In rapidly ageing societies, informal care is fundamental for many families and for the sustainability of most healthcare systems (Brandt et al., 2009; Tur-Sinai et al., 2020; Wolff et al., 2016). Between 12% and 18% of European adults regularly provide informal care to family members (European Commission, 2021); in the UK, for example, men and women aged 50 are expected to spend an average of 4.9 and 5.9 years of their remaining lives as informal caregivers (Di Gessa & Deindl, 2024). Although numerous studies examined the consequences of family caregiving (for an overview, see Schulz et al. (2020)), less attention has been given to the transition into caregiving and how social inequalities across the life-course may affect the timing of this transition.
Integration of family caregiving into life-course trajectories
Despite the growing prominence of family care in ageing societies, relatively little empirical research has investigated caregiving trajectories. Recent developments have advocated for recognizing family caregiving as a distinct trajectory within the life-course, arguing that it is a normative phenomenon whose increasing diversity and cumulative impact on late-life outcomes are inadequately understood (Keating et al., 2019). This conceptualization stems from the central assumption in life-course research that transitions and trajectories influence the structure and pace of individual lives, as the impact of experiences is critically influenced by when they occur within the life-course (Alwin, 2012). In particular, Keating and colleagues emphasized the importance of the age at onset of the first care episode (i.e., timing within the life-course) as crucial in shaping caregiving and other overlapping trajectories. Capturing the life-course stage at which individuals become caregivers is fundamental for adequately understanding different pathways into caregiving and their intersection with family and employment. It makes a significant difference whether caregiving begins before or after retirement, or before or after becoming a grandparent (Hamilton & Cass, 2017). Researchers have started to move beyond snapshots of individual predictors of caregiving onto larger mechanisms and dynamic processes (Moen & DePasquale, 2017), aiming to understand pathways to caregiving and its life-course timing. Nonetheless, differences in age of caregiving onset and the factors that influence such timing remain unexplored.
Numerous studies have explored the social determinants of family caregiving, yet they often adopted a static approach, which understates the complexity of caregiving trajectories within the life-course (Rodrigues et al., 2022). Differences in the timing of caregiving onset may be influenced by cumulative processes of social (dis)advantage across various life-course domains (Carmichael & Ercolani, 2016; Fast et al., 2021). Social positions result from cumulative exposure to risks during adult life, such as weak attachment to the labour market, family conflicts or reduced social networks (Hradil, 2012). These positions are associated with different opportunities and advantages, not only deriving from individual responsibility but also from structural inequalities, and may set pathways to caregiving at a particular age. Several studies indicated that mid-life (ages 45–60 for intergenerational caregiving) and late-life (ages 60–75 for intragenerational caregiving) are the periods with the highest likelihood of providing care (Conde-Sala et al., 2010; Hajek & König, 2016).
Focusing on late-life as the timing of care transition, a more nuanced understanding of the differences in pathways to caregiving onset may help explain why late caregivers suffer more social disadvantage, financial strain and poorer mental and physical health compared to those who become caregivers earlier in life (Keating et al., 2019). Caregiving onset in this phase often overlaps with end-of-employment trajectories and other family commitments towards parents and children, potentially compromising these responsibilities. Recent studies have examined how the timing of caregiving is linked to other life trajectories such as employment (Raiber et al., 2022; Simard-Duplain, 2022), family relations (Hamilton & Cass, 2017; Latham-Mintus et al., 2022), and health (Barnett, 2015).
Particularly for intergenerational care, earlier onset of parental caregiving may imply a longer overlap between caregiving responsibilities and working years, increasing the likelihood of financial strain (Simard-Duplain, 2022). This is especially important in pre-retirement years, as becoming a caregiver at younger ages could negatively impact the final employment years and lead to pension penalties. Earlier caregiving onset could act as a catalyst for the accumulation of inequalities over time, potentially accelerating the health and wellbeing deterioration while setting individuals onto trajectories of weaker employment ties or reduced social activities (Fast et al., 2021; Raiber et al., 2022). Most importantly, the earlier this transition occurs, the more persistent these trajectories are likely to be, with more profound consequences in later life.
Determinants of timing of caregiving onset and intersectionality
Alongside with population aging, growing social inequalities have become paramount in the study of prerequisites and consequences of informal care (Brandt et al., 2022; Cohen et al., 2019; Moen, 2001). The “Informal Care Model” posits that caregiving transitions arise from care needs in the family, followed by a decision process involving individual disposition, expectations, social norms and availability of care alternatives (Broese van Groenou & De Boer, 2016). Moreover, it is likely that all these steps are socially stratified. While behavioural components are important to understand the onset of care provision, diversity of contexts and the influence of individual axes of inequalities as determinants of the timing of caregiving onset merit special attention. Family caregiving is largely influenced by social determinants such as sex/gender, migration background or socioeconomic status (SES), with women and those with lower SES being more likely to provide care (Lee & Tang, 2015; Schmitz et al., 2024). Although there is substantial evidence about the gendered and socioeconomic gradient in family caregiving, most of the work unveiling differences in the timing of care transitions has focused on single indicators of social inequalities rather than their intersections.
Earlier life events and social determinants such as sex/gender, SES or social class, particularly when considered together, can influence the timing of caregiving onset, and thus mutually shape the consequences for the caregivers’ life-course (Carmichael & Ercolani, 2016). Characteristics like the caregiver’s income (lower), sex/gender (female), and partnership status (single) are associated with an increased likelihood of becoming a caregiver (Gaugler et al., 2003; Quashie et al., 2022; Uccheddu et al., 2019). However, the stratification of the timing of caregiving onset by social determinants or their intersections has rarely been investigated. The gendered nature of caregiving has been extensively documented, with women typically becoming caregivers at earlier ages on average (Fast et al., 2021; Rodrigues et al., 2022). Such disparities in the timing of caregiving onset are illustrative of sex/gender as context, where a gendered life-course determines the impacts of social roles and shapes differential caregiving pathways, opportunities, and risks (Kim, 2023). Regarding migration background, older non-western immigrant women tend to have earlier transitions to caregiving than their non-migrant counterparts (Syed, 2022; Zhou, 2013). This variance in caregiving onset should be accounted for by considering life-course timings within intersectional and transnational feminist perspectives (Syed, 2022). Further, differences in SES prior to family caregiving are associated with divergent onset timings, where individuals with lower education, lower social class and less skilled occupations become caregivers at earlier life phases (Carmichael & Ercolani, 2016; Moen & DePasquale, 2017). Low-skilled occupational classes may begin caregiving earlier due to limited resources, including a lower ability to afford paid home care.
While some evidence links social determinants to the age of caregiving onset, few studies have explored this association through a cumulative (dis)advantage perspective (Rodrigues et al., 2022). Differences in the timing of caregiving onset have been investigated in terms of sex/gender, migration background or SES, but not by considering the impact of multiple overlapping social determinants. The intersectionality framework can provide new insights, based on the idea that people can access to social positions following the intersection of multiple socio-environmental characteristics that have been accumulated throughout the life-course (Crenshaw, 1990). Intersectionality entails that existing interlocking systems of privilege and oppression interact upon the individual social position, creating a perpetuation of structural social and health inequalities that define people’s discrimination experiences (e.g., sexism, racism, classism) (Crenshaw, 1990; Dressel et al., 1997; Hill Collins, 1990).
Most importantly, individuals’ intersectional social strata might determine the age of care onset, shaping a distinct impact in the nature of caregiving and other overlapping trajectories. A recent scoping review concluded that family care research has largely overlooked aspects of diversity and intersectionality, calling for the adoption of an intersectional perspective to achieve a more nuanced understanding of the caregiving experiences (Hengelaar et al., 2023). The novel approach of Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA) provides the opportunity to incorporate intersectionality into quantitative analyses (Merlo, 2018), but it has not been applied yet in the family care context. Developed by Evans et al. (2018), MAIHDA is useful to gain a nuanced understanding on differences in health care outcomes (i.e., timing of caregiving onset) across intersectional social strata, while embedding intersectionality within a life-course perspective (Bell et al., 2019; Holman & Walker, 2021).
The present study
The aim of the present study was to investigate the age of caregiving onset, and whether such timing in the life-course varied across intersectional social strata. Strata were created by the intersection of sex/gender, migration background, education and occupation. Thereby, we considered intra- and intergenerational care relationships separately. Given the later stage in the life-course and more accumulated inequalities, we assumed that between-strata differences in the age of caregiving onset would be more pronounced for the intragenerational than for the intergenerational cases, although the evidence on this is limited. We hypothesized that women, with a migration background, with lower education, and with lower-skill occupations would have an earlier caregiving onset than men, without a migration background, with higher education, and in white-collar high-skill occupations.