalence ratios. On average, female Veterans were younger, more were Non-Hispanic Black and unmarried. Females and males reported a similar prevalence of problems across all domains. However, compared to males, female Veterans had a lesser prevalence of missed appointments due to transportation (aPR 0.49; 95% CI: 0.26–0.92), housework unmet needs (aPR: 0.44; 95% CI: 0.20–0.97), and medication management unmet needs (aPR: 0.33; 95% CI: 0.11–0.95) but a higher prevalence of healthcare communication unmet needs (aPR: 2.40; 95% CI: 1.13–5.05) and monitoring health conditions unmet needs (aPR: 2.13, 95% CI: 1.08–4.20). Female Veterans’ common experience of unmet needs in communicating with their healthcare teams could result in care that is less aligned with their preferences or needs. As the number of older female Veterans grows, these data and additional work to understand sex-specific unmet needs and ways to address them are essential to providing high-quality care for female Veterans.
Ethical approval
This project was classified as a non-research project by the Miami Veterans Affairs Healthcare System Human Studies Subcommittee because the findings were intended to inform VA operations and were therefore exempt from IRB review in compliance with VA Handbook 1058.05i.
No compensation was provided to Veterans for participation. To ensure privacy, efforts were taken to protect the identity of participants and ensure that data were kept confidential. Identifiable information will only be maintained on a VA server; documentation of the procedure used to code the data will remain within the VA. All identifiers collected as part of this research project will be destroyed as per the records control schedule (RCS 10-1) of the Veterans Health Administration. Electronic files will be stored in folders with restricted access on a protected computer shared drive behind the VA firewall in a secure server. Data will not be transmitted as an attachment to unprotected email messages. The data will be accessible only to personnel involved in the study. All staff was trained to avoid breach of confidentiality issues.
Author contributions
Sandra Garcia-Davis wrote the manuscript and performed the data analysis All authors contributed to the concept, preparation, and revision of the manuscript and approved its final version. Jared Hansen and Benjamin Brintz derived the weights used in this study. The investigators retained full independence in the conduct of this research. The views expressed in this paper are those of the authors and do not reflect the position or policy of the Department of Veterans Affairs or the US government. The authors assume full responsibility for the ideas presented.
Disclosure statement
No potential conflict of interest was reported by the author(s).
Data availability statement
The data sets generated and analyzed during this study are not publicly available owing to Department of Veterans Affairs and ethical redactions as well as redaction of ethically sensitive information; however, instructions on obtaining the data are available upon request.