Older Unpaid Carers: Who Cares in Later Life, for How Long, and at What Cost

Unpaid care does not stop at retirement age. In Canada in 2018, almost one in four people aged 65 and over cared for a family member or friend, and in the oldest age groups half of those carers were looking after a spouse or partner, often for as many hours as a part-time or full-time job, while managing health conditions of their own.

Much of the care that keeps older people at home is given by other older people. It is the husband in his eighties who has taken over the cooking, the medicines and the night-time help; the woman in her seventies who drives her sister to hospital appointments; the parents in their late sixties still supporting a disabled son or daughter. This study brings together national surveys and research from Canada, Australia, the European Union, England and Wales and the United States to show how many older people care, for whom, for how long, what it does to their own health and how little support reaches them.

On most measures, between one in eight and one in four people over 65 give unpaid care

Every country with good survey data finds large numbers of older carers. In Canada’s 2018 General Social Survey, 24% of people aged 65 and over had given care or help to family or friends with a long-term condition, a disability or problems related to aging in the past year, close to the 25% of all Canadians aged 15 and over. The median age of these older carers was 71^[1]. Australia’s 2022 Survey of Disability, Ageing and Carers counted 3.0 million carers, 11.9% of people living in households, and found the rate of primary carers (those giving the most help to one person) was 8.7% at ages 65 to 74 and 7.2% at 75 and over, as high as in middle age^[2].

Across the 27 countries of the European Union, the 2019 European Health Interview Survey asked a stricter question: care or help given at least once a week. On that measure, 18.6% of people aged 65 to 74 and 13.1% of those aged 75 and over were carers, against a peak of 25.0% at ages 55 to 64^[3]. In the United States, the 2009 Behavioral Risk Factor Surveillance System found 21.6% of adults aged 65 and over were caregivers^[4].

These figures come from different surveys with different questions (any care in the past year, weekly care, being the main carer) and different years, so they are not directly comparable and should not be ranked. What they share is the pattern: caring peaks in late middle age, falls only gradually after 65, and remains common into the late seventies and beyond. In England and Wales, the 2021 Census found unpaid care peaked among women aged 55 to 59 (19.9%) and men aged 60 to 64 (13.0%)^[5], but many carers are far older than that, as the next sections show.

In the oldest age groups, men care as often as women, or more often

Unpaid care is usually described as women’s work, and across most of adult life it is: in England in 2021, 10.3% of females aged 5 and over gave unpaid care against 7.6% of males (age-standardised)^[5]. In later life the picture changes. The 2021 Census for England found women were statistically significantly more likely than men to give unpaid care in every age group up to 75 to 79, but “from the age of 80 years onwards, males were statistically significantly more likely to provide unpaid care.” The oldest men were also the most likely to be caring intensively: the highest share giving 50 hours or more of care a week was among men aged 85 to 89 (7.4%); among women the peak came earlier, at ages 75 to 79 (5.6%). Wales showed the same pattern: 8.7% of men aged 85 to 89 and 6.9% of women aged 75 to 79^[5].

Other countries find something similar. In Canada in 2022, the gender gap in caring that exists at younger ages had closed among people aged 65 and over, with about 23% of men and 24% of women giving care to adults who depended on them^[6]. In Australia in 2022, the age groups of men with the highest rates of caring were those aged 65 to 74 (19.7%) and 75 and over (20.1%)^[2].

One likely reason, though the census analysis does not test it, is partnership: many of these men will be caring for a wife or partner. Older male carers can be overlooked by services that picture carers as daughters or wives, and the data suggest that services should expect to find them. The care itself is still divided: among Canadian carers aged 65 and over, women were more likely to give personal care and help with medical treatment, while men were more likely to do house maintenance and outdoor work (47% against 29%)^[1]. For the wider picture of older women’s unpaid care across the life course, see our study of older women.

Older carers mostly care for a partner, and spousal care means the longest hours

As carers get older, the person they care for is increasingly the person they live with. In Canada in 2018, 34% of carers aged 65 and over mainly cared for a spouse or partner. That rose from 28% of carers aged 65 to 74 to 47% of those aged 75 and over and 50% of those aged 85 and over^[1]. The 2022 Canadian Social Survey found the same shift: 38% of carers aged 65 and over cared for a spouse or partner, against 14% of carers aged 55 to 64^[6]. In Australia, a spouse or partner was the most common person cared for by primary carers of any age (37.4%), and 59.5% of primary carers looking after a spouse or partner were themselves aged 65 or over^[2].

Caring for a partner is the most intensive kind of care. Across all ages in Canada in 2022, people caring for a spouse, partner or adult child gave a median of 20 hours a week, against a median of 8 hours for all carers of adults^[6]. Among Canadian carers aged 65 and over in 2018, about 18% gave 30 hours or more a week; among those caring for a spouse, 31% did. Older women caring for a husband or partner gave a median of 20 hours a week, against 14 hours for older men^[1]. A meta-analysis of 168 studies found that spouses give more care than adult children or children-in-law who care for an older relative^[7].

Many older carers did not choose the role. In Canada, 63% of carers aged 65 and over said they had no choice but to take on their caring responsibilities, rising to 78% of those caring for a spouse^[1].

Some older carers are parents still caring for an adult son or daughter with a disability or long-term condition. National surveys rarely report this group separately, and we found no comparable cross-country figures for it; the evidence for this intersection is thin. Our study of older people with a learning disability covers the families who support them.

Many older carers are managing their own health conditions, and strain rises with the hours

Older carers bring their own health into the role. In Australia in 2022, 59.6% of carers aged 65 and over had a disability, almost twice the rate among carers aged 15 to 64 (31.5%)^[2]. In the United States, carers aged 65 and over in 2009 were more likely than younger carers to rate their own health as fair or poor (23.8% against 15.7%) and to report frequent physical distress (15.0% against 11.5%)^[4]. Part of that gap reflects age itself, not caring.

The same US survey found something more hopeful: older carers reported less frequent mental distress than younger carers (8.6% against 15.3%) and were less often dissatisfied with life (3.8% against 7.6%)^[4]. Caring is not uniformly harmful, and many older carers describe it as rewarding. What the evidence shows most clearly is that strain depends on how much care is given and how much help there is. In Canada in 2018, a third (33%) of carers aged 65 and over found caring stressful or very stressful, women more often than men (39% against 26%), and 27% said caring had harmed their overall health. Among older women giving 20 hours or more a week, almost half (46%) said their health had been affected^[1].

Spouses carry the heaviest load. The meta-analysis of 168 studies found spouse carers reported more depression symptoms, greater financial and physical strain and lower psychological well-being than adult children or children-in-law who were caring, explained “mostly—but not completely—by higher levels of care provision”^[7].

Whether caring shortens life is less clear than is often claimed. A US study of 392 carers and 427 non-carers aged 66 to 96 who lived with their spouses found that carers who reported mental or emotional strain had a 63% higher risk of death over about four years than non-carers (relative risk 1.63, 95% confidence interval 1.00 to 2.65, a borderline result); carers without strain had no raised risk^[8]. A later, larger US study matched 3,503 family carers taking part in a national stroke study with similar non-carers and found carers had an 18% lower rate of death over about six years (hazard ratio 0.823)^[9]. Both are observational studies, so neither proves cause. Read together, they point to strain, not caring itself, as the thing to address. For carers of people living with dementia, see our study of unpaid dementia carers.

Support has not kept pace with the care older people give

Most older carers are not entirely alone: in Canada in 2018, one of the two most common sources of help for carers aged 65 and over was their own children (41%)^[1]. But formal support falls short. Canadian carers aged 65 and over who said they had unmet needs were asked what help they would have liked. More than half (56%) named financial support, government assistance or a tax credit; 45% named home care or support, 33% information or advice and 29% help from medical professionals. Statistics Canada noted these needs were similar to those of carers in other age groups^[1].

The availability of formal care matters to carers as well as to the people they look after. A study using the Survey of Health, Ageing and Retirement in Europe (SHARE), covering about 1,800 spousal carers in 138 regions of 11 countries, found carers’ life satisfaction, loneliness and depression were better in regions with more formal long-term care, partly because carers felt more in control. The authors concluded that “perceived alternatives to the private care arrangement go along with greater well-being of informal caregivers”^[10]. The study compares regions, so it shows an association, not proof that adding care places improves carers’ well-being.

The scale of what unpaid carers provide is large. The WHO Centre for Health Development in Kobe puts the value of informal caregiving at between 0.8% and 4.9% of GDP a year, and says “the main way to support informal caregivers is through greater investments in formal LTC [long-term care] systems.” It also cautions that cash benefits for carers may “pressure women to remain in traditional, informal caregiving roles”, and that the evidence that training on its own reduces the harms of intensive caring is weak^[11]. For older people who live alone with no one to care for them, the reverse problem applies; see our study of older people living alone.

What the evidence asks of us

The figures point to a group that gives a great deal of care, often to a partner, often for long hours and often with health conditions of its own. They suggest five things for services, commissioners and governments.

• Find older carers, including men. England’s National Institute for Health and Care Excellence (NICE) guideline on supporting adult carers asks practitioners to “actively seek to identify carers”^[12]. The census data show that in the oldest age groups men are at least as likely as women to be carers, so identification should not assume the carer is a daughter or a wife.
• Invest in formal long-term care. The WHO Kobe Centre’s analysis and the European evidence agree that home care, residential care and other formal services are the main way to support unpaid carers, not a substitute for them^[10][11].
• Make breaks and practical help routine. NICE asks practitioners to “regularly discuss with carers the value of having a break from their caring role”, to offer training so carers can give care safely and to consider psychosocial and psychoeducational support^[12]. Because strain rises steeply with hours, these supports matter most to spousal carers.
• Plan for the carer’s own health changing. NICE asks services to support carers when their circumstances change, including when they “become less able to care as they get older”^[12]. With most older Australian carers having a disability themselves^[2], contingency planning should be part of every carer’s support, not an emergency response.
• Count older carers properly. Statistics offices should publish carer data by age bands above 75, by relationship to the person cared for and by hours, and should report older parents caring for adult children separately. Several countries already collect the data; few publish it at this level.

Language: this piece says "older people" rather than "the elderly", and "unpaid carers" (in the United States and Canada, "family caregivers" or "caregivers") for people who look after a partner, relative or friend without pay, as carers’ organisations do. We avoid describing the person cared for as a burden.

Why we're publishing this

Older carers keep partners, relatives and friends at home and out of hospital, often for years, and much of what they do is never counted. We have gathered the best national data we could find, from several countries, so that carers’ organisations, and the older carers they work with, can point to the numbers. The case is theirs; the figures are here to support it.

How to read this data

Almost all the figures here come from national household surveys in which people report their own caring, so they depend on whether people see themselves as carers; many spouses do not. Surveys ask different questions: Canada’s General Social Survey asks about any care in the past 12 months, the European Health Interview Survey about care at least once a week, Australia’s Survey of Disability, Ageing and Carers identifies primary carers, and the England and Wales census asks everyone aged 5 and over whether they give unpaid care and for how many hours a week. They cover different years (2009 to 2022), so they should not be compared country with country or read as a trend. People living in care homes are usually outside these surveys. The US comparison of older and younger carers compares age groups, so part of the difference in health reflects age, not caring. The mortality studies are observational and reach different conclusions. Evidence is thinnest for low- and middle-income countries, for carers aged over 85 and for older parents caring for adult children; Japan publishes detailed data on older people caring for older people, but we could not open the official release in a form we could verify, so it is not included.

Use this data

Free to cite with attribution to Understanding Aging. Charities, carers' groups, campaigners and journalists are welcome to reuse these figures and charts. For the underlying figures as a spreadsheet, get in touch.

Important: This article summarises published research and statistics for general information. It is not medical, care or financial advice and cannot be used to diagnose, treat or predict anything about an individual. If you have concerns about your own or someone else's health, please speak to a GP or another qualified health professional.

Sources

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2. Australian Bureau of Statistics. Disability, Ageing and Carers, Australia: Summary of Findings, 2022. ABS, 2024. abs.gov.au/statistics/health/disability/disability-ageing-and-carers-australia-summary-findings/latest-release
3. Eurostat. Persons providing informal care or assistance at least once a week by sex, age and educational attainment level (hlth_ehis_ic1e), European Health Interview Survey 2019. Eurostat. ec.europa.eu/eurostat/…/data/hlth_ehis_ic1e
4. Anderson LA, Edwards VJ, Pearson WS, Talley RC, McGuire LC, Andresen EM. Adult caregivers in the United States: characteristics and differences in well-being, by caregiver age and caregiving status. Preventing Chronic Disease, 2013. cdc.gov/pcd/issues/2013/13_0090.htm
5. Office for National Statistics. Unpaid care by age, sex and deprivation, England and Wales: Census 2021. ONS, 2023. ons.gov.uk/…/unpaidcarebyagesexanddeprivationenglandandwales/census2021
6. Statistics Canada. More than half of women provide care to children and care-dependent adults in Canada, 2022. The Daily, 2022. www150.statcan.gc.ca/n1/daily-quotidien/221108/dq221108b-eng.htm
7. Pinquart M, Sörensen S. Spouses, adult children, and children-in-law as caregivers of older adults: a meta-analytic comparison. Psychology and Aging, 2011. europepmc.org/article/MED/21417538
8. Schulz R, Beach SR. Caregiving as a risk factor for mortality: the Caregiver Health Effects Study. JAMA, 1999. europepmc.org/article/MED/10605972
9. Roth DL, Haley WE, Hovater M, Perkins M, Wadley VG, Judd S. Family caregiving and all-cause mortality: findings from a population-based propensity-matched analysis. American Journal of Epidemiology, 2013. europepmc.org/article/MED/24091890
10. Wagner M, Brandt M. Long-term care provision and the well-being of spousal caregivers: an analysis of 138 European regions. Journals of Gerontology, Series B, 2018. europepmc.org/article/MED/29237034
11. WHO Centre for Health Development (WHO Kobe Centre). Supporting informal long-term caregivers for older people. World Health Organization, 2024. wkc.who.int/resources/news/item/01-10-2024-supporting-informal-long-term-caregivers-for-older-people
12. National Institute for Health and Care Excellence. Supporting adult carers (NG150): Recommendations. NICE, 2020. nice.org.uk/guidance/ng150/chapter/Recommendations