‘Sandwich generation’ caregivers caught between two generations in need

Becky Engram is redefining what it means to spend time with her family. Engram is a member of the “sandwich generation,” adults who find themselves caring for two generations simultaneously: the young children they are raising as well as the parents who raised them.

According to a 2022 study in the Journal of the American Geriatrics Society, about one in four adult caregivers in the U.S. also care for a minor child or children. Estimates place the number of adults in this position anywhere between 2.5 million and 11 million.

And that number may continue to grow as couples increasingly delay parenthood, said Dr. Lianlian Lei, an assistant professor in the department of psychiatry at the University of Michigan in Ann Arbor and lead author of the 2022 study.

According to the Centers for Disease Control and Prevention, the average age of first-time mothers has risen to 27 in the U.S., and a growing number of women don’t have a first child until their 30s or 40s, meaning they are still raising young children into their 40s and 50s as their parents reach their 70s and beyond and begin to experience deteriorating health.

Multigenerational caregiving comes with a host of challenges that can be physical, emotional and financial, experts say. Compared to their caregiving peers who aren’t raising children, more sandwich caregivers report substantial emotional and financial difficulties and higher caregiver role overload.

A recent study in the British journal Public Health found sandwich caregivers who spent more than 20 hours a week caring for a family member experienced physical and mental health declines that could last for several years.

“The most challenging part is how many responsibilities they have,” Lei said. Her 2022 study found that nearly 70% of sandwich caregivers hold jobs on top of the more than 77 hours per month, on average, they spend on caring for older adults.

Sandwich caregivers juggle tasks such as setting up medical appointments, managing health information and accompanying their parents to the doctor, Lei said. They help with shopping, errands and personal care. This is on top of taking their children to and from activities, feeding their families, overseeing homework and bringing in income to cover the added medical expenses.

“Any one of these pieces can be very stressful,” she said. “If you combine all of these pieces, it just makes the situation so much worse.”

And caregivers aren’t the only ones who feel the impact. “They’re not able to spend enough quality time with their own children,” Lei said. “This may affect the children’s school performance. Marital relationships can be affected as well. There could be all kinds of impacts on the family.”

The time spent juggling roles also takes time away from the caregiver’s ability to care for themselves, said Dr. Francesca Falzarano, an assistant professor at the Leonard Davis School of Gerontology at the University of Southern California in Los Angeles. And because that juggling leaves less time for socializing, it can shrink support networks at a time when caregivers need them most.

The “sandwich generation” moniker doesn’t fully capture the complexity of the situation, she said. “It’s more like a seven-layer dip than a sandwich.”

Studies suggest how people view these roles and responsibilities—and how it affects their mental health—may be influenced by their culture. Some studies have found cultures with higher levels of familism, which emphasizes supportive family relationships and places family above self, have more positive attitudes about caregiving and a lower burden of mental health issues associated with this role.

For example, some research has found Black and Hispanic family caregivers experience better psychological health than their white counterparts, especially when they have positive relationships with the person for whom they are providing care.

Falzarano’s own experience as a caregiver for her parents started much earlier than most. When she was 14, her mother developed early-onset dementia. As the only daughter in an Italian immigrant family, Falzarano said, the expectation was that she would take on the caregiving role and step into her mother’s place to help with tasks such as grocery shopping and managing household bills.

The experience shaped her decision to become a gerontologist and a researcher specializing in the ways cultural values affect dementia caregivers.

“The caregiving experience is contingent upon the values we hold,” Falzarano said. “In some cultural backgrounds, there are internalized expectations and beliefs that impact how we view this experience.”

In a traditional Italian family, Falzarano said, caregiving falls to the women, regardless of age, so her older brothers were not expected to help. She didn’t just take care of her mother. Her mother’s dementia took a toll on her father, and when he later developed cancer, she became his caregiver as well.

“My role evolved as my parents’ health and functioning declined,” she said.

Another emotional challenge stems from the role reversal of caring for a parent, Falzarano said. “A relationship that once existed, parent and child, is undergoing a dramatic restructuring and roles are becoming reversed. It starts to slowly become more unidirectional.”

Seeking support from others is critical for people who find themselves juggling caregiving roles, Falzarano said. “It’s very easy to feel like you are an island, all by yourself. But there is support out there. Find a network and connect with other people in similar situations. When you share your experience with others, it can be a game changer.”

Not only does it make the caregiver feel more emotionally supported, others in a similar situation may also share tips and information that help lessen the burden, Falzarano said. “You can learn from others who have already navigated these situations.”

Engram said finding a support group was one of the first things she did, once she realized her situation wouldn’t be temporary. She also looked to friends and neighbors, in addition to her husband, to help with child care and other logistical challenges.

2025 American Heart Association, Inc., distributed by Tribune Content Agency, LLC

Becky Engram is redefining what it means to spend time with her family. Engram is a member of the “sandwich generation,” adults who find themselves caring for two generations simultaneously: the young children they are raising as well as the parents who raised them.

According to a 2022 study in the Journal of the American Geriatrics Society, about one in four adult caregivers in the U.S. also care for a minor child or children. Estimates place the number of adults in this position anywhere between 2.5 million and 11 million.

And that number may continue to grow as couples increasingly delay parenthood, said Dr. Lianlian Lei, an assistant professor in the department of psychiatry at the University of Michigan in Ann Arbor and lead author of the 2022 study.

According to the Centers for Disease Control and Prevention, the average age of first-time mothers has risen to 27 in the U.S., and a growing number of women don’t have a first child until their 30s or 40s, meaning they are still raising young children into their 40s and 50s as their parents reach their 70s and beyond and begin to experience deteriorating health.

Multigenerational caregiving comes with a host of challenges that can be physical, emotional and financial, experts say. Compared to their caregiving peers who aren’t raising children, more sandwich caregivers report substantial emotional and financial difficulties and higher caregiver role overload.

A recent study in the British journal Public Health found sandwich caregivers who spent more than 20 hours a week caring for a family member experienced physical and mental health declines that could last for several years.

“The most challenging part is how many responsibilities they have,” Lei said. Her 2022 study found that nearly 70% of sandwich caregivers hold jobs on top of the more than 77 hours per month, on average, they spend on caring for older adults.

Sandwich caregivers juggle tasks such as setting up medical appointments, managing health information and accompanying their parents to the doctor, Lei said. They help with shopping, errands and personal care. This is on top of taking their children to and from activities, feeding their families, overseeing homework and bringing in income to cover the added medical expenses.

“Any one of these pieces can be very stressful,” she said. “If you combine all of these pieces, it just makes the situation so much worse.”

And caregivers aren’t the only ones who feel the impact. “They’re not able to spend enough quality time with their own children,” Lei said. “This may affect the children’s school performance. Marital relationships can be affected as well. There could be all kinds of impacts on the family.”

The time spent juggling roles also takes time away from the caregiver’s ability to care for themselves, said Dr. Francesca Falzarano, an assistant professor at the Leonard Davis School of Gerontology at the University of Southern California in Los Angeles. And because that juggling leaves less time for socializing, it can shrink support networks at a time when caregivers need them most.

The “sandwich generation” moniker doesn’t fully capture the complexity of the situation, she said. “It’s more like a seven-layer dip than a sandwich.”

Studies suggest how people view these roles and responsibilities—and how it affects their mental health—may be influenced by their culture. Some studies have found cultures with higher levels of familism, which emphasizes supportive family relationships and places family above self, have more positive attitudes about caregiving and a lower burden of mental health issues associated with this role.

For example, some research has found Black and Hispanic family caregivers experience better psychological health than their white counterparts, especially when they have positive relationships with the person for whom they are providing care.

Falzarano’s own experience as a caregiver for her parents started much earlier than most. When she was 14, her mother developed early-onset dementia. As the only daughter in an Italian immigrant family, Falzarano said, the expectation was that she would take on the caregiving role and step into her mother’s place to help with tasks such as grocery shopping and managing household bills.

The experience shaped her decision to become a gerontologist and a researcher specializing in the ways cultural values affect dementia caregivers.

“The caregiving experience is contingent upon the values we hold,” Falzarano said. “In some cultural backgrounds, there are internalized expectations and beliefs that impact how we view this experience.”

In a traditional Italian family, Falzarano said, caregiving falls to the women, regardless of age, so her older brothers were not expected to help. She didn’t just take care of her mother. Her mother’s dementia took a toll on her father, and when he later developed cancer, she became his caregiver as well.

“My role evolved as my parents’ health and functioning declined,” she said.

Another emotional challenge stems from the role reversal of caring for a parent, Falzarano said. “A relationship that once existed, parent and child, is undergoing a dramatic restructuring and roles are becoming reversed. It starts to slowly become more unidirectional.”

Seeking support from others is critical for people who find themselves juggling caregiving roles, Falzarano said. “It’s very easy to feel like you are an island, all by yourself. But there is support out there. Find a network and connect with other people in similar situations. When you share your experience with others, it can be a game changer.”

Not only does it make the caregiver feel more emotionally supported, others in a similar situation may also share tips and information that help lessen the burden, Falzarano said. “You can learn from others who have already navigated these situations.”

Engram said finding a support group was one of the first things she did, once she realized her situation wouldn’t be temporary. She also looked to friends and neighbors, in addition to her husband, to help with child care and other logistical challenges.

2025 American Heart Association, Inc., distributed by Tribune Content Agency, LLC