How Being a ‘Sandwich Carer’ Could Take a Toll on Your Health

People who care for both aging parents and young kids—sometimes referred to as “sandwich carers”—may be more likely to experience some mental and physical health problems, according to a new study.

The report, published on Jan. 8 in Public Health, found that these caretakers experienced higher levels of psychological distress as compared to non-sandwich carers. Plus, sandwich carers who spent more than 20 hours weekly on caretaking tasks saw faster rates of physical decline.

It’s easy to understand why someone caring for both their children and their parents might experience health issues, Justin Puder, PhD, a psychologist in private practice based in Florida, told Health.

“What we see [in sandwich carers] is a huge spike in cortisol levels, and when stress goes up, almost all other mental health difficulties—such as depression, anxiety, panic—increase as well,” Puder explained.

Researchers know less about how being a sandwich carer affects physical health, but the new study indicates caretaking takes a toll on the body, too.

What’s even more concerning is that, among the study participants, “the mental health and physical health decline associated with becoming an intensive sandwich caregiver persisted for several years,” said Baowen Xue, PhD, study author and associate professor in quantitative methods and social epidemiology at University College London.

In general, this report highlights the need for greater public policies that support sandwich carers, experts said. This is especially true as this caretaking demographic grows, with life expectancy increasing and people choosing to have kids later in life.

“Having social support networks, access to respite care, and workplace flexibility may buffer the health effects of sandwich care,” Xue told Health.

Here, experts explain why caretaking can be hard on your health, and ways to protect yourself if you do care for both your parents and your kids.

Sandwich carers are often pulled in multiple directions as they care for their children, care for their parents, and work, Xue said. An estimated 2.5 million Americans are sandwich caregivers, as are 1.3 million people in the U.K.

The challenges that people in this group face are unique—time and financial issues are common, as carers often have significant housing and healthcare costs, but also may not be able to work full time. Previous research found that sandwich caregivers reported substantial emotional and financial difficulties as compared to non-sandwich carers.

To further investigate how these hurdles affect sandwich carers’ mental and physical health, Xue’s team analyzed data from 2,632 sandwich carers in the U.K. between 2009 and 2020. The average age of sandwich carers was nearly 37 years old—in general, people aged 30 to 49 are most likely to fall into this caregiving category, Xue explained. Just over two-thirds were women.

Participants filled out questionnaires that asked about their health before, during, and after becoming a sandwich carer. One survey, called the 12-item General Health Questionnaire, asked about factors related to mental health, including any concentration, decision-making, or sleeping issues. The second survey, the 12-item Short Form Survey, was meant to assess both mental and physical health, including anxiety, social activity, body pain, mobility issues, and more.

The participants’ answers were then compared to those of non-sandwich carers.

The study authors found that self-reported mental health issues got worse as people took on sandwich caregiving. Mental and physical health concerns were also more common among sandwich carers compared to the control group, with the rates being particularly high among people who spent at least 20 hours each week caregiving.

The added stress of caregiving—which can exacerbate mental health conditions—is likely driving this divide. However, being a sandwich carer can also make it difficult for people to prioritize and maintain their physical health too, Susan Albers, PsyD, a psychologist at the Cleveland Clinic Women’s Health Center, told Health.

Many sandwich carers end up scheduling and attending many doctor’s appointments for their parents and children, but “for any caregiver, there is a significant drop in self-care,” Albers explained. “Your health appointments may fall off the radar.”

Missing appointments or deprioritizing health can also put caregivers at a higher risk of chronic conditions. A report from the Centers for Disease Control and Prevention (CDC) found that obesity, asthma, arthritis, and chronic obstructive pulmonary disease were more common in caregivers than in non-caregivers.

More research on the health impact of caregiving is necessary, especially when it comes to caregiving for both children and parents. Even with this new study, the authors noted some limitations.

For one, Xue and her team didn’t know which kinds of health conditions the care recipients had, so the results may not be universally applicable to everyone who ends up in a sandwich carer position. The authors also noted that they didn’t collect information on why people took on these unpaid care roles.

Still, the new report highlights the need for greater targeted health interventions for sandwich carers, Xue said. But until those are put in place, it’s important that individuals do their best to keep track of how they’re doing—mentally and physically—while juggling caretaking responsibilities, experts said.

That is sometimes easier said than done, especially since prioritizing your health takes time—a luxury many sandwich carers don’t have.

But if the option is available to you, it can be helpful to delegate certain tasks to others in your family or community. You might ask your partner to check in on an aging parent one day so that you can take a short break, or you might speak with your siblings to determine who will do what to care for your parent, Albers said.

If delegating isn’t an option, it could be helpful to speak about any struggles with a doctor or therapist or even a trusted friend or partner.

“There’s an unspoken shame [people feel], where they think, ‘I’m not allowed to say I’m burned out, because my mother with Alzheimer’s or my helpless kids need me,’” Puder said.

But this is an unhealthy way to think about the extreme demands of being a sandwich carer—being honest about how caregiving is impacting you is a start.

“There’s no shame in articulating how you’re doing,” said Puder.