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This study examined: (1) the effects of one’s own and spouse/partner’s health on older adults’ perceived marital support and strain, (2) the extent to which these effects differ by gender, and (3) the mediating effects of financial strain and household cleanliness in explaining these relationships. Data are from the Health and Retirement Study, a probability sample of older adults aged 51 and over and their spouses/partners (n = 4,425). We used multi-level model for dyadic analysis to estimate the models. Results show that one’s own and spouse’s poor health were associated with lower levels of marital support and higher levels of marital strain. Spouse’s poor health exerted more negative influence on women’s than men’s perception of their marital relationship. The findings suggest that health decline in old age may put marital relationship under distress and that the consequences of spouse’s health decline are more detrimental for women than men. Future research should look into ways that we can preserve marital support and minimize strain in times of stress. In addition, assessments of gender differences in caregiving burden and needs for respite care may help address the gender disparity in the effects of spousal health.