Children below. Parents above. Stressed-out caregivers in the middle, spreading themselves thin managing demands from spouses, careers, home, health and more. Nicknames attached to specific generations can be confusing, in part because not everyone agrees on what these terms mean. But in 1981, a social worker named Dorothy Miller hit on a name everybody could agree on. She coined “sandwich generation” to describe “adult children of the elderly who are ‘sandwiched’ between their aging parents and their own maturing children…subjected to a great deal of stress.” The analogy is perfect. A layer above; a layer below; pressure from both sides. And because sandwich generation defines a functional life stage (rather than set of years during which a person was born), the term was rapidly adopted, gaining currency in both professional and popular circles, officially entering the lexicon via inclusion in the Oxford English Dictionary in 2003.

Stressed-out caregivers in the middle, spreading themselves thin managing demands...

Unlike exclusionary labels such as “Baby Boomer,” “Greatest Generation” or “Millennial,” which can isolate us via experiences shared only by those in our age cohort, members of this generation can overlap by decades. Common experiences, stresses, and needs forge the bonds that bond the members of Generation Sandwich—not just age.

A generation of caregivers: That’s the simplest answer to the question of, “what is the sandwich generation?”

The sandwich generation definition

The Pew Research Center, which tracks American social and demographic information and provides insights and analysis over time, offered a comprehensive overview of the state of the sandwich generation in 2013. At that time, nearly half of Americans (47%) who were in their 40s and 50s reported being “sandwiched,” with at least one living parent (age 65 or older) and still raising dependent children or financially supporting a grown child. Furthermore, 15% of members reported providing financial support for both a parent and a child. So, what is the sandwich generation?

The short answer is, because the members of the generation are constantly changing, the sandwich generation definition itself is constantly changing. Unlike other “generations,” its members are continually turning over, so naturally it replaces itself as older members “age out” and younger people “age in.”

  • In 2013, according to Pew, 71% percent of these multi-generation caregivers were members of between 40 and 59
  • An additional 19% were under 40
  • Another 10% were over 60

Caregiving is the heart of the sandwich generation definition. And caregiving is a role—a responsibility and a calling, not an age. Medicare offers a round-up of insights and statistics from the National Longitudinal Survey regarding members of the sandwich generation and everything they do for elders and children:

  • Of American adults who have the caregiving responsibility for a living parent and a child, nearly 80% invest a minimum of 23 hours per week caring for their parents or their in-laws
  • 30% of these also report spending an additional 26 hours per week helping their children
  • Women in particular report additional childcare responsibilities—an average of 28 hours per week (presumably caring for grandchildren, but actual familial relationships were not specified)
  • In aggregate, sandwich generation adults reported investing a total of 1,350 hours per year on average caregiving for parents and children—an enormous amount of unpaid time
  • In addition, 80% of surveyed adults reported spending money on their children (separate from college expenses and support)
  • 70% reported also contributing financial support to parents
  • The National Alliance for Caregiving and AARP further reported in 2015 that 43.5 million adults had provided unpaid care for an older adult or a child in the previous year; of those caregivers, 60% were women and 40% were men (although among the 25% of caregivers who are Millennials, between the ages of 18 and 34, the gender breakdown was equal)

Unsurprisingly, providing all of that help, support, care, and assistance takes a predictable toll on sandwich generation caregivers, leading to predictable sources of stress. But just because this generation caregivers are stressed, that doesn’t necessarily mean caregivers are unhappy. In fact, surprisingly, Pew reported that 31% of sandwich generation members caring for two generations simultaneously reported they were “very happy” with their lives, and an additional 52% said they were “pretty happy.” Those numbers tracked quite closely with happiness rates among adults who were not sandwiched—of adults without caretaking responsibilities for generations above and below, 28% reported being “very happy,” and 51% said they were “pretty happy.”

Recognizing sandwich generation caregiver stress

Caring for parents, in-laws, other aging relatives, and/or children simultaneously, in addition to tending to the everyday responsibilities of managing a full, demanding life in the middle years, can become overwhelming. Stress can come from multiple directions; limits on time, finances, physical capabilities, and resources can generate worry. Interpersonal conflict with children, elders, and other family members can heighten tensions. And the toll of constant stress on a body, mind, and spirit can lead to both visible and invisible health consequences—physical, emotional, and mental—for caregivers in the sandwich generation.

It isn’t that caregivers don’t cherish and love those for whom they care, or that caregiving isn’t deeply rewarding. It’s simply that our bodies and minds have evolved together to unconsciously be alert for, assess, and be ready to respond to danger. And caregiving is full of dangers both real and imagined, from financial pressures to the threat of accidents and unexpected falls.

Stress is the body’s fight-or-flight reaction, and it is a healthy, adaptive reaction. Think of the last time you were driving and somebody nearly sideswiped you. Your brain saw the threat and recognized it; your body instantaneously released a cascade of stress hormones and your reflexes used those hormones, like adrenaline and cortisol, to remove you (and your car) from the danger zone. The fight-or-flight process worked perfectly, probably before you even had any conscious idea what was happening.

That was the stress reaction working as it should. You had control over the stressful situation; your brain and body told you to run, and you removed yourself from danger.

Chronic stress, on the other hand, is a physiological syndrome in which people have no control over the source of stress. As a result, stress hormones are released with nowhere to go, building up in the body. When we live in a consistent state of low-grade worry or anxiety, we experience the consequences in a wide variety of ways.

  • Insomnia
  • Chronic pain
  • Autoimmune diseases
  • Heart disease
  • High blood pressure
  • Respiratory infections
  • Headaches
  • Fatigue
  • Digestive problems
  • Social withdrawal
  • Depression and sadness
  • Loss of interest in hobbies
  • Anxiety and restlessness
  • Irritability, impatience and anger
  • Sexual dysfunction
  • Concentration, thinking and memory problems
  • Alcohol/drug abuse
  • Overeating or undereating
  • Tobacco use
  • Getting less exercise

If and when you recognize common signs and symptoms of chronic stress, don’t hesitate to slow down, take a deep breath, and make a call and a plan to manage it. That may require reaching outside of your own circle of family and friends to find resources to help.

Assess your stress tolerance

The simplest way to define the sandwich generation may be the most basic: It’s a generation doing its best to cope with intergenerational caregiver stress. Because unrecognized, unrelieved chronic stress can lead to a cascade of health conditions for caregivers, it’s important to develop a keen ability to self-monitor.

Several factors make living with stress easier to cope with on a long-term basis.

  • Your sense of control over what happens in your life. The psychological concept of locus of control may sound cold and clinical, but it’s a way of classifying each individual’s sense of how much control he or she has over events, situations, circumstances, and choices. And while none of us control external events like weather, politics, or even whether the neighbor dog is barking all night long—we do control our own choices. Psychological research has proven time and time again that people who believe they control their own fate and choices are less stressed and have better mental health overall than those who feel helpless, acted upon, and out of control of their own lives. The difference is an internal locus of control versus an external locus of control. If you tend to believe others are in control of you and what happens to you, no matter what you do, your stress levels will be higher, and caregiving will be harder. The next time you feel controlled or trapped, ask yourself, “What choice could I make right now that would change the situation?” Could you ask for help, step away, make a call, move to a different position, change your tone of voice? Could you use technology to offload some stress and worry associated with caregiving? Working with a counselor may help people with ingrained issues around locus of control issues to reframe ingrained thought patterns to help mitigate the long-term consequences of chronic stress.

Your sense of control over what happens in your life

Your support networks, near and far

Your own physical health

Your support networks, near and far. No matter which sandwich generation definition you are working from, one truth is self-evident: Every caregiver needs support, and support comes in many shapes and forms. From nearby family and friends who can provide unpaid respite when you just need to step away for a massage, a movie, or a game night with friends to formal support groups, either facilitated online or in person, we all find ways to refill our tanks in ways that are meaningful to us. Some of us may arrange hikes or walks in nature because quiet time with one or two people is the best way to reset in a calm, restorative setting. Others may find answers and resources in a face-to-face setting with a professional moderator. The AARP facilitates and moderates active online caregiver forums that cover topics from finances to Medicare and Medicaid with compassion and sensitivity.

Your own physical health. Good nutrition, cardiovascular fitness, appropriate muscle tone to handle the physical challenges of caregiving including lifting and positioning when it is required, and keeping up with your own physician’s appointments; these are sometimes the first things that slip off the calendar when the sandwich generation starts burning the candle at both ends. But that’s setting yourself up for injuries, illnesses and accidents that could put you out of commission either temporarily or even longer, and could (potentially) place the children you’re caring for today in a premature sandwich generation dilemma of their own in just a few short decades. So slow down. Schedule time to attend to your own daily physical well-being. Take walks. Lift weights. Learn about the critical basics of ergonomics (body mechanics) for senior care to avoid unnecessary back, shoulder, leg, arm, and wrist injuries. As every flight attendant makes it a point to tell passengers, you can’t help others if you don’t put your own oxygen mask on first, and that message is doubly important for sandwich generation members, with important people relying on them both above and below.

Minimizing sandwich generation stress

No matter what your definition is, you can take proactive steps to minimize the stress. Providing care for parents and children at the same time through some of the same time-honored stressbusting techniques people have been using to

Talk to your employer. Some of the challenges that come with this generation can’t simply be wished away, and some of those issues arise from inevitable conflicts between the obligations of employers and family. If you’re a member of the sandwich generation and find yourself fraying around the edges, you don’t have to go it alone, and you shouldn’t suffer silently. Speak with your boss or your HR office about the situation and be clear about the extra obligations you’re shouldering in your caregiving roles. There may be resources available through your organization’s Employee Assistance Program you weren’t aware of that can help ease your burden. In addition, American employees who can afford to may qualify for additional benefits, including up to 12 weeks of unpaid annual leave per year to care for ailing family members (which includes parents) under the Family Medical Leave Act, or FMLA.

Get familiar with respite care. Speaking of family leave, respite care is a term members of the sandwich generation should become familiar with early in their new roles. Essentially a bridge between care provided by family and care provided by professionals, respite care is short-term, temporary care provided a few hours or a few days at a time, on an as-needed basis, for children or adults, to provide temporary relief for caregivers who need time off. Nobody works a full-time job 24/7/365, and it is unrealistic to expect family caregivers to work those hours providing loving, compassionate, responsible care to their own children or parents without relief. Respite care resources offer vetted, professional, local assistance for members of the sandwich generation so they can return to caregiving after a break, refreshed and renewed.

Learn to be in the moment. Caregiving to members of another generation is ultimately an exercise in slowing down and being present, even when the world around is moving at a terrifying pace. Children grow up at a startling rate, outgrowing clothes and shoes and books seemingly within months. At the same time, parents and older relatives tell us time goes by more quickly each year, and as we grow older, we seem to see more and more evidence that’s true as we care for them and take more steps to help them with increasing challenges and frailties. Managing stress through activities that emphasize calm mindfulness such as yoga, meditation, deep breathing, and tai chi can help to trigger the body’s own innate relaxation response, which in turn helps to defuse stress hormones like cortisol, diminishing chronic stress and elevating feelings of calm and serenity.