Background Older women’s contributions to their families, societies, and economies—including as caregivers for grandchildren—have remained largely invisible within a dominant public discourse that tends to portray older people as societal burdens. Methods This article explores the phenomenon of skip-generation caregiving in rural Cambodia, where grandparents become caregivers to their grandchildren as a consequence of long-term labour migration of the parental generation. We use an intersectional lens to situate the health concerns of older populations within broader interlocking systems of power and wider, converging, and dynamic social structures. Results Through an in-depth intersectional analysis of a case study of a Cambodian grandmother caregiver we illustrate how interlocking systems of power (ageism, ableism, sexism, and classism), converge with health policy to structure the life chances of a multiply marginalised older woman. The analysis exposes the limits of current global health policy and infrastructure to adequately address the needs of older women who are multiply disadvantaged by the intersection of their unique social locations. Conclusion Considering the cumulation of structural disadvantages across the life course, policies and interventions are needed that support older women to fulfil their pivotal caregiving roles without self-neglect. An intersectional understanding of older women’s lived realities can help to advance policies and interventions aimed at alleviating these existing intergenerational and gender-based inequalities.