{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T18:15:06Z","timestamp":1783448106923,"version":"3.55.0"},"reference-count":44,"publisher":"Oxford University Press (OUP)","issue":"7","funder":[{"name":"Center of Innovation to Accelerate Discovery and Practice Transformation","award":["CIN 13\u2011410"],"award-info":[{"award-number":["CIN 13\u2011410"]}]},{"name":"Department of Veterans Affairs Caregiver Support Program and Quality Enhancement Research Initiative"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,6,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Objectives<\/jats:title>\n                    <jats:p>Respite care provides temporary relief to family caregivers yet remains underused, and the factors shaping its utilization among Veteran caregivers are not well understood. This evaluation examined caregiver\u2011 and Veteran\u2011specific characteristics associated with respite care use within the Department of Veterans Affairs (VA) Caregiver Support Program\u2019s Program of General Caregiver Support Services (PGCSS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Research Design and Methods<\/jats:title>\n                    <jats:p>We analyzed survey and administrative data from 1,727 caregivers of Veterans enrolled in PGCSS who completed baseline surveys between 2018 and 2021. Caregivers were predominantly female (96%) with a mean age of 62 years; Veterans averaged 70 years. Respite use within 2 years of survey completion was identified through linked VA data. Guided by Andersen\u2019s Healthcare Utilization Model, 34 caregiver and Veteran variables were evaluated with random forest models to identify characteristics that most strongly differentiated respite users from non\u2011users.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Respite care was used by 23.5% of caregivers. Use was more common among older caregivers and Veterans (predisposing factors), among caregivers reporting greater burden, depression, or financial strain and Veterans with higher frailty, functional limitation, or dementia (need factors), and among caregivers perceiving stronger communication and collaboration with the clinical team (enabling factors). Model performance was strong (testing accuracy = 0.79 with all variables; 0.77 with the top 15), and results remained consistent in a sensitivity analysis limited to caregivers of Veterans who survived the 2\u2011year follow\u2011up period.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion and Implications<\/jats:title>\n                    <jats:p>Both caregiving intensity and care\u2011recipient complexity characterize respite use even within a system of broad service availability. Findings provide a foundation for future hypothesis\u2011driven studies and inform efforts to align respite programs more closely with caregiver\u2013Veteran needs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/geront\/gnag098","type":"journal-article","created":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T12:15:50Z","timestamp":1777637750000},"source":"Crossref","is-referenced-by-count":0,"title":["Factors associated with respite care use among veteran caregivers: a machine learning analysis"],"prefix":"10.1093","volume":"66","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5430-7890","authenticated-orcid":false,"given":"Melissa","family":"Harris-Gersten","sequence":"first","affiliation":[{"name":"Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Healthcare System, Veterans Health Administration , Durham, North Carolina,","place":["United States"]},{"name":"Department of Population Health Sciences, Duke University School of Medicine , Durham, North Carolina,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8917-9868","authenticated-orcid":false,"given":"Zhen","family":"Li","sequence":"additional","affiliation":[{"name":"Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Healthcare System, Veterans Health Administration , Durham, North Carolina,","place":["United States"]},{"name":"Department of Population Health Sciences, Duke University School of Medicine , Durham, North Carolina,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-4252-6233","authenticated-orcid":false,"given":"Pujan","family":"Patel","sequence":"additional","affiliation":[{"name":"Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Healthcare System, Veterans Health Administration , Durham, North Carolina,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-6845-0998","authenticated-orcid":false,"given":"Jeanie","family":"Lo","sequence":"additional","affiliation":[{"name":"Health Economics Resource Center, VA Palo Alto Health Care System , Menlo Park, California,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4020-8936","authenticated-orcid":false,"given":"Megan","family":"Shepherd-Banigan","sequence":"additional","affiliation":[{"name":"Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Healthcare System, Veterans Health Administration , Durham, North Carolina,","place":["United States"]},{"name":"Department of Population Health Sciences, Duke University School of Medicine , Durham, North Carolina,","place":["United States"]},{"name":"Mid-Atlantic MIRECC, Durham VA Health Care System , Durham, North Carolina,","place":["United States"]},{"name":"Duke-Margolis Health Policy Institute, Duke University , Durham, North Carolina,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6726-2369","authenticated-orcid":false,"given":"Katherine","family":"Miller","sequence":"additional","affiliation":[{"name":"VA Partnered Evidence-based Policy Resource Center, Boston VA Health Care System , Boston, Massachusetts,","place":["United States"]},{"name":"Johns Hopkins Bloomberg School of Public Health Health Policy and Management , Baltimore, Maryland,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0366-2985","authenticated-orcid":false,"given":"Josephine","family":"Jacobs","sequence":"additional","affiliation":[{"name":"Health Economics Resource Center, VA Palo Alto Health Care System , Menlo Park, California,","place":["United States"]},{"name":"Department of Health Policy, Stanford University School of Medicine , Stanford, California,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5750-8820","authenticated-orcid":false,"given":"Susan N","family":"Hastings","sequence":"additional","affiliation":[{"name":"Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Healthcare System, Veterans Health Administration , Durham, North Carolina,","place":["United States"]},{"name":"Department of Medicine, Duke University School of Medicine , Durham, North Carolina,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3901-0172","authenticated-orcid":false,"given":"Nadya","family":"Majette","sequence":"additional","affiliation":[{"name":"Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Healthcare System, Veterans Health Administration , Durham, North Carolina,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1776-773X","authenticated-orcid":false,"given":"Cassandra","family":"Dictus","sequence":"additional","affiliation":[{"name":"Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Healthcare System, Veterans Health Administration , Durham, North Carolina,","place":["United States"]},{"name":"School of Nursing, Duke University , Durham, North Carolina,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy","family":"Jobin","sequence":"additional","affiliation":[{"name":"Department of Veterans Affairs, Caregiver Support Program\u2014National Program Office , Washington, D.C.,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0783-1611","authenticated-orcid":false,"given":"Courtney","family":"Van Houtven","sequence":"additional","affiliation":[{"name":"Department of Population Health Sciences, Duke University School of Medicine , Durham, North Carolina,","place":["United States"]},{"name":"Duke-Margolis Health Policy Institute, Duke University , Durham, North Carolina,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,5,6]]},"reference":[{"key":"2026070713264696800_gnag098-B1","doi-asserted-by":"publisher","DOI":"10.26419\/ppi.00103.001","volume-title":"Caregiving in the United States 2020","author":"AARP and National Alliance for Caregiving","year":"2020"},{"key":"2026070713264696800_gnag098-B2","doi-asserted-by":"publisher","first-page":"533","DOI":"10.1097\/00005650-197807000-00001","article-title":"Access to medical care in the US: Realized and potential","volume":"16","author":"Andersen","year":"1978","journal-title":"Medical Care"},{"key":"2026070713264696800_gnag098-B3","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1016\/S0749-3797(18)30622-6","article-title":"Screening for depression in well older adults: Evaluation of a short form of the CES-D (Center for Epidemiologic Studies Depression Scale)","volume":"10","author":"Andresen","year":"1994","journal-title":"American Journal of Preventive Medicine"},{"key":"2026070713264696800_gnag098-B4","doi-asserted-by":"publisher","first-page":"652","DOI":"10.1093\/geront\/41.5.652","article-title":"The Zarit Burden Interview: A new short version and screening version","volume":"41","author":"B\u00e9dard","year":"2001","journal-title":"The Gerontologist"},{"key":"2026070713264696800_gnag098-B5","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1023\/A:1010933404324","article-title":"Random forests","volume":"45","author":"Breiman","year":"2001","journal-title":"Machine Learning"},{"key":"2026070713264696800_gnag098-B6","doi-asserted-by":"publisher","first-page":"63","DOI":"10.1080\/01488376.2021.1952144","article-title":"Respite services utilization and self-rated health of older family caregivers in the United States: Differences between young-old and old-old caregivers","volume":"48","author":"Chen","year":"2022","journal-title":"Journal of Social Service Research"},{"key":"2026070713264696800_gnag098-B7","doi-asserted-by":"publisher","first-page":"271","DOI":"10.1002\/nur.4770150406","article-title":"The caregiver reaction assessment (CRA) for caregivers to persons with chronic physical and mental impairments","volume":"15","author":"Given","year":"1992","journal-title":"Research in Nursing & Health"},{"key":"2026070713264696800_gnag098-B8","author":"Hodges","year":"2022"},{"key":"2026070713264696800_gnag098-B9","doi-asserted-by":"publisher","first-page":"655","DOI":"10.1177\/0164027504268574","article-title":"A short scale for measuring loneliness in large surveys: Results from two population-based studies","volume":"26","author":"Hughes","year":"2004","journal-title":"Research on Aging"},{"key":"2026070713264696800_gnag098-B10","doi-asserted-by":"publisher","first-page":"052031","DOI":"10.1088\/1757-899X\/546\/5\/052031","article-title":"Feature selection using random forest classifier for predicting prostate cancer","volume":"546","author":"Huljanah","year":"2019","journal-title":"IOP Conference Series: Materials Science and Engineering"},{"key":"2026070713264696800_gnag098-B11","doi-asserted-by":"publisher","first-page":"908","DOI":"10.1186\/s12913-018-3689-2","article-title":"Validation of the JEN frailty index in the National Long-Term Care Survey community population: Identifying functionally impaired older adults from claims data","volume":"18","author":"Kinosian","year":"2018","journal-title":"BMC Health Services Research"},{"key":"2026070713264696800_gnag098-B12","doi-asserted-by":"publisher","first-page":"303","DOI":"10.1093\/geront\/gnu060","article-title":"Anticipating an easier day: Effects of adult day services on daily cortisol and stress","volume":"56","author":"Klein","year":"2016","journal-title":"The Gerontologist"},{"key":"2026070713264696800_gnag098-B13","doi-asserted-by":"publisher","first-page":"72","DOI":"10.1186\/s13690-018-0316-y","article-title":"Barriers and enablers in the use of respite interventions by caregivers of people with dementia: An integrative review","volume":"76","author":"Leocadie","year":"2018","journal-title":"Archives of Public Health = Archives Belges de Sante Publique"},{"key":"2026070713264696800_gnag098-B14","doi-asserted-by":"publisher","first-page":"e133","DOI":"10.5334\/ijic.845","article-title":"The effect of caregiver support interventions for informal caregivers of community-dwelling frail elderly: A systematic review","volume":"12","author":"Lopez-Hartmann","year":"2012","journal-title":"International Journal of Integrated Care"},{"key":"2026070713264696800_gnag098-B15","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3310\/hta11150","article-title":"A systematic review of the effectiveness and cost-effectiveness of different models of community-based respite care for frail older people and their carers","volume":"11","author":"Mason","year":"2007","journal-title":"Health Technology Assessment (Winchester, England)"},{"key":"2026070713264696800_gnag098-B16","volume-title":"Interactive map series on family caregiver respite services","author":"National Academy for State Health Policy","year":"2025"},{"key":"2026070713264696800_gnag098-B17","doi-asserted-by":"publisher","first-page":"121","DOI":"10.1093\/geront\/43.1.121","article-title":"Psychometric properties of an abridged version of the Zarit Burden Interview within a representative Canadian caregiver sample","volume":"43","author":"O\u2019Rourke","year":"2003","journal-title":"The Gerontologist"},{"key":"2026070713264696800_gnag098-B18","doi-asserted-by":"publisher","first-page":"1100","DOI":"10.1177\/07334648241229574","article-title":"Factors influencing caregivers\u2019 use of respite care services: Secondary analysis of the National Study of Caregiving","volume":"43","author":"Ogunjesa","year":"2024","journal-title":"Journal of Applied Gerontology: The Official Journal of the Southern Gerontological Society"},{"key":"2026070713264696800_gnag098-B19","doi-asserted-by":"publisher","first-page":"e501","DOI":"10.1093\/geront\/gnz029","article-title":"Health-promoting self-care in family caregivers of people with dementia: The views of multiple stakeholders","volume":"59","author":"Oliveira","year":"2019","journal-title":"The Gerontologist"},{"key":"2026070713264696800_gnag098-B20","doi-asserted-by":"publisher","first-page":"igab037","DOI":"10.1093\/geroni\/igab037","article-title":"Does adult day service use improve well-being of black caregivers of people living with dementia?","volume":"5","author":"Parker","year":"2021","journal-title":"Innovation in Aging"},{"key":"2026070713264696800_gnag098-B21","doi-asserted-by":"publisher","first-page":"155","DOI":"10.1080\/08959420.2017.1414539","article-title":"Factors associated with caregivers\u2019 use of support services and caregivers\u2019 nonuse of services sought","volume":"30","author":"Potter","year":"2018","journal-title":"Journal of Aging & Social Policy"},{"key":"2026070713264696800_gnag098-B22","first-page":"7","article-title":"America\u2019s military and veteran caregivers: Hidden heroes emerging from the shadows","volume":"12","author":"Ramchand","year":"2024","journal-title":"Rand Health Quarterly"},{"key":"2026070713264696800_gnag098-B23","doi-asserted-by":"publisher","DOI":"10.26419\/ppi.00216.00","volume-title":"Respite services: A critical support for family caregivers (LTSS Choices Spotlight)","author":"Reinhard","year":"2023"},{"key":"2026070713264696800_gnag098-B24","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3310\/hta13200","article-title":"Systematic review of respite care in the frail elderly","volume":"13","author":"Shaw","year":"2009","journal-title":"Health Technology Assessment (Winchester, England)"},{"key":"2026070713264696800_gnag098-B25","doi-asserted-by":"publisher","first-page":"282","DOI":"10.1186\/s12877-017-0676-0","article-title":"Key stakeholders\u2019 experiences of respite services for people with dementia and their perspectives on respite service development: A qualitative systematic review","volume":"17","author":"Shea","year":"2017","journal-title":"BMC Geriatrics"},{"key":"2026070713264696800_gnag098-B26","doi-asserted-by":"publisher","first-page":"2675","DOI":"10.1111\/jgs.16767","article-title":"Family caregivers of veterans experience high levels of burden, distress, and financial strain","volume":"68","author":"Shepherd-Banigan","year":"2020","journal-title":"Journal of the American Geriatrics Society"},{"key":"2026070713264696800_gnag098-B27","doi-asserted-by":"publisher","first-page":"1175","DOI":"10.2147\/RMHP.S297838","article-title":"The random forest model has the best accuracy among the four pressure ulcer prediction models using machine learning algorithms","volume":"14","author":"Song","year":"2021","journal-title":"Risk Management and Healthcare Policy"},{"key":"2026070713264696800_gnag098-B28","doi-asserted-by":"publisher","first-page":"41","DOI":"10.31389\/jltc.4","article-title":"Family caregiver use and value of support services in the VA Program of Comprehensive Assistance for Family Caregivers","volume":"0","author":"Sperber","year":"2018","journal-title":"Journal of Long-Term Care"},{"key":"2026070713264696800_gnag098-B29","doi-asserted-by":"publisher","first-page":"e046187","DOI":"10.1136\/bmjopen-2020-046187","article-title":"What are the consequences of caring for older people and what interventions are effective for supporting unpaid carers? A rapid review of systematic reviews","volume":"11","author":"Spiers","year":"2021","journal-title":"BMJ Open"},{"key":"2026070713264696800_gnag098-B30","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1186\/1471-2105-8-25","article-title":"Bias in random forest variable importance measures: Illustrations, sources and a solution","volume":"8","author":"Strobl","year":"2007","journal-title":"BMC Bioinformatics"},{"key":"2026070713264696800_gnag098-B31","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3310\/hsdr05120","article-title":"Updated meta-review of evidence on support for carers","volume":"5","author":"Thomas","year":"2017","journal-title":"Health Services and Delivery Research"},{"key":"2026070713264696800_gnag098-B32","doi-asserted-by":"publisher","first-page":"58","DOI":"10.1186\/s12877-019-1405-7","article-title":"Adapting Andersen\u2019s expanded behavioral model of health services use to include older adults receiving long-term services and supports","volume":"20","author":"Travers","year":"2020","journal-title":"BMC Geriatrics"},{"key":"2026070713264696800_gnag098-B33","doi-asserted-by":"publisher","first-page":"1566","DOI":"10.1111\/jgs.18213","article-title":"Characterizing caregiving supportive services use by caregiving relationship status","volume":"71","author":"Travers","year":"2023","journal-title":"Journal of the American Geriatrics Society"},{"key":"2026070713264696800_gnag098-B34","volume-title":"VHA Handbook 1140.02: Respite care","author":"U.S. Department of Veterans Affairs","year":"2008"},{"key":"2026070713264696800_gnag098-B35","author":"VA Caregiver Support Program","year":"2023"},{"key":"2026070713264696800_gnag098-B36","doi-asserted-by":"publisher","first-page":"784","DOI":"10.1177\/1077558717747985","article-title":"Development and initial validation of the Caregiver Perceptions About Communication With Clinical Team Members (CAPACITY) measure","volume":"76","author":"Van Houtven","year":"2019","journal-title":"Medical Care Research and Review: MCRR"},{"key":"2026070713264696800_gnag098-B37","doi-asserted-by":"publisher","first-page":"1277","DOI":"10.1002\/gps.4504","article-title":"Effectiveness of respite care in supporting informal caregivers of persons with dementia: A systematic review","volume":"31","author":"Vandepitte","year":"2016","journal-title":"International Journal of Geriatric Psychiatry"},{"key":"2026070713264696800_gnag098-B38","doi-asserted-by":"publisher","first-page":"767","DOI":"10.1186\/s12913-024-11058-0","article-title":"WHO, WHEN, HOW: A scoping review on flexible at-home respite for informal caregivers of older adults","volume":"24","author":"Viens","year":"2024","journal-title":"BMC Health Services Research"},{"key":"2026070713264696800_gnag098-B39","doi-asserted-by":"publisher","first-page":"2002","DOI":"10.1111\/1475-6773.12454","article-title":"Risk adjustment tools for learning health systems: A comparison of dx CG and CMS-HCC V21","volume":"51","author":"Wagner","year":"2016","journal-title":"Health Services Research"},{"key":"2026070713264696800_gnag098-B40","volume-title":"ARCH\u2019s respite research initiative: Measuring the value of respite","author":"Whitmore","year":"2024"},{"key":"2026070713264696800_gnag098-B41","doi-asserted-by":"publisher","first-page":"1231","DOI":"10.1093\/geront\/gnaa178","article-title":"Taking a break: Daily respite effects of adult day services as objective and subjective time away from caregiving","volume":"61","author":"Wylie","year":"2021","journal-title":"The Gerontologist"},{"key":"2026070713264696800_gnag098-B42","doi-asserted-by":"publisher","DOI":"10.1093\/geront\/gnad067","article-title":"Use of caregiving support services among diverse dementia caregivers by geographic context","volume":"64","author":"Yoshikawa","year":"2024","journal-title":"The Gerontologist"},{"key":"2026070713264696800_gnag098-B43","doi-asserted-by":"publisher","first-page":"649","DOI":"10.1093\/geront\/20.6.649","article-title":"Relatives of the impaired elderly: Correlates of feelings of burden","volume":"20","author":"Zarit","year":"1980","journal-title":"The Gerontologist"},{"key":"2026070713264696800_gnag098-B44","doi-asserted-by":"publisher","first-page":"963","DOI":"10.1177\/0733464819901094","article-title":"The effect of National Family Caregiver Support Program services on caregiver burden","volume":"40","author":"Zebrak","year":"2021","journal-title":"Journal of Applied Gerontology: The Official Journal of the Southern Gerontological Society"}],"container-title":["The Gerontologist"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/gerontologist\/advance-article-pdf\/doi\/10.1093\/geront\/gnag098\/68234227\/gnag098.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/gerontologist\/article-pdf\/66\/7\/gnag098\/68234227\/gnag098.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/gerontologist\/article-pdf\/66\/7\/gnag098\/68234227\/gnag098.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T17:26:58Z","timestamp":1783445218000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/gerontologist\/article\/doi\/10.1093\/geront\/gnag098\/8671353"}},"subtitle":[],"editor":[{"given":"Joseph E","family":"Gaugler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,5,6]]},"references-count":44,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2026,6,9]]}},"URL":"https:\/\/doi.org\/10.1093\/geront\/gnag098","relation":{},"ISSN":["0016-9013","1758-5341"],"issn-type":[{"value":"0016-9013","type":"print"},{"value":"1758-5341","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,7]]},"published":{"date-parts":[[2026,5,6]]},"article-number":"gnag098"}}