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Objective This study aims to explore how age and gender are associated with health deterioration related to caregiving among caregivers aged 75 and older in Spain.Design Observational, descriptive, cross-sectional study.Setting Nationwide survey in Spain: 2020 Survey on Disability, Personal Autonomy and Situations of Dependency.Participants All non-professional caregivers identified by the survey (3746): 3166 caregivers younger than 75 (CG75−) and 580 caregivers 75 years old or older (CG75+).Primary outcome measure Self-reported caregivers’ health deterioration, as a categorical variable (present or absent).Results The majority of caregivers in both groups were women (63.2% of CG75− and 57.0% of CG75+, p=0.011). CG75+ provided care 16 hours/day (vs 14.1 hours/day of CG75−, p=0.032). Over half of CG75+ reported health deterioration (53.0%), compared with 43.5% of CG75− (p<0.001). Being 75 or older was significantly associated with caregivers’ health deterioration only for women (OR 1.70, 95% CI 1.12 to 2.57). For men, age was not associated with caregivers’ health deterioration (OR 0.83, 95% CI 0.48 to 1.43).Conclusions In Spain, older caregivers have a specific socio-demographic profile, provide high-intensity care and report a higher caregiving-related health deterioration. However, the association between older age and health deterioration was found only in women. Public health interventions must prioritise older female caregivers.