Caregiver Stress And The Sandwich Generation

I’m planning to give a talk on caregiver stress in a few weeks, and I figured I’d ask my lovely readers to help me make this talk awesome.

What is a caregiver?  A caregiver is defined as someone who provides care for another person in need.  Generally the person being cared for is unwell in some way and needs help with daily tasks.  Those with cancer, dementia, and many other chronic conditions may need help with dressing, bathing, eating, medication management and other critical tasks.

Who are our nation’s caregivers?  According to, over 20% of adult Americans will provide unpaid care to an elderly or disabled person each year.  61% of informal or family caregivers are women, and most are middle-aged.  59% of women who provide informal care to a family member are also employed. Over half of these employed female informal caregivers have made changes at work to accommodate caregiving, such as scaling back their work hours or changing their schedules.

There is an interesting term to refer to those providing informal or family caregiving:  The Sandwich Generation.  There are several types of Sandwich Generationers:

  • Traditional Sandwich – those caring for both aging parents and their own children
  • Club Sandwich – those caring either for both aging parents and their own adult children and grandchildren (4 layers!) OR aging parents and grandparents and their own children
  • Open-Faced Sandwich – anyone else involved in informal caregiving

Sandwich generation caregivers have an extra level of stress because they have competing priorities.  There is only so much time and they often feel they can’t do justice to any single task because they’re pulled in so many different directions.

Caregivers have definitely Got Stress.  How does one know when caregiver stress is becoming unhealthy?  The Alzheimer’s Association has a lot of information on their website about caregiver stress and burnout.  Symptoms can include anxiety, irritability, trouble concentrating, depression and anger.  Caregivers may be in denial about their loved one’s illness.  They may withdraw from friends and family, have trouble sleeping and feel exhausted.

Caregivers’ own health may suffer due to stress and burnout.  Researchers at the CDC found that 20% of caregivers surveyed rated their own health as fair or poor.

If you are a caregiver and find yourself struggling with stress and burnout, what can you do about it?  Better yet, if you find yourself (or know someone else who is) in the caregiver role, how can you minimize the risk of burnout?

  • Don’t beat yourself up because you can’t do everything.  Recognize you’re only human and be gentle with yourself.
  • Look for resources.  Check with the local Area Agency on Aging to explore what services are available near you.  There may also be disease-specific resources and services available.
  • Be proactive and take a problem-solving approach, rather than worrying and feeling helpless.
  • Do your best to take care of yourself.  Exercise, eat right, and get enough sleep.  See your doctor for your annual physical and other scheduled visits.  Remember, you can’t take care of others if you’re not well yourself.
  • Actively practice proven stress reduction strategies.  Meditation and yoga are good options.  Check out this recent post about Sudarshan Kriya Yoga.  Go to church, temple or other religious services regularly.
  • Don’t be afraid to ask other family members for financial help if you need it.
  • Ask for and ACCEPT help.  Have a mental list of things people can do and let them choose one.  For instance, a sibling can take Mom for visits on weekends to give you a break.
  • Be realistic and don’t be afraid to say no if you can’t commit to something.  Someone else will be able to chair the PTA and run the fundraiser.
  • Stay in touch with family and friends.  Isolation makes stress worse and accelerates burnout.
  • Keep a sense of humor!

I want to make sure you realize that there are significant upsides to the caregiver role too.  Many of my patients are providing care to aging parents and grandparents and find it incredibly rewarding.  For instance, one patient was the full-time caregiver for her father until he passed away in his 90s.  She has told me it was wonderful being able to share that time with him, knowing the time was limited and coming to a close.  Focusing on the blessings rather than the trials and keeping her (boisterous!!) sense of humor helped her keep burnout at bay.

Research has also shown that the healthiest and longest-lived people on Earth tend to live in multi-generational households.  Maintaining close relationships between generations is good for your health and for society.  One of my friends is a caregiver for her grandfather who has Alzheimer’s disease.  She is homeschooling her son and they spend the day together as a family.  Her grandfather is fascinated by his great-grandson’s schooling and the little guy adores spending time with him every day.

Providing family caregiving services to an elderly or ill family member is stressful, no doubt about it.  Caregiver stress is common and falls largely on women.  It doesn’t have to lead to conflict, burnout and physical illness though.  Acknowledging your limitations, asking for help, practicing good self-care, and seeking out the positive can help keep you healthy and make caregiving a rewarding experience for you AND your loved one.

QUESTION:  Are you providing caregiving services for someone you love?  What are you struggling with, and what helps you manage?


6 thoughts on “Caregiver Stress And The Sandwich Generation

  1. Hi Dr Jen, I’m taking care of my 91 year old father now and he has been with me for a year now. I’ve taken care of a mother with pancreatic cancer, my mother in law with breast cancer and my brother with lymphoma leukemia, then came Bob with GBS.. My father has glaucoma is legally blind and has alzheimer’s. My advice would be if you don’t take care of yourself you can’t help take care of someone else. Your helping others when you first take care of yourself. Also, you will realize it was a blessing taking care of the ones you love!

  2. Dear Dr. Jen,

    Thank you for this article. I has been crazy since Nov. 2014 when my mom who had been living with us for 15 years suffered Congestive Heart failure. Working, running to the hospital and eventual placing her in a skilled nursing facility has been hard. Like you said between working, checking on my mom (93) and often helping with the grandchildren, I wish I could be cloned. Here I am at almost 65 and trying to live my life by doing the things I love to do and there is just not enough time. Please let me know when this talk is going to be I would love to attend. This year has been stressful for us both. I have been praying for your husband Russ and family. My prayer list has become quite long. I lost my cousin Jack in March, my neighbors parents in April and May, my sewing friend in June. My brother came to visit for our mother’s birthday in July and ended up in the VA hospital for a month. I am ready for the New Year. God Bless you and your family.
    Thanks for listening. Cathy

  3. I provide care for family members I love, elderly neighbors who have no one else, and friends who are overwhelmed. I do it because I am truly blessed and I feel that is one of the ways that I can give back. I struggle at times because while I want to do it I also resent it a little. I resent it because I am not the only family member or friend who is capable of providing care yet I am the only one who does it. However, I remind myself that this is my choice just as it is the choice of those around me to refuse to engage. I have recently started asking my husband to help with some of these caregiving commitments when I’m feeling overwhelmed or resentful and while he historically didn’t seem to understand why I offered, he now always steps in to lend a hand when needed.

  4. I cared for my mother for the last 8 years of her life. It was very hard having to mother the woman that raised me. I had three children I was mothering at the same time and the contrast was stark. Mothering children to have as positive a future as possible. And mothering one to have as comfortable an end of life as possible. Caregiving is a pretty thankless task. Having grown up an only child, moving often with spouse’s career, there was nowhere to turn for support twenty years ago. But I think it’s safe to say we’re all doing fine now.

  5. Pingback: How To Take Care Of A Cancer Patient - Jennifer Wurst, MD

  6. My husband and I first took care of my mother-in-law 89 yrs old who had a stroke and after that everything went down hill with her health. She was put in a nursing home and thinking she will get better with rehab and come home but unfortunately that didn’t happen and she passed away. Then my mother moved in with us after my dad passed away from a heart attack. She was fairly healthy and then she had a stroke also and we took care of her as she eventually became bedridden and passed away at age 91. We had Hospice come in and they are absolute angels could never done it without them. People say she lived a good life but in reality you never want to let go no matter the age but you must. It was the hardest thing my husband and I endured but with the love we had for both our parents, and our faith got us through the hard times and they were hard times. It’s not ever easy but we did get through it and I do not regret one minute of how we helped our parents. I often think of those hard times but then you thank God you got through it with home health care nurses coming in. It is a very very difficult time but you do get through it. Makes you feel good and gives comfort to know you made their last days as comfortable as possible. I would say if you could have a family member or close friend stay with the parent and go out and have dinner or a movie just to get some relief for a short time it does help. But I commend anyone that does take on this very hard time as my husband and I know what it is as with my mom did it for 5 years and you somewhat put your life on hold and trust me it is well worth it!!!

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