ASK THE DOCTORS Members of the sandwich generation must avoid burnout

DEAR DOCTOR: I’m worried about my best friend. She seems overwhelmed by taking care of her elderly parents as well as her own family, but she won’t admit it. How do I know if she’s in trouble?

DEAR READER: There’s a name for the rapidly increasing number of people who find themselves in your friend’s position of caring for older parents while raising a family — the sandwich generation. They account for a significant chunk of the estimated 43 million adults in the United States who act as unpaid caregivers to ageing parents or relatives. And when the scope and stress of the duties they’ve taken on becomes too great, many put the needs of loved ones ahead of their own well-being.

Among cooking, cleaning, shopping, errands, homework help, extracurricular activities for their own families and managing similar tasks, plus medical appointments for an ageing or ailing relative, personal welfare often falls by the wayside. This includes no longer spending time with friends and engaging in personal interests, and neglecting their careers, medical care, and mental and spiritual health.

There’s no question that being a caregiver can be rewarding. When you pitch in to help an ageing parent, relative or friend, you enhance that person’s quality of life. Often, this unpaid care allows older adults to remain in their own homes. Much of the help involves emotional support, and many caregivers report a deepening of their relationships with the people they’re helping.

But the role of caregiver is often complicated. It can be difficult for both parties to navigate the change of roles when a child becomes a parent’s guardian. An ageing parent’s escalating lack of control over his or her own life can be frightening, and the parent can grow demanding and even unreasonable. This becomes even more of a challenge when someone has cognitive problems, as with dementia and Alzheimer’s disease.

You’re correct that the demands of caregiving can be overwhelming. They often lead to fatigue, apathy, anger, depression and, eventually, burnout. Signs of this include withdrawal from family, friends and activities, as well as feelings of loss, worthlessness or hopelessness. There may be changes to sleep and mood; changes to weight; abuse of alcohol or drugs, which includes prescription medications; and a lack of interest in self-care.

To prevent burnout, it’s important for caregivers to make time each day for themselves. Even a half-hour for a solo walk, a dive into a magazine or a novel or to chat with a friend can help to ease stress. It’s also important to be willing to ask for help, and to be specific. Make a list of tasks for friends and relatives who want to lend a hand, such as shopping for groceries, handling a doctor’s visit, taking a pet to the vet or doing some housecleaning.

Dr Eve Glazier is an internist and associate professor of medicine at UCLA Health. Dr Elizabeth Ko is an internist and assistant professor of medicine at UCLA Health.