Are you part of the sandwich generation?

One of the burdens assumed by adult children is caring for their aging parents while dealing with their own children at the same time.  According to Pew Research Center, about one out of every eight Americans between the ages of 40 and 60 care directly for an aging parent while an additional seven to ten million Americans help their parents or other aging relatives even from a  long distance. At the same time, many of them also have children who also need emotional or financial help. And the number of children caught in this double-bind is expected to grow as more and more members of the baby boom generation become senior citizens themselves. This is what it means to be part of the sandwich generation.

First coined by social worker Dorothy Miller in 1981, "sandwich generation" has taken on a life of its own. Even the venerable Miriam-Webster dictionary first listed the term in 2006. As well, books, magazine articles, and workshops aimed at helping sandwich adults cope are becoming more widely available. While not all children share the burden of caring for aging parents evenly, the pressure of dealing with this care, especially if the parent has serious medical problems such as stroke or cancer, can be extreme. 

While balancing the double burden of caring for parents and children at the same time is hardly new, improvements in geriatric care are ensuring that people are living longer. That means that adult children often carry this burden decades longer than their parents or grandparents did. The stress that this places on adult children acting as caregivers can be overwhelming, especially as new health problems develop in their aging parents. Since adult children often have limited financial resources, paying personal support workers or nurses to come in to help is usually out of the question.   Even in communities that have programs that can help, dealing with long waiting lists means that one or more family members will be forced to stay home full-time to provide this care themselves.  

The changing economic climate has also aggravated  the problems  faced by adult children caring for their parents since their children may require help as well.  With the hiring situation being more difficult for the younger generations, fewer of them are able to find jobs or live on their own.  Recent surveys show that twenty-nine percent of young adults between the ages of twenty-five to thirty-four live with their parents.  As a result, it's hardly surprising that members of the "sandwich generation" feel increasingly squeezed from both directions at once. As these beleaguered "sandwich generationers" grow older themselves, the health problems that develop due to stress are going to become more severe as well.  

And the problems become far worse for adult children dealing with parents or other relatives suffering from dementia.  For family members providing full-time care for someone with Alzheimer's disease or one of the other major dementias, dealing with the emotional, behavioural, and cognitive problems that only become worse with time is a major burden with few real alternatives.  To date, most research into the caregiver stress associated with dementia has looked at spouses of dementia patients. There has been relatively little research looking at the effect of stress on children caring for a parent with dementia, especially children who also need to deal with their own children as well.  

While the problems faced by members of the sandwich generation have received increasing publicity in recent years, research into the kind of coping strategies these "sandwich generationers" use to handle the unique stressors they face is still limited.  And this is especially true when they are dealing with a parent with dementia.  A new research study published in the journal GeroPsych attempts to fill that gap by examining the stress experienced by adult caregivers of elderly demented parents.    Conducted by Laurence M. Solberg at the University of Florida College of Medicine and a team of fellow researchers,  the study tested the reliability of a new test measuring the impact of caregiver stress on adult children of dementia parents as well as whether being in the sandwich generation created additional stress.

The new test developed by Solberg and his fellow researchers was a 51-item survey questioning caregivers about the stress in their lives, the background, and how well they coped with being a caregiver. Some of the test items include,, "Since caring for my parent, my enjoyment of sexual activity has been...", or "Since caring for my parent, my marital relationship has been.." with a rating scale to indicate whether things are better, worse, or the same. Other items asked about coping strategies, special programs that might help the caregiver, and whether problems were growing worse with time.   

Results showed that the total caregiver stress in the study participants who were in the sandwich generation and who cared for a parent with dementia on a daily basis was no different from non-sandwich generation adults. For all participants, whether they were part of the sandwich generation or not,  providing daily care meant increased irritability, less time for hobbies or other recreation, and increased emotional stress when taking a parent to the doctor or other appointments. Also, the majority of participantss reported that their own personal health had been negatively affected by their caregiving responsibilities and were more likely to experience depression and anxiety. 

Regarding what kind of special programs the participants felt were most helpful in easing their stress, they largely endorsed seminars on the care of dementia patients, regular meetings with caseworkers to discuss community resources, and self-care workshops to learn coping strategies.  Other programs, including yoga classes,  medication reviews with a doctor, and support group meetings were regarded as being less helpful.

Although there was nothing surprising about the impact of caregiver stress on adult children caring for demented parents, it was still surprising that being part of the sandwich generation doesn't appear to add to this stress.  One possible reason suggested by Solberg and his associates was that the children of these sandwich generation adults may be providing enough emotional support to offset the additional stress of dealing wth their children.  Also, the children themselves may be helping to care for their demented grandparents which would ease the burden somewhat for their sandwiched parents. 

Though the small sample size of this study may not reflect the kind of stress faced by many members of the sandwich generation, the conclusions do show that caregiver stress is a major problem for children of parents with dementia.   If these results hold up with larger studies, it may reflect the changing reality of dementia care for more and more people as the baby boom generation ages. With the soaring number of new cases of dementia that are expected over the next few decades, the burden of caring for relatives with dementia will continue to be a family affair.

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