A woman holds a person's hand close to their chest.
Many middle-age adults are in the “sandwich generation,” responsible for tending to an elderly parent and a young child. (For Spectrum Health Beat)

Feeling like you’re failing everyone. Never having time for yourself. Being afraid to ask for help.

These are just some of the challenges facing people in what’s called the “sandwich generation”—those caught between caring for their children and their aging parents.

According to a 2019 T. Rowe Price survey, more than one-third of parents with 8- to -14-year-old children are also caring for an aging family member.

About 68 percent of them have an elderly parent or relative living with them.

The unique struggles facing this generation is a topic that comes up frequently for Iris Boettcher, MD, division chief for geriatrics, home based care, and home and community services for Spectrum Health Medical Group.

The first step to finding the best quality of life in this stage of life, she said, is to abandon the denial of the situation.

“You need to recognize that this is your life and, however long it takes, it’s not something you can hurry up and get through,” she said. “You also need to recognize the reality that it affects the entire family.”

Once you come to grips with that, you can start to develop a plan to deal with some of the challenges of being a “double-duty caregiver.”

Dr. Boettcher urges people to make sure they account for four priorities: the dignity of the senior, the sanctity of their marriage (if that applies), the demands of being a parent and the mental health of the caregiver.

Tips for maintaining dignity and mental well-being:

Seek creative solutions

Dr. Boettcher warns against falling into the temptation to separate the children’s lives from the elderly parent’s life.

“It’s unrealistic and it leads to a series of no-win choices and feeling like you are failing everyone,” she said.

Rather, she said, try to creatively balance the two.

“‘Do I go to my kids’ ball game or do I go to make sure my dad eats his dinner?’ Well, think that through a little more and try to think of creative solutions,” she said. “Maybe that’s going to the game and then checking on dad before or after. Or can you take Dad to the ball game?”

Find support from friends, family, community

Nobody can do it all, Dr. Boettcher said.

“Determine what your own capabilities are, and where you need to take break,” she said. “You can’t be super-person all the time, 24/7. It’s not humanly possible.”

There are a number of community resources available to help with the care of elderly parents to reduce stress.

“Get some help for as many task-oriented things as you can so you can concentrate on being an adult child, a parent and a spouse,” she said.

Partner with doctors

As a physician caring for elderly adults, Dr. Boettcher said she welcomes conversations with her patient’s children, if permission is granted.

The three “Ds” often come up: dementia, depression and driving.

“One of the biggest things is aging parents under-recognizing the degree of cognitive impairment they have and how that impairs their decision making,” she said. “The comment I often hear is that the aging parents do not recognize the need, so it’s difficult to try to get them to do something different, like stopping driving.”

Partnerships with the doctor can help with decisions like that. It’s also important to be sure the doctor has a clear understanding of the patient’s degree of impairment.

“Sometimes, in my experience, if the aging parent has gone to the same doctor for years, the degree of cognitive impairment is under-recognized,” she said. “Patients can keep it together for a 15-minute appointment, especially if they have well preserved social skills.”

It might be helpful to request a cognitive evaluation by the primary care physician, or to reach out to a doctor who specializes in geriatrics or aging issues.

Be a proactive planner

It’s critical to have honest conversations about what lies ahead, Dr. Boettcher said.

“It’s important to talk about when this happens, not if this happens,” she said. “You’re just kidding yourself if you think you don’t need to plan ahead.”

Talk about whether the aging parents value staying in their home or are open to going to a retirement community. Also, reassess as often as needed, she said.

Decisions are always based on a balance between a parent’s wishes and other factors.

“You might not feel that there’s 100% safety, but knowing that staying at home is what’s most important to them, you’re going to need to talk about getting some help and what needs to be done to accomplish that,” she said.

Maintain your health and relationships

Don’t forget to take some time for yourself and your own relationships as well. After all, you cannot help anyone else if you don’t take care of yourself first.

“If you have a spouse or partner, do not neglect that relationship,” Dr. Boettcher said. “Take care of yourself. Find time for things you enjoy. Do not neglect the quality of your own life because you are taking care of others.”