Functional Limitations and Associated Factors among Older Low-Income U.S. Veterans: Results from the National Veteran Homeless and Other Poverty Experiences Study

INTRODUCTION: Older low-income U.S. veterans experience elevated physical and social vulnerabilities, yet their functional limitations remain understudied. This study estimated the prevalence of activity of daily living (ADL) and instrumental activity of daily living (IADL) limitations and identified associated sociodemographic, health, and psychosocial factors. MATERIALS AND METHODS: We analyzed nationally representative data from the 2021 National Veteran Homeless and Other Poverty Experiences (NV-HOPE) Study of low-income veterans aged ≥ 55 years (N = 877; weighted ≈ 7.41 million). Survey-weighted logistic regression models identified factors associated with any ADL or IADL limitation across sociodemographic, health (chronic conditions, depression, anxiety, other mental diagnoses), and social/contextual domains (network size, perceived support, loneliness, housing). Exploratory margins analyses were used to descriptively examine potential differences across sex and race/ethnicity. RESULTS: Overall, 4.28% reported having at least 1 ADL limitation and 14.98% having at least 1 IADL limitation. ADL limitations were associated with higher anxiety (odds ratio [OR] = 1.32, 95% confidence interval [CI]: 1.04-1.67), "other" race/ethnicity (OR = 3.98, 95% CI: 1.27-12.51), and some college education (OR = 3.43, 95% CI: 1.13-10.46), whereas home ownership was protective (OR = 0.38, 95% CI: 0.16-0.91). IADL limitations were associated with Black (OR = 2.41, 95% CI: 1.12-5.16) and "other" race/ethnicity (OR = 2.61, 95% CI: 1.13-6.05), more chronic conditions (OR = 1.24 per condition, 95% CI: 1.10-1.40), higher anxiety (OR = 1.27, 95% CI: 1.04-1.54), and other mental diagnoses (OR = 2.15, 95% CI: 1.13-4.09); a moderate social network (3-5) was protective (OR = 0.37, 95% CI: 0.16-0.85). Descriptive subgroup analyses indicated that associations between mental health and ADL limitation appeared stronger among women, whereas relationships between depression, anxiety, or loneliness and IADL limitation varied across racial and ethnic groups. CONCLUSIONS: Functional limitations among older low-income veterans are multifactorial, reflecting intersecting demographic, clinical, and social determinants. Findings support integrated care models that combine mental-health screening and social-resource supports. Exploratory subgroup patterns highlight the importance of considering sex and race/ethnicity in identifying low-income veterans most at risk for functional decline and in tailoring prevention and intervention efforts.