Feature Article | The Sandwich Generation

They’ve been dubbed the sandwich generation, middle-age people caring for aging parents while still taking care of their own children–‘sandwiched’ between two generations. According to the Pew Research Center, one out of every eight Americans age 40 to 60 is raising a child and caring for a parent at home. And those numbers are only expected to rise as our population ages.

Pulled in many directions, these family jugglers are at at risk for stress, depression and other health problems. The demographics of our society may make it impossible to avoid being sandwiched, but there are steps those in the middle can take to protect their physical and emotional health.

The facts

Thanks to advances in life expectancy, more middle-age people have living parents. More than 70 percent of the baby boom generation (people born between 1946 and 1964) have at least one living parent. It's not surprising, then, that boomers make up the majority of the estimated 65 million family caregivers in the United States.

In addition to caring for aging parents, many middle-age people face the strain of providing financial support to both parents and children. According to the Pew Research Center, 10 million baby boomers are raising young children and/or supporting an adult child while also giving a financial hand to an aging parent.

At the same time, boomers are worrying about their own retirement funds and job security in the midst of stock market swings, a troubled economy and high unemployment. People between ages 45 and 54 make up the largest percentage of the unemployed. And if they’re laid off, older unemployed workers are less likely to find new work than younger job seekers. Among employed boomers ages 50 to 61, six-in-ten say they may have to postpone retirement due to the recession.

The impact

Given today’s reality, it’s not surprising that middle-age people are stressed out. According to the Centers for Disease Control, major depression rates are highest among among men and women ages 45 to 64 years. Women, who shoulder the majority of sandwich responsibilities, are particularly effected. According to the July 2011 Gallup-Healthways Well Being Index report, women between the ages of 45 and 64 have the lowest well-being of any age group.

Add caregiving to the mix and health risks go even higher. According to latest data from AARP, 40 percent to 70 percent of caregivers of older adults have clinically significant symptoms of depression. Family caregivers may also be at higher risk for heart disease, diabetes and cancer. And elderly caregivers have a higher mortality rate than non-caregivers of the same age.

What to do about it

The good news is there is much the sandwich generation can do to maintain mental and emotional health in the face of these challenges. Being open and honest about how much responsibility you can handle, and then recognizing the early signs of stress and depression can help you navigate this stage of life.

Ask for help.

Many family caregivers are reluctant to ask for help because they are burdened by guilt and a sense of obligation, say experts featured on Be Smart. Be Well. But it’s in the best interest of both the caregiver and the aging parent to acknowledge when help is needed.

“They feel like they’re failing if they’re saying, ‘I can’t do this anymore; I need someone to help me.’ But this is actually a very healthy response,” says Dorothy Northrop, VP of Research and Clinical Operations at the National Multiple Sclerosis Society. “They’re realizing, ‘I want to keep doing this for a long time and if I’m going to be able to do it, I’ve got to have some support.’”

Take some time for yourself.

It’s also vitally important for people caring for children and parents to carve out a few moments for themselves each day. That’s difficult to do when juggling work, carpools, home responsibilities and caregiving, but essential for emotional and physical health.

“There has to be a boundary so that they can actually take care of themselves and keep themselves healthy spiritually, emotionally and physically,” says Jewel Dallas-Bruner, a licensed clinical social worker who works with families of people with Alzheimer’s disease.

“We have to help caregivers understand that they have to be doing things that are energizing them and giving their life meaning. Because otherwise they’re being zapped of their energy; they have no energy to give,” Northrop agrees.

Pay attention to your own health, and take it seriously.

While shuttling aging relatives to and from doctors appointments, make sure you don’t skip your own. “Family caregivers don’t take care of themselves. Not only are we mismanaging our own body and our own life, but if we fall apart, then what happens?” says Suzanne Mintz, president of the National Family Caregivers Association.

(Learn about caregiver stress and health, and see more of Dorothy Northrop, Jewel Dallas-Bruner and Suzanne Mintz at Be Smart. Be Well. Caregiving.)

Don’t be embarrassed to admit you feel stressed or depressed.

“These are diseases. They are not your fault, they are not because you are evil, they are not because you are lazy,” says Nada Stotladt, MD, past president of the American Psychiatric Association.

Know the warning signs of depression.

Sadness that lasts for weeks at a time
Loss of interest or pleasure in activities you used to enjoy
Change in weight
Difficulty sleeping or sleeping too much
Energy loss
Feelings of worthlessness
Thoughts of death or suicide

If you do feel overwhelmed, stressed or depressed, talk to a healthcare provider.

“If we catch it early, when you’re just beginning to have some signs and symptoms, we can keep you from going downhill much better,” Dr. Stotland says.

“Mental illnesses are like any other illness,” says Michael Fitzpatrick executive director of the National Alliance on Mental Illness. “They’re treated the same, with medication and rehabilitation, and with the idea that people can recover.”

(Learn about the prevention and treatment of mental illness, and see more of Michael Fitzpatrick and Dr. Stotland at Be Smart. Be Well. Mental Health.)

Life Story Videos: Sandwich Generation

Watch this three-minute video to see how baby boomers Chris and Ann manage caring for their aging parents, and what happens when it gets to be too much.
Watch Chris and Ann’s story

Taking on too much can cause stress and depression. Watch this short video and learn how to recognize and manage mental illness.
Watch Just the Facts