TheSandwichGenerationChallengesofCaringfor

1、“the sandwich generation”: challenges of caring for parents, children, and yourself dr. katherine l. fioriderner institutemarch 20th, 2012“the sandwich generation”lthe term describing a generation of people who care for their aging parents while supporting their own childrenlmerriam-webster official

2、ly added the term to its dictionary in july 2006ltend to be in the 40 to 65 years of age group, but.generation, or situation?“the sandwich situation”:gender differencesl75% of caregivers for older adults are womenltypical sandwich-situation member = working female caring for both aging parents and c

3、hildrenltype of assistance providedmen financial supportwomen emotional support and daily tasksoutlinelchallenges (and joys) of midlifeltruth or myth? (i.e., what does the research show?)la real life exampleltips and toolscaring for your parentscaring for your childrencaring for yourself challenges

4、(and joys)of midlifelpsychologicala transition, not a crisis (for most)questioning the past and facing the future (“generativity”)increasing positive emotionsmore likely to accept who you are and feel more in charge of situations and responsibilitieslphysicalincreasing body fat, high blood pressure,

5、 increasing cholesterol“the sandwich situation”: truth or myth?lbrody (1981): “women in the middle”ltheme of caregiving researchlbut is it real?ldebate:(1)is there really a high incidence and prevalence of this demographic?(2)are these multiple roles necessarily stressful, and/or could they be satis

6、fying?demographic trendslpeople live longer (more midlife adults have surviving parents)lpeople delay marriage and having childrenldeclines in fertility (fewer caregivers available)lmore adult children are choosing to live at home during college yearslproportion of midlife women in the workforce has

7、 increasedthe sandwich situation: actual prevalence/incidence?l44% of married individuals aged 35 to 44 both live with children and have at least one parent in fair to poor health (marks, 1998)l33.9 million americans (16%) provide care for an older family memberlparent care + dependent child + worki

8、ng = 8% of american women and men (rosenthal et al., 1996)the sandwich situation: actual prevalence/incidence?la new york times article from 2008 reported that there are 20 million americans (mostly women) who are juggling responsibilities for their own children and their aging parents at the same t

9、imel53% of those women reported feeling forced to choose (at least once a week) between being there for their children or being there for their ailing parentslpew research center: 1 out of 8 americans aged 40 to 60 are raising a child and caring for a parentlalthough the majority of adults are not “

10、sandwiched,” it will likely become increasingly prevalent given current demographic trendsthe sandwich situation: good or bad?lholding multiple roles:role strain theory vs. role enhancement theory vs. role context theorylrole context theorycaregiving mastery for women in 50s and 60s, but not in late

11、 60s and 70sfor women, caregiving + work caregiving alone in terms of psychological well-beingfor men, help to parents distress, but less so when combined with employment; help to adult children and parents life satisfaction (women less affected by multiple roles, either positively or negatively)the

12、 sandwich situation: good or bad?lin sum, psychological health effects (negative or positive) are smalllcaring for parents, in particular, can be an unexpected, unpredictable, and frustrating stressor it is a nonnormative, unanticipated demandlif the sandwich situation is viewed increasingly as norm

13、ative, coping strategies may be positively influencede.g., having a strong sense of support and care from community, using acceptance strategies, focusing on positive outcomeslbutrecent research shows that there may be negative health effects (chassin et al., 2010)the sandwich situation: good or bad

14、?lthe not-so-good feelings of being in the sandwichguilt, resentment, fear and anxiety, anger and frustration, confusion/ambivalence, depression/sadnesstorn between love and resentment, between duty to parents and duty to spouses and children, between wanting to do the right thing and not wanting to

15、 change their liveslthe good feelings of being in the sandwichhonor, respect, pride/joy, lovelthe wide range of emotions is common when caring for an aging parent and being “sandwiched” a “real life” examplelthe sandwich generationtips and tools: caring for your parentslmaladaptive functioning in ad

16、ult relationship likely stems from maladaptive functioning in earlier relationshipforgiveness must be conscious effort (self-awareness, personal therapy, active reflection)lrole reversal emotional turmoildisappointment, anger, guiltanxiety over parents mortality and worry about their own mortalityti

17、ps and tools: caring for your parentslmaking decision about care locationput them in the drivers seatlet them parent youbring in the expertslif hiring a professional provider, get references, and contact them! lif you dont have money to pay for professional help, and dont feel comfortable asking fri

18、ends, turn to volunteerschurches, senior centers, 4h clubs, hs community service organizations, colleges that train nurses and social workers (like adelphi!)let volunteers sort mail, go grocery shopping, do laundry, pay social visits, help them at mealtime, drive them to appointmentstips and tools:

19、caring for your parentslbe proactiveltry to involve parent in day-to-day household tasks/chores, even if very simplewiping off table after dinner“supervising” the childrenlscheduled/spontaneous activities with grandchildrenl“special moment” each day, separate from childrentips and tools: caring for

20、your parentslif parent is in an assisted-living center or nursing home, get to know other adult children with family members thereluse online tools to get help with healthcare issuese.g., web md offers a “ask the dr. checklist”ltake advantage of assistive technologyif insurance company says no, ask

21、doctor to write a lettertips and tools: legal interventionllegal intervention may become necessary when parents can no longer handle their own financial and practical affairslmentally competent parents (capable of making decisions and understanding consequences)bank account held jointly with adult c

22、hildliving trust or trust account with automatic inheritancepower of attorneyldeclaration of legal incompetenceguardian controls wards property and personadults should specify in advance (i.e., in a will) the person they want to act as guardian in case of becoming mentally incompetenttips and tools:

23、 caring for your parents with dementialdementia: development of multiple cognitive deficits including memory impairment12+ illnesses with similar symptoms but different causes (alzheimers most common)rate doubles every 5 years after age 75, with 8.5% of people ages 85 to 89 affected; mild dementia a

24、ffects almost 30% after age 90lresearchers have found that a person who provides care for someone with dementia is twice as likely to suffer from depression as a person providing care for someone without dementiacaregiver burdentips and tools: caring for your parentslto cope with impending loss:stay

25、 in the momentmanage your own fears about death and dying (counseling?)manage your own feelings about the pastexpress your love often, if you canremember to say what needs to be said nowbe with your parent where he/she is celebrate small thingsreminiscefind joytips and tools: caring for your childre

26、nltalk with children and prepare themneed for supportfuture plans and adjustmentlovelfinancial woes: being frugal, cutting costs, and teaching children a valuable lessontips and tools: caring for your childrenltake moments out to express how much you love and value your children (“special moment” ea

27、ch day)sit with child at breakfast every morning (routine)say a word of praise each morningput a note in your childs backpackhave dinner consistently at the same time every night when possiblehelp with homework (dont nag)assign chores, and give praise when they are donehave a consistent bedtime hour

28、 and sit with child when he/she goes to bedcaring for your children:warning signslpre-school/elementary kids:withdrawndepressedisolated (cant get them to open up)regressive - thumb sucking, soilinganxious - clingy, poor sleep/eating, irritablefrequent fighting/aggression/acting outcaring for your ch

29、ildren:warning signslmiddle school (and beyond)sleeping poorly, nightmaresdepressed/withdrawnavoidance (school bus, lunch room, absenteeism)anxious - pacing, nightmaressubstance abusesomatic complaints: headaches, stomachaches, visits to the rn office oftenfrequent fighting/aggression/acting out1-80

30、0-lifenettips and tools: caring for yourselfldont be a martyrself-pity is unhelpful (negativity does not change the situation, only depletes energy)ldo not do it alone; ask for help! why?can provide an opportunity for relief (respite)the person who is asked will feel neededcaregiver will feel less i

31、solatedrecipient of help may benefit from having a “fresh” helperllet go of unreasonably high standards, if necessarylreturn favors (if you can) and give “thank you”s!tips and tools: good news about asking for helplresearch shows that caregivers with adequate community support report many dimensions

32、 of personal growth!more empathic, caring, understanding, patient, compassionate, closer to person they are caring for, more appreciative of own good healthtips and tools: caring for yourselfltake respite: yearly vacation, plus weekly and daily respitelnurture your partnerestablish a routinebut expe

33、ct interruptionlask employer for more flexible work schedule, possibly leave provisions family and medical leave act of 1993lcounseling, online support, self-help groupstips and tools: caring for yourself depressionlcaregivers are at particular risk for mild to severe depressionlsymptoms:change in e

34、ating habits (unwanted weight gain or loss) or sleep patterns (too much sleep or not enough); feeling tired all the timeloss of interest in people and/or activities that once brought you pleasure becoming easily agitated or angered; feeling that nothing you do is good enough thoughts of death or suicide, or attempting suicide ongoing physical sympto