No one signs up ahead of time to become a caregiver, yet millions of Americans today are caregivers. The Family Caregiver Alliance’s definition of caregiving states that the group of caregivers is composed of, “Anyone who provides assistance to someone else who is, in some degree, incapacitated and needs help” (www.caregiver.org/caregiver/jsp/content_node.jsp?nodeid=439). Typically, when one considers the statistics and the definition of caregiving the image one conjures up is of an older adult receiving care provided by either an informal caregiver (spouse, adult child, sibling, friend or relative) or a formal caregiver (home care professional). This perspective is prevalent in both the professional and consumer literature where the caregiver is often typified as the adult child, usually the adult daughter, who is the one caring for their older parent. These adult children have been labeled as being the “sandwiched” generation, caught between caring for their older parents and their own families. Yet, caregiving roles are much broader than this narrow conceptualization. Older adults do find themselves in caregiving roles, most often caring for their spouses or siblings. What is less obvious, are those older adults who have assumed the role of caregiver for their adult children. They constitute a hidden sandwich generation of caregivers.
This sandwiched cohort is caught between caring for their own adult children and their own physical and mental health needs. There are various reasons underlying why this cohort finds themselves in this position, ranging from having a child born with a developmental disability, to having a child who suffers from a long-term disability or having an adult child who has been diagnosed with a psychological disorder. Parents of those with long term disabilities have spent many years as caregivers, a role many of them have successfully managed with the aid of both informal and formal supports. However, as these children age and become adults their parents are confronting aging issues as well.
Families are the primary providers of care for adult children who have a developmental or psychological disability. Mothers, whether young or old, continue to be the primary caregiver, with fathers generally accepting this role only once the mother has died (Factor, 2004). According to Factor (2004), parents who had learned to embrace, negotiate, and manage the role of caregiver, even seeing it as a legitimatizing and important social role, which has provided them with a purpose, may begin to face challenges as a result of their own aging process. As older adults experience age related changes they may become less able to provide care for their children, many of whom are now beginning to experience their own aging related issues.
Older adults are plagued by many of the same physical and emotional struggles and challenges as their younger caregiver counterparts. Research has found that caring for a mentally ill child has a long-term impact on the caregiver’s well-being, both physically and psychologically (Ghosh & Greenberg, 2009). In general, caregivers are less likely to practice preventative healthcare, develop poor eating habits, fail to exercise or to stay in bed when they are ill, and postpone medical appointments. These caregivers not only suffer from medical problems but are also likely to suffer from mental health problems. It has been well documented that caregivers are more likely than their non-caregiving counterparts to suffer from symptoms of depression and anxiety as well as suffering from burnout (Cannuscio, Jones, Kawachi, Colditz, Berkman, & Rimm, 2002). Ghosh and Greenberg (2009) found that aging fathers caring for schizophrenic children reported experiencing higher levels of depression, poorer perceived health, lower levels of psychological well-being, and decreased marital satisfaction as compared to non-caregiving aging parents. In addition, these men were unlikely to seek out or utilize formal support services despite their distress.
Mental health professionals must help older adults cope with the numerous stressors and strains resulting from being sandwiched between caregiving roles and their own aging. On one side of the sandwich are the stressors arising from the financial impact that caregiving has on them, the emotional strain from caring for another person, frustrations when the person being cared for does not respond to one’s efforts to help them, worries about who can be relied on within one’s family to assist with the caregiving role, and feelings of anger towards family members who do not offer assistance. On the other side of the sandwich are the issues relating to facing one’s own fears about growing older, facing one’s own health issues, mortality, and worries over who will advocate for them as well as their adult child if they should ever face a health crisis. Many older adults experience symptoms of anxiety related to numerous concerns about the long-range needs of their adult children, particularly what will happen to this adult child when they are no longer physically capable of providing for this child’s care. For some older adults who are caring for an adult child who is suffering from psychological problems, emotions may center on feelings of failure, responsibility for their child’s emotional state, self-doubt, and despair.
Older adults benefit from mental health treatment when experiencing stressors and strains related to caregiving, whether it is caring for a spouse or an adult child. Strategies to improve caregiver mental health are similar to those for any caregiver. It is important for caregivers to take care of themselves first if they are going to provide care to anyone else. This includes, maintaining a healthy diet, regular exercise, getting sufficient sleep, not abusing drugs or alcohol, making time to find an activity that they enjoy to participate in, even if it is just for a few minutes a day, recognizing the signs and symptoms of stress, burnout, and overload, recognizing and seeking treatment for depression and anxiety, maintaining supportive relationships and support networks, embracing one’s limits, asking for help with caregiving tasks, utilizing respite services when needed, and engaging in long range planning for themselves as well as for their adult children.
Mental health professionals must acknowledge that adult children are not the only caregivers caught in this “sandwich” role. Older adults are often the hidden generation of sandwiched caregivers. Attention needs to be provided to the struggles that they face when caught between caring for their adult children and their own aging. With proper mental health care and support older adults can continue to provide care for their children.
Dr. Abramson is also the Co-Chair of the Nassau County Geriatric Mental Health Alliance.