The Silent Service: Identifying Under-Recognized Young Military Caregivers

Introduction: Recognizing and supporting family caregivers is critical to the Department of Veteran Affairs mission to support Veterans health and reduce the risk of long-term institutionalized care. Veteran family caregiving often involves multiple family members, including young adults, youth, and even children (young caregivers). Having a young caregiver (<25 years) may be associated with greater social need. We examined the association between having no caregiver, a young caregiver, or older caregiver, and unmet functional needs. Materials and Methods: Cross-sectional secondary analysis of a large-scale caregiving survey administered to Veterans from July to December 2021. We included Veterans who reported a limitation in at least 1 of 8 activities of daily living (ADL) or 1 of 7 instrumental activities of daily living (IADL) (N = 4,744). Veterans were classified by caregiving network type - no caregiver, at least one young caregiver (<25 years) in network, or only older caregiver(s) (age 25 or older) in network. We ran 2 separate logistic regression models to examine the association between caregiving network type and the outcomes of unmet ADL and IADL needs. Models were adjusted for demographic, clinical, and functional characteristics that were significant in univariable analyses. Results: Most Veterans had only older caregivers (70%) in their caregiving network, while 3% had at least one young caregiver and 27% had no caregiver. Veterans with young caregivers in their caregiving network were younger, and more likely to report low health literacy (65.9%), food insecurity (28.9%), and transportation problems (17.8%) compared to Veterans with no caregivers and Veterans with only older caregivers (all P <. 05). Veterans with at least one young caregiver had significantly higher odds of unmet ADL needs (aOR = 2.11; 95% CI: 1.41-3.17) compared to those with only older caregivers, adjusting for minority status, low health literacy, homebound status, and total ADL needs. Having young caregivers in the caregiving network was not associated with unmet IADL needs, however, having no caregiver was associated with both lower unmet ADL and IADL needs compared to those with only older caregivers in their caregiving network. Conclusion: Our findings suggest important differences in caregiving arrangements when young caregivers (<age 25) are in a caregiving network. In this study, Veterans with young caregivers reported more unmet ADL and IADL needs, which compliments findings from Miller et al. 2024 that aging civilian adults with young caregivers presented more health and social risks than other aging adults. Taken together, the presence of a young caregiver may be an important distinction to guide support services for aging Veterans and their families. Specifically, Veterans with young caregivers may need more support in regards to health literacy, nutrition, transportation, and social connectedness. Future research should focus on additional risks that the presence of a young caregiver may signal and explore how caregiving impacts young caregivers' mental and physical health, educational and economic outcomes, including career choice or delay education and/or career, and how this differs for military, Veteran, and civilian families.