Caring Against the Odds: Experiences of Male Dementia Caregivers from Lower Socioeconomic Settings in India.

India's 8.8 million older adults living with dementia (World Health Organization, 2023) are cared for almost entirely within households. However, the men who bear this burden in economically disadvantaged families continue to be invisible in caregiving research and policy. This study contributes a structurally-based understanding of dementia caregiver burden that goes beyond caregiving demands to consider the compounding intersection of economic precarity, gendered cultural obligation, and institutionalized neglect for low-income male caregivers in patrilineal Indian households. Ten male familial caregivers of dementia patients were selected through purposive sampling from government hospitals of Jaipur and Fatehgarh Sahib, India, and interviewed using semi-structured methods, and the data were analyzed using Braun and Clarke's (2006) thematic analysis. Results show how the roles of being a provider for the sole income of the household, as well as a 24-hour caregiver, combine to create multiple disruptions of occupation, debt loads, and psychological stress. The cultural ethic of seva (moral and filial responsibility towards parents) was paradoxical, providing the caregiver with moral meaning and sustaining them while simultaneously increasing their entrapment in roles that were neither recognized nor supported. These were systematically foreclosed by hegemonic masculine stoicism and by class-based survival imperatives that made emotional processing an indulgence. These findings build on the caregiver burden scholarship by emphasizing that, in low and middle-income settings, burden is not just an individual phenomenon, and that reconceptualizing burden has implications for culturally adapted education and caregiving policies that address socioeconomic inequality as a primary determinant of caregiver well-being.