Material Hardship and Perceived Physical Health Among Grandparent Caregivers: A National Trend Analysis

Background and Purpose: Grandparent caregivers often experience significant financial challenges. Raising grandchildren increases expenses associated with food, housing, and childcare, which can lead to difficulties engaging in health promoting behaviors like purchasing prescriptions or attending medical appointments. Although grandparent caregivers often do not qualify for financial assistance, the CARES Act of 2020 introduced flexible economic relief policies to mitigate the economic impact of COVID-19. However, little is known about how these policies may have influenced perceived physical health among grandparent caregivers. This study examines changes in the relationship between material hardship and perceived health over time, using a nationally representative sample of grandparent caregivers.

Methods: Data on grandparent-headed households were obtained from the 2018–2023 National Survey of Children’s Health (n = 11,355), an annual, nationally representative study examining the wellbeing of children and their caregivers in the United States. Measures of material hardship included economic insecurity and food insecurity. Using a 4-point Likert scale, economic insecurity was measured by the question, “since this child was born, how often has it been very hard to cover the basics, like food or housing, on your family’s income? Food insecurity was measured by the question “which of these statements best describes your household’s ability to afford the food you need during the past 12 months?” Perceived physical health was measured using a 4-point Likert scale ranging from excellent to poor. Controlling for sociodemographic factors, we used fixed effects regression modeling to examine the relationship between perceived physical health, economic insecurity, and food insecurity over time.

Results: The sample was predominantly female (79%) and comprised participants who identified as White non-Hispanic (40%), were married (53%), lived in urban areas (84%), had a high school education (35%), and had a biological parent living in the home (49%). Controlling for demographics, the multivariate regression model showed a significant negative relationship between economic insecurity and physical health (B = -.16, p < .01). When examining change over time, results showed a significant interaction between economic insecurity and physical health (B = .06, p < .05), with trend analyses indicating that grandparent caregivers that experienced economic insecurity the most often showed the largest declines in perceived physical health. Regression modeling also showed a significant negative relationship between food insecurity and physical health (B = 0.53, p < .01) and a significant interaction between food insecurity and physical health (B = .058, p < .05), with trend analyses indicating that grandparent caregivers with the highest rates of food insecurity showed the largest declines in perceived physical health.

Conclusion and Implications: The most economically vulnerable grandparent caregivers experienced the greatest declines in perceived physical health over time, likely exacerbated by the COVID-19 pandemic, which disproportionately affected older adults. These findings underscore the need for comprehensive and accessible economic and social supports to promote the health and well-being of grandparent caregivers. Future efforts should prioritize policies and programs that address the intersection of aging, caregiving, and economic strain, particularly in times of public health crisis.