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The Sandwich Generation:
Caregiving in Aging Adult Relationships

Lucy S. Raizman, LCSW, LMFT
June 26, 2006

As a middle-aged baby boomer I have a special interest in an issue that affects a growing number of adults regarding multiple caregiving roles that include aging adult parents as well as adult and younger children. Recently I spoke to this subject in a presentation entitled “The Sandwich Generation: Coping with Being in the Middle,” and found an audience of other caregivers, faces of mostly women who were also partners, mothers, grandparents, and adult children of aging parents.

Current research and statistics show that more than 60% of those providing care to aging adult parents are women, members of what is being called the “sandwich generation.” In addition, many of these same women are also coping with the challenging demands and obligations of the needs of partners and other family members.

It is further estimated that some 26 million caregivers work and the majority of female caregivers have children under age 18. So, it’s hardly a wonder that there can be stress-related consequences from what can be called the “price of caring”; these include increased risks of fatigue and sleep deprivation, compromised mental well-being and physical health, economic hardships, and the impact of disruptions on social life and relationships that arise from overwhelmed or overburdened family members and support systems.

Those of us in the broad middle-aged generation of “40, 50 and 60 somethings” often face a new and complex reality, responding to the financial, physical, and emotional hardships involved in caring for aging parents in our culture. There will continue to be a growing population over 65 in the next decade, and throughout our new century the extended years of old age or frail elderly aged 85 and older means that those most likely to have chronic health problems and the risk of dementia differs significantly from the ‘younger’ aging population in their 70’s.

The reversal of parent and child roles means that increasingly middle-aged adults are juggling their own professional and personal family responsibilities and their growing obligations to attend to the needs of often difficult and challenging aging parents! This can translate into the reality of day-to-day problem solving decisions as well as long-term care decisions. Although we should not become our parents’ parents, the struggle to do what’s right or best often means balancing “doing for” rather than “being with” in terms of time and attention to those relationships. The shift to this type of role reversal as our parents grow older impacts how we manage our own lives and our own nuclear families and creates inevitable conflicts regarding values, loyalty and bonds with our family of origin.

There are a number of shared concerns, particularly relating to how we deal with the inevitable fallout of having to reconsider our own priorities, our own plans for retirement, our own sense of ourselves and roles, and what gives our lives meaning, beyond the responsibilities of caregiving. We are at an age when we anticipated (as some other empty nesters or soon-to-be free of adult children living at home) all those potentially stressful issues for the time being settled. Now, we might have children or grandchildren as well as partners complicating these old parent-child and sibling relationships. In terms of dealing with later life transitions and changes in parent-child relationships, like it or not, we all remain part of one another’s lives, requiring adults and children to accept each other’s strengths as well as the many shortcomings, limitations, and imperfections that accompany human development and the aging process. Addressing hidden and unspoken expectations and assumptions is a very important part of this process, involving parents’ expectations that their adult children owe them caregiving or are obligated for caregiving in return for earlier child rearing and parenting. Easier said than done, right? Also, how we handle the emotional pain, sadness and heartache that accompanies suffering and distressing decisions regarding care and quality of life and end of life or dying issues become even more complicated for those of us in the “sandwich generation,” struggling to maintain a sense of control over our lives.

Amid these dilemmas, there are some tips to consider:

1. Actively listening and understanding and communicating relationship needs and fears with all those involved, family members and professionals.
   
   
2. Reflecting empathy by putting yourself in the other’s shoes, so to speak, and creating an environment of honesty and openness while acknowledging and validating differences of opinion or perception and distressing feelings when agreement is difficult and complicated.
   
   
3. Learning stress management skills and relaxation techniques for better self-care and self-soothing.
   
   
4. Setting and respecting yours and others’ time limits and boundaries, including saying no and asking for relief.
   
   
5. Utilizing a treatment team approach of appropriate experts and professionals by asking for help and support when it comes to both problem-solving and practical day-to-day coping strategies.
   
   
6. Being open and curious to the possibilities that creativity and acceptance bring to the process of making sense and finding meaning in these situations.

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Lucy S. Raizman, LCSW, LMFT is a Senior Staff Therapist in CFR’s Doylestown and Spring House offices. She can be reached at 215-345-8454 ext. 2.

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