Cohort Study Analysis: Physical Health, Cognitive Impairment, and Financial Wellbeing

About this research

RBL’s Needs Analysis brought together robust insight to build a comprehensive picture of the UK Armed Forces community, while also revealing important gaps in our understanding of demographics, needs, and outcomes.

To address some of these gaps, in 2025 we commissioned the King’s Centre for Military Health Research (KCMHR) to analyse data from Phase 4 (2022-23) of their large-scale Health and Wellbeing cohort study. 

KCMHR’s cohort study:

• Has been ongoing since 2004
• Tracks those who served in the UK Armed Forces during the Iraq and Afghanistan-eras
• Includes more than 3,000 Regular serving and ex-serving personnel in Phase 4 (2022-23)
• Collects data on demographics, military background, and life outcomes

We commissioned analysis to understand more about topics where there are important gaps in our understanding: physical health, cognitive impairment and financial wellbeing. This builds on our previously commissioned analysis of gambling, intimate partner violence and abuse, and help-seeking.

While these findings do not represent all serving personnel or veterans, they provide vital new insight into the needs and experiences of an important group within the Armed Forces community. These insights support RBL’s ability to design effective services, influence policy and advocate for meaningful change – while also informing implementation of our 10-year Strategy and contributing to the wider sector evidence base.

Physical Health

Physical health problems can affect quality of life, wellbeing and day-to-day functioning. Service in the UK Armed Forces can involve occupational demands and exposures, such as physically demanding activities and blast exposure, which may contribute to musculoskeletal and hearing-related problems, as indicated in our hearing impairment research. However, less is known about how different physical health symptoms occur together and the factors associated with them. Understanding these patterns is important for ensuring appropriate support is available to members of the Armed Forces community.

Ex-serving Regulars were more likely than serving Regulars to report physical health problems across all measures except ringing in the ears, after accounting for age.

Among serving Regulars:

• 42% reported musculoskeletal problems
• 9% reported chronic pain
• 6% reported mobility problems

Among ex-serving Regulars:

• 50% reported musculoskeletal problems
• 17% reported chronic pain
• 15% reported mobility problems

A higher proportion of ex-serving Regulars reported ringing in ears (40%) and hearing problems (36%) compared to serving Regulars (36% and 26% respectively).

Physical health problems often occurred together. Nearly half of ex-serving Regulars (47%) reported a combination of fatigue symptoms, 44% reported a combination of musculoskeletal symptoms – and more than a quarter (27%) reported both. 

Physical and mental health were closely linked, with mental health problems showing some of the strongest associations with physical health symptoms.

The overlap between physical health, mental health and wider circumstances highlights the importance of holistic, joined-up support.

Cognitive impairment

Cognitive impairment refers to a deterioration in mental abilities beyond what would normally be expected with ageing. It can affect areas including memory, attention and concentration, reasoning and decision-making, and the ability to manage everyday tasks.

Around one in five serving and ex-serving Regulars screened positive for probable cognitive impairment using a self-reporting tool.

Among serving and ex-serving Regulars in the KCMHR cohort:

• 21% screened positive for probable cognitive impairment
• Serving Regulars only – 21%
• Ex-serving Regulars only – 22%

There was no statistically significant difference between serving and ex-serving Regulars, including after accounting for the younger age profile of serving personnel.

There was no significant difference in cognitive impairment by age, suggesting that younger people were no less likely to experience cognitive decline in this cohort.

Probable cognitive impairment was associated with a range of mental health, physical health, financial and trauma-related factors.

It was also associated with lower social support and greater functional impairment, including difficulties with everyday activities and work.

These findings provide important new UK evidence on an area where there is currently limited understanding, while highlighting the need for more research into long-term cognitive decline among serving and ex-serving personnel and how this may relate to dementia and future need.

Financial wellbeing

Financial wellbeing is about how well someone feels they can manage financially and get by with the resources they have. While there is some evidence on employment and benefit receipt among UK ex-serving personnel, less is known about their broader financial circumstances, job satisfaction, the wider factors associated with financial wellbeing, and how these change over time.

Most ex-serving Regulars were in paid employment and managing financially, but a notable minority experienced financial difficulty, and financial circumstances changed for many over time.

In terms of employment:

• 82% of ex-serving Regulars were in paid employment
• 10% reported overall job dissatisfaction

Looking at how ex-serving Regulars felt they were managing financially:

• 37% were living comfortably, and 42% were doing alright
• 14% were just getting by
• 5% were finding it quite difficult, and 2% were finding it very difficult

Financial difficulty was not linked to one single factor. It was associated with employment status, demographic characteristics, and wider health, suggesting that financial problems may form part of a broader pattern of need.

Links between mental health, physical health and financial wellbeing highlight the value of identifying financial difficulties early and considering them alongside health and employment support.

Using these insights

It is important to keep context in mind when interpreting this analysis. The study’s sample served during the Iraq and Afghanistan conflicts; this represents a specific subgroup of serving personnel and veterans. 

It is important to recognise that experiences may differ across individuals and groups. Further research is needed to understand the range of experiences within the wider Armed Forces community - including where challenges are shared, and where additional or tailored support may be required. 

This research provides valuable insight into the experiences of those who have served, offering an important contribution to the evidence base. It helps highlight key areas of need, and supports RBL and the wider sector to make informed decisions about how policy and services are designed and delivered, to better support the Armed Forces community. 

If you are interested in exploring this research in more depth, please get in contact: [email protected].