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Association between specific unmet functional needs and desire to institutionalize among caregivers of older veterans

APA Citation:

Brenner, R. J., Hansen, J., Brintz, B. J., Bouldin, E. D., Pugh, M. J., Rupper, R., Munoz, R., Garcia-Davis, S., & Dang, S. (2023). Association between specific unmet functional needs and desire to institutionalize among caregivers of older veterans. Journal of the American Geriatrics Society, 71(7), 2264-2270. https://doi.org/10.1111/jgs.18307

Abstract Created by REACH:

Caregivers of Veterans with functional impairments may experience the desire to institutionalize (i.e., consider placement in a nursing home or assisted living facility), depending on the the Veterans' impairment and the support they need to carry out daily tasks. 3,257 caregivers of Veterans reported their Veterans’ specific functional needs (e.g., managing incontinence, arranging services in the home), the extent to which these needs were met, and whether they had thought about institutionalization. Veterans’ unmet functional needs (e.g., transportation) were identified as common motives for caregivers who had considered institutionalizing their Veteran.


Physical health

Branch of Service:

Multiple branches

Military Affiliation:


Subject Affiliation:

Military families
Spouse of service member or veteran


Adulthood (18 yrs & older)
Aged (65 yrs & older)
Very old (85 yrs & older)


Cross sectional study
Quantitative Study


Brenner, Rachel J., Hansen, Jared, Brintz, Ben J., Bouldin, Erin D., Pugh, Mary Jo, Rupper, Randall, Munoz, Richard, Garcia-Davis, Sandra, Dang, Stuti


Objectives To evaluate the associations between specific functional needs of older Veterans and the desire to institutionalize (DTI) among their caregivers. Methods Cross-sectional multivariable logistic regression analysis of 3579 Hero Care survey responses from caregivers of Veterans at five US sites from July to December 2021. Unmet needs were areas in which the caregiver reported the Veteran needed a little more or a lot more help. Caregiver DTI was defined as the caregiver reporting that they had discussed, considered, or taken steps toward a nursing home or assisted living placement for the Veteran or that they felt the Veteran would be better off in such a setting or they were likely to move the Veteran to another living arrangement. Results Caregivers were largely white, retired, females with an average age of 71 and with some college education who spent an average of 8–9 h per day 6 days a week caring for a Veteran spouse. There was evidence of associations between the following needs and a DTI: managing incontinence, using the telephone, transportation, and arranging services in the home such as visiting nurses, home care aides, or meals on wheels. Unmet functional needs in other selected domains were not associated with the DTI. Conclusion Among caregivers of older Veterans, a need for more assistance managing incontinence, telephone use, transportation, and arranging in-home services were associated with the DTI. These may represent functional markers of important clinical determinants for institutionalization as well as potential targets for intervention to reduce caregiver DTI, such as programs that provide more caregiver or Veteran support in the home to meet these needs and reduce caregiver burden.

Publication Type:

REACH Publication


caregivers, desire to institutionalize, function, institutionalization

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REACH Publication Type:

Research Summary

REACH Newsletter:

  June 2023

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