The sandwich generation

They could be called the "tug-of-war generation," constantly torn between their responsibilities. Or the "basketball generation," running flat-out toward one goal and stopping suddenly as their duties yank them in the opposite direction.

Caught between children and aging parents
Instead they're called the "sandwich generation," layered between the dual roles of raising their children and caring for their aging parents or an infirm family member. Maybe it's the best description because, for many people living through it, stress is eating them alive.

The National Family Caregivers Association (NFCA) estimates that one-fourth of adult Americans are involved in caring for a sick or disabled family member. In a survey of its members, the association reported that 34 percent of caregivers are between the ages of 36 and 50, the years when people's careers are in full swing and they're most likely to have teenagers in the house.

Caregivers under stress
Given the added responsibility of caring for an elderly parent or other loved one, it's not surprising that growing numbers of sandwich-generation members are reporting an increase in depression, sleeplessness, headaches, backaches and stomach problems.

"It's the stress of care-giving," says NFCA President Suzanne Mintz. "There have been some studies that reported that stressed caregivers heal more slowly than someone who isn't stressed, showing the impact of stress on your own recuperative system."

"If you're dealing with someone who needs lifting or you need to lift equipment, you're also at risk for back problems," she adds. "Then there is fatigue and exhaustion. They all play into each other."

Many feel guilty for not doing more In a recent study released by AARP, many members of the sandwich generation said they were happy for the chance to help care for their parents. But almost half said they felt guilty about not doing more.

It's enough of an issue that the American Medical Association issued a self-assessment questionnaire last summer to help doctors identify and treat caregivers at risk for stress-related health problems. The questions cover both physical and emotional well-being, asking caregivers if they've ever felt "completely overwhelmed," had their sleep disrupted or had a crying spell within the last week or so, for example.

Looking after yourself is priority number one
Stella Henry is a registered nurse from Culver City, Calif., who works with families caring for aging parents. The author of the book, "Difficult Choices, Compassionate Solutions," she's constantly reminding family caregivers that their own health has to come first.

"There's a bumper sticker that says, 'If mom isn't happy, nobody's happy.' That's so true," she says. "Emotionally, who do you take care of first? Yourself. If you're not well, you can't take care of anyone else."

A sandwich-generation member herself, Henry cared for her father before he died and now cares for her mother, who has dementia. She works full time and has a teenage son.

"You've got all these ways you're pulled," she says. "I sat down one time and wrote a list of day-to-day things a caregiver has to do. It equals another full-time job. You're on call 24 hours a day."

Caregivers need time out
With that kind of time commitment, care-givers need time for themselves, even if it's just a long shower or going for a walk, health experts say.

"If you think about the workplace, people take lunch breaks," Mintz says. "If they have regular jobs, they have paid vacations. People who are caregivers don't get automatic lunch breaks or a vacation. Sometimes people check into a hotel just to sleep. Sometimes the break you need is rest, plain old sleep."

Getting a good night's sleep and eating regularly are two keys to staying healthy, Henry says, along with getting help, especially from other family members, when it's needed.

That's a tough one for many caregivers, Mintz says.

Asking for help is essential
"People have a very, very hard time asking for help," she says. "They need to recognize their strengths as well as their limitations. Superman and Wonder Woman exist on television and comic books. We're real, live human beings. Intensive caregiving is more than a one-person job."

Mintz adds that family caregivers can't sacrifice their own health to tend to the rest of the family.

"Caring for yourself isn't a selfish issue, it's not a luxury," she says. "Your own good health is the best present you can give to your loved ones."

(Susanb Erasmus, Health24, March 2005)