Is caring for older people a social determinant of health?

Full title: Caring for older people as a social determinant of health: who experiences the greatest impacts and what works to support them?

Supporting carers to continue to care is a policy priority. Unpaid carers are a critical component of our welfare system, and one that would be difficult to replace.

This project focuses on carers of older people and addresses one of the enduring challenges of an ageing population.

Many unpaid carers give their time willingly and derive positive benefits from their work. But caring can also be physically and emotionally demanding, with adverse consequences for the health and wellbeing of the caregiver.

Recent research commissioned by Public Health England suggested that caring should be viewed as a social determinant of health. Carers often experience poor physical and mental health, and can also have their own, diverse unmet care needs.

However, the research also identified a number of gaps in our understanding of caring and its consequences.

In particular, more evidence is needed on the specific needs of carers of older people, the physical and social consequences of caring and the best ways to support these carers. There are a number of intervention/outcome combinations that appear promising, where the evidence base is unclear.

This study will provide essential information to support future programmes to target interventions at the most vulnerable carers.

A better understanding of who experiences the most serious adverse consequences of caring and how the impacts are distributed across society will enable identification of people with the greatest need for intervention.

We will have a particular focus on groups (defined by carer/care recipient characteristics) that are expected to be most vulnerable to the adverse consequences of caring and interventions to improve outcomes.

Aims

• To enhance our understanding of how the consequences of caring for older people may vary for carers in different circumstances, and what might help.

Objectives

• To map research evidence from relevant UK cohort studies on the health, wellbeing, social and economic status of carers of older people (and older carers), associated impacts of caring, and how these vary with social disadvantage.
• To identify gaps in the evidence from UK observational studies the impacts of caring for an older person (or being an older carer) that can be addressed using data from the English Longitudinal Study of Ageing.
• To synthesise qualitative evidence on socioeconomic variation in carer perceptions of the consequences of caring and effective interventions.
• To produce recommendations for selected interventions and target populations, based on best available evidence.

Research methods

• Work package 1: Scoping review of observational studies from relevant UK cohort studies (studies that allow identification of carers such as the English Longitudinal Study of Ageing).
• Work package 2: Qualitative evidence: synthesis of the published and grey qualitative literature on caring for an older person.
• Work package 3: Analysis of data from the English Longitudinal Study of Ageing.
• Work package 4: Targeted rapid evidence synthesis and horizon scanning.

Policy relevance

This work is relevant to the reform and commissioning of social care, and policy on health inequalities, long-term conditions and disability.

Delivery timeline

• February 2022 – June 2023

Associated publications and resources

• Caring for older people as a social determinant of health: poster presentation 05.07.22 (PDF)
• Stowell et al (2024) “Caring for older people as a social determinant of health: findings from a scoping review of observational studies” (Journal of Long Term Care) DOI: 10.31389/jltc.207 
• Caring for older people as a social determinant of health: Integrated Summary (PDF)