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Are you a member of the “Sandwich” generation?  The phrase was aptly coined to describe those of us who, at midlife, find ourselves with the responsibility for caring for not only a child (or children), but an elderly parent (or parents) as well.  If you’re living your life in the middle of that “sandwich,” you’re not alone. A report from the American Association of Retired Persons (AARP) estimates that 44% of adults between the ages of 44 and 55 have at least one living parent and at least one child under the age of 21.

Multi-generational, multi-responsibility caregiving is certainly not a new phenomenon; adults have been meeting the needs of their aging parents while raising their own kids since families began.  But for a number of reasons, increased attention has been focused on these caregivers in recent years.  Medical advances allow people to live longer.  With more and more women pursuing careers outside the home, adults are marrying and having children later in life. And economic factors are forcing more and more grown children to stay or return home to reside with their parents.  The confluence of these trends means more men and women in their 40s and 50s are finding themselves “sandwiched” into a position of simultaneously parenting their kids and “parenting their parents.”

This article will look at the issues impacting individuals who are juggling multiple caregiving responsibilities.  What signposts should you watch for to indicate that your own mental health, physical health or relationships may be suffering while you attend to the needs of others?  What steps can you take today to “care for the caregiver?”

The joy, and the burden, of caregiving

Although here we are focusing on the potential toll caregiving can take, it’s important to note up front the many benefits one can experience when caring for loved ones. Studies cited by the Family Caregiver Alliance’s National Center on Caregiving illustrate that a significant number of caregivers report feeling appreciated by those they care for, with many emphasizing that their relationships with those they care for have improved.  In addition, many caregivers note more positive feelings about themselves as a result of being able to help a loved one.

Those and other positive outcomes can result from giving of oneself for others.  But there is a cost, too.  Research compiled by the National Center on Caregiving paints a picture of today’s sandwich generation as overworked, overextended, overstressed and at risk of developing depression or other emotional or physical illnesses.

• The majority of caregivers hold down full- or part-time jobs in addition to providing care.
• Approximately 75% of caregivers are women, although the percentage of male caregivers has grown significantly in recent years.
• It’s more common for caregivers than for non-caregivers to experience anxiety, depression and other symptoms of emotional stress.  Estimates of the percentage of caregivers reporting symptoms of depression range between 20% and 50%, with a higher incidence of depression reported by those caring for people with dementia. Overall, female caregivers are at greater risk than men for developing these symptoms.
• Stressors including financial concerns and marriage and family conflicts place the caregiver at even greater risk of experiencing depression or other emotional distress.
• Caregivers who neglect their own needs while caring for others may be jeopardizing their own physical health in the process. Research indicates that caregivers are at increased risk of developing serious conditions including  elevated blood pressure and insulin levels, a weakened immune system, and even cardiovascular complications.

Clearly, the scientific literature confirms what many sandwich generation caregivers know all too well:  the burden of caregiving is significant.  Although both men and women may assume caregiving responsibilities, statistics show that women bear the brunt of that responsibility.  And societal expectations and current economic realities can combine to make that burden even heavier.  In many, indeed in most cultures, women are expected to assume caretaking responsibilities for children and other relatives.  Coupling that expectation with the increased pressures today’s economy places on household finances, more and more women find themselves returning to work or increasing their working hours, in some cases compensating for a spouse’s job loss, with no corresponding relief in their caregiving duties. The result can mean stress, anxiety and depression for the caregiver and the entire family.

Can the pattern of compromising one’s own welfare while caring for others be avoided? Experts, including those at the University of Michigan Depression Center, believe it can. The key is to make a new, healthier “sandwich” by devoting the same awareness and vigilance to our own wellbeing as we do to that of the loved ones under our care.  Simple to say but not always easy to do, it begins by following these steps:

Listen to your inner caregiver.

Chances are if you’re caring for both a parent and a child, you’ve developed some reliable instincts for diagnosing problems and determining courses of action. It may be time to put those abilities to work for your own good.  Are you experiencing any of the signs or symptoms of depression? As a first step to finding out, explore our self-guided PHQ-9 test, a reliable tool healthcare providers use to assess the presence and severity of symptoms.

Seek help for your own symptoms. 

If you’ve determined that there’s cause for concern about your own mental health, don’t ignore or minimize your symptoms.  Get help.  It’s important that you discuss your concerns with a healthcare professional.  Some caregivers avoid therapy because they are reluctant to share their feelings – especially the mixed or conflicted emotions many of us feel about our responsibilities.  But great relief can be found in talking with a professional.  Research indicates that brief psychotherapy can be very beneficial.  Cognitive Behavioral Therapy (CBT) can help validate emotions and identify unrealistic expectations. Interpersonal Psychotherapy (IPT) may be called for to develop strategies to manage conflict and function better within the family.  Feeling uncomfortable raising the subject with your healthcare provider?  Check out our tips for getting the conversation started.

That goes for your physical symptoms, too.

As noted above, caregiving can often exact a physical cost as well.  See your healthcare provider to make sure you have a plan to keep your own health on track. Together, you can identify the steps you can take to maintain or improve your physical health – including getting plenty of sleep, physical activity and proper nutrition. In the process of adopting some new, healthier behaviors, you’re very likely to improve your emotional health, too.

Recognize stereotypes and stigma, and fight back.

You have enough on your plate caring for those who rely on you.  You don’t need the added worry of living up to unrealistic societal expectations or unfair cultural biases.  Contrary to what you may have grown up thinking, or what others may say (or make clear without saying), there is nothing wrong with admitting you can’t do it all.  There is nothing wrong with asking for help.  There is nothing wrong with taking action to take care of yourself.  Reaching out to others does not make you weak, or negligent, or a failure, or a bad child, or a bad parent. It makes you a smart adult, and a responsible caregiver.

Recharge by plugging in to available resources.

Enlist the help of others to meet your caregiving responsibilities.  Allow extended family members and friends to assist with childcare and even attend your children’s activities when you can’t be there. Chances are they’ll appreciate being asked. When it comes to caring for your aging loved one, explore resources in your community like respite care or adult day care to build in much-needed breaks for you.

Nurture your other significant relationships.  

It’s easy to get so caught up in thinking about and interacting with those you are caring for that you neglect other key relationships.  Those relationships, with your spouse or partner, family members and friends, can become strained when caretaking takes center stage.  Couples or family therapy may be a useful tool to explore to help heal relationships that have been wounded or neglected due to the strain of caregiving. You may also be able to access resources such as workshops or support groups in your community.

Be the one who sets the boundaries.

It may not always seem so, but you are the keeper of your own calendar.  It will require some assertiveness on your part, but you can and should set limits on the time you devote to others.  Be clear about the frequency and duration of visits with your aging parent.  Sit down with your kids and map out the week’s activities, including setting aside time for fun and relaxation.  And make sure time is blocked out (not just in your mind, but on your calendar) time for exercise, sleep, socialization and an occasional change in scenery.

You are to be applauded for taking on the responsibilities of caring for both older and younger family members.  But no one will benefit if your efforts result in burning yourself out.  Make sure you devote the time and resources necessary to care for the caregiver. 

Contributions to this article were provided by Laura Nitzberg, BA, MS, Lead Social Worker, University of Michigan Department of Psychiatry. In addition, this article references research from the American Association of Retired Persons (“In the Middle: A Report on Multicultural Boomers Coping with Family and Aging Issues,” 2001) and cites numerous studies published by the Family Caregiver Alliance’s National Center on Caregiving.  To read their research and access their many resources, we encourage you to visit their website at www.caregiver.org.

Connie’s comments: I seek out help from friends and family. I go for $20 foot massage each week where they also massage your body. Try to get good sleep and motivate yourself every day. Volunteering and helping out another help combat depression.