1. To describe the multidomain unmet needs of Veterans who are stroke survivors. 

Stroke is a leading cause of disability. Stroke survivors frequently experience several unmet needs, which can significantly impact quality of life and ability to age in the community.  Few reports detail the long-term care needs of stroke survivors.

We used data from the HERO CARE survey, fielded in 2021 to 20,000 community-dwelling Veterans across five VA sites (respondent N=8,056). Veterans with a history of stroke diagnosis were defined by Hierarchical Condition Category 100 (n=576). We sought to describe the long-term care needs of stroke survivors across five domains: activities of daily living (ADLs), instrumental ADLs (IADLs), nursing, health care coordination, and social (legal and housing). We classified respondents as having an unmet need if they responded that they needed a little or a lot more help for a specific need in any of the five domains.

Veteran respondents were mostly men (97.7%), average age 80.4 (SD 8.7), married (61.3%), Non-Hispanic White (74.1%), residing in urban areas (81.9%), low health literacy (61.8%), and with a caregiver (70.4%). Veterans reported difficulties with ADLs (69.3%), IADLs (79.0%), nursing tasks (70.6%), health care coordination (72.2%), and social (48.5%). Overall, 54.2% reported having an unmet need, with ADLs (29.5%), IADLs (38.6%), nursing (29.4%), health care coordination (30.3%), and social (20.5%). Veterans also reported psychological and social concerns: dementia (29%), possible depression (29%), possible anxiety (18.8%), food insecurity (19.1%), transportation problems (17.1%), medication insecurity (6.6%), and substance use disorder (6.4%). The most prevalent combination for both needs and unmet needs was with all 5 need domains followed by difficulty with all need domains except social.

Stroke survivors experience multiple unmet needs and require proactive, comprehensive support to live independently. These findings can guide programs and policies to better support survivors and their caregivers.