The Social Determinants of Health
Background: Gender, socioeconomic status, and age are well-known social determinants of health in general populations. More often they are examined separately, less often in combination in terms of their intersectionality. Among informal caregivers to older adults with dementia, they also tend to be studied separately rather than for their combined effects. Furthermore, while poverty is known to be disadvantageous for caregivers’ quality of life, whether being female is disadvantageous is more contentious, and being an older caregiver may be advantageous. Objectives: This paper asks whether being female, living in poverty, or being older, singly and in combination, are disadvantageous for the quality of life of caregivers to older adults as the social determinants of health literature would suggest. Methods: Four quality of life outcomes (self-esteem, burden, anxiety, and depression) are measured in a non-random sample of 767 informal caregivers to older adults with dementia. All caregivers were living in British Columbia, Canada and all care recipients living in the community. Data were collected by in-person interviews at two points in time, one year apart. Bivariate correlations examined the relationship between the three statuses and the four outcome measures then analyses of variance conducted as general linear models were conducted on each outcome measure separately at T1 and at T2 to assess two- and three-way interaction effects. Post-hoc analyses to assess pairwise differences in group means were conducted using the Bonferroni Type I error correction. Conclusions: The analyses point to the complexity of the caregiving experience, the theoretical value of the concept of intersectionality and the fact that some social determinants apply differentially to some groups. Socio-economic status operates as expected. Gender does not. Age operates as the general social determinants of health literature would suggest but opposite to many of the findings for caregivers. Male caregivers living in poverty emerge as especially vulnerable to lower quality of life.