Sandwich Generation Caregivers: Baby Boomer and Generation X Caregivers in the United Statess

Background and Purpose. A social worker, Miller coined the term, “sandwich generation” in 1981 describing caregivers who care for both a child and an older adult simultaneously. It is estimated that 11 million people are sandwich caregivers in the United States. They are in middle-age and their working years. They may be experiencing their own emerging health concerns. Baby Boomer and Generation X belong to this age cohort. Therefore, learning about their health conditions and caregiving situations is essential and should be treated as an urgent, public health priority because the lives of younger and older generations depend on the sandwich caregivers’ assistance. Moreover, our health care system continues to rely on the contributions from unpaid informal caregivers to maintain the flow of care. The purposes of the study were to (1) estimate the prevalence of informal caregiving among Baby Boomer and Generation X, (2) describe the type of care they provide, and (3) evaluate whether their overall health and mental health differ from each other and with non-sandwich caregivers.

Methods. Using data from the 2015-2018 Behavioral Risk Factor Surveillance System (BRFSS) Caregiver Module, we compared the prevalence and characteristics of sandwich caregivers across these two generations. Data represented adults from 44 states, the District of Columbia, and Puerto Rico. Sandwich caregivers were classified as those who lived with a child (≤18 years) and provided care/assistance to a parent/grandparent with a long-term illness/disability during the past 30 days. We categorized caregivers into generations using their age at the time of the survey. Prevalence ratios (PR) from log-binomial regression models that included generation, sandwich caregiver status, sex, and race/ethnicity were used to compare weighted estimates.

Results. In the final sample of 34,777 caregivers, Baby Boomers and Generation X were 60% and 40% respectively and 6% of Baby Boomers and 31% of Generation X were sandwich caregivers (p<0.001). The racial and ethnic diversity of sandwich caregivers was similar across generations. Sandwich caregivers had a lower prevalence of chronic health condition (PR=0.77, p=0.01) and fair/poor health (PR=0.87, p=0.003) than non-sandwich caregivers, but the similar prevalence of physical and mental distress. Between Baby Boomer and Generation X caregivers, Baby Boomer caregivers were more likely to report a chronic health condition, fair/poor health, and frequent physical distress than their Generation X counterparts, but less likely to report frequent mental distress. Baby Boomer sandwich caregivers were more likely to care for someone with Alzheimer’s disease/dementia (22% vs. 12%) and have provided care for more than 2 years (56% vs. 42%), while Generation X counterparts cared for someone with other health conditions and provided personal care (55% vs. 43%).

Conclusions and Implications. Sandwich caregivers face unique challenges of caring for two age cohorts. Although they appeared to be in good health, it is critical to support the needs of sandwich caregivers as they age given their important role in meeting the needs of both children and older adults as well as because of the prevalence of their own underlying health conditions, especially during the pandemic.