The well-being of SGCs is widely discussed in the literature. In particular, attention is paid to the effect of multiple caregiving on the emotional and physical health of caregivers and their general life satisfaction. Below is a brief overview of empirical studies that quantitatively analyze the effect of sandwich caregiving on these aspects of well-being of individuals in developed countries. We mainly focus on studies using nationally representative datasets.

Sandwich caregiving may worsen health behavior of caregivers. The constant time pressure, stress, and mental fatigue induced by high caregiving burden could force SGCs to be less focused on their own health. Chassin et al. (2010) shows that in comparison with non-SGCs those who are caring for two generations simultaneously are less likely to use seat belts, less likely to check the health value of food, they smoke more and are less likely to exercise regularly. The authors conclude that a “possible explanation for the poorer health behavior of sandwiched individuals may be a reduced salience of personal health goals. That is, those caring for multiple generations may place more importance on the health of others than on their own health” (p. 45). It is worth noting that the study of the health behavior of SGCs is especially important as health behavior not only influences current health status, but also largely determines health in later life.

A number of works are devoted to the analysis of the effect of sandwich caregiving on the current health status of caregivers. In most studies, self-assessed health is used as an indicator of health. Although self-assessed health is not an objective measure of health status, it is an important predictor of morbidity and mortality (Idler and Benyamini, 1997; Wu et al., 2013), especially for middle-aged people (Miilunpalo et al., 1997). Basically, the research results indicate that dual caregiving has a negative effect on the health of caregivers. Do et al. (2014) show that in the US for those individuals who have children under the age of 18, involvement in elderly care leads to lower levels of self-assessed health. Multigenerational caregiving is associated with the lower self-assessed health of Canadian employees (Duxbury and Higgins, 2013). The negative effect of sandwich caregiving on the self-assessed health of women in Norway is reported in the study (Daatland et al., 2010). In Switzerland, sandwich caregiving negatively affects the self-assessed health of male caregivers, but does not influence the self-assessed health of female caregivers (Häusler et al., 2018).

The emotional health of SGCs is of particular interest to researchers. Some studies (Rubin and White-Means, 2009; Duxbury and Higgins, 2013; Pew Research Center, 2013) show that SGCs experience greater levels of stress and have significantly less free time than non-SGCs. The combination of providing care to both children and parents increases the risk of psychological distress and the effect is more pronounced for women (Voydanoff and Donnelly, 1999). Sandwich caregiving not only provokes high levels of stress, but can also cause depression (Brenna, 2021; Turgeman-Lupo et al., 2020; Hammer and Neal, 2008).

However, not all studies support the hypothesis of the negative impact of multigenerational caregiving on the caregivers’ health. Loomis, Booth (1995) did not find a negative effect of sandwich caregiving on the physical and psycho-emotional health of individuals. The results of Williams (2004) suggest that caring for multiple generations negatively affects self-assessed health but does not affect stress levels.

Interestingly, caring for two generations may not negatively impact life satisfaction, the major cognitive component of personal subjective well-being (Künemund, 2006; Williams, 2004; Pew Research Center, 2013). In some cases, dual care may positively affect life satisfaction (Künemund, 2006; Daatland et al., 2010).

Russia is experiencing the same demographic trends as most developed count­ries — increasing longevity, a higher childbearing age, and a lower birth rate. In 2022, in Russia, the age dependency ratio, defined as the number of children (­0–14 years old) and elderly (65 years or older) per 100 population aged 15 to 64 years, was 50, which is somewhat lower than the OECD average (55). Comparable to Russia, the age dependency ratio is observed in countries such as Austria, Hungary, Canada, Spain, Mexico, Norway, Poland, and the U.S. Israel and Japan have the highest­ age dependency ratio (67 and 71 respectively) (World Bank, 2022). According to the demo­graphic projections, in the next 30 years, the age dependency ratio in Russia is expected to increase (Vishnevsky and Scherbakova, 2018).

In Russia, the increase in care burden in the middle generation caused by demo­graphic processes is amplified by the relatively low level of the development of social services, especially the long-term care system. While parents can count on state support in caring for children, although the volume and variety of forms of such support are often criticized (Ovcharova, 2008; Volkova and Kudaeva, 2019), caring for elderly relatives in Russia mainly falls on family members (Korchagina and Prokofieva, 2012).

The underdevelopment of formal care services in Russia is one of the key reasons for the prevalence of informal elderly care. Formal home-based elderly care has a limited variety of forms and limited assistance. Most often, older people receive help only with shopping. Assistance with activities of daily living (­washing, cooking, caring for clothes and home) is rarely provided by social services in practice (Parfenova, 2017). Institutional elderly care is also very limited in Russia. Unfortunately, despite the ongoing large-scale reform of the long-term care system in Russia, the quality of care in public nursing homes is still low, and even the logistical support for nursing is considered to be insufficient (Zdravomyslova and Nazimova, 2019; Kiryanova and Kozlova, 2011). The market for private nursing homes in Russia is still in early development stages. The quality of care in private nursing homes is higher than in public ones, but the costs are high and private institutional care is inaccessible for the vast majority of the population.

The other important factor of informal care prevalence is that in Russia, caring for parents is traditionally considered as the responsibility of children (mainly daughters) (Levin et al., 2015). Formal care is usually seen as a last resort (Smirnova and Smirnov, 2020). Thus, the problems of sandwich caregiving are especially relevant in Russia.

There is some evidence of the negative impact of kinship care on the health and well-being of caregivers in the Russian literature. For example, Anikina and Pshonova (2019), Savenysheva and Zapletina (2019) conclude that childcare leads to high levels of parental stress, which can have a negative impact on the mental and physical health of caregivers. Informal caring for elderly relatives significantly worsens the emotional and psychological health of caregivers in Russia, increases the likelihood of stress and depression, chronic diseases, and lowers self-assessed health (Grishina and Tsatsura, 2020; Zdravomyslova and Savchenko, 2020; Maltseva et al., 2016). We formulate the hypothesis that SGCs are a particularly vulnerable group in Russia. Caring for two generations could increase the likelihood and severity of negative effects, described in the literature for caregivers of only one generation.

There is limited research on the well-being of sandwich caregivers in Russia. Most studies are based on qualitative sociological research (Zdravomyslova, 2016; Tkach, 2015). Research results indicate that people caring for two generations simultaneously experience burnout, psychological difficulties, and a lack of free time.

To the best of our knowledge, the only attempt to estimate the quantitative effect of sandwich caregiving on the well-being of caregivers in Russia is a study (Kartseva, 2021). The empirical basis of the work was the nationally representative data of the time budget survey, conducted by Rosstat in 2019. The study showed that SGCs are statistically significantly more likely to have chronic diseases, experience a constant lack of time, and have less free time. The study did not reveal a significant effect of sandwich caregiving on self-assessed health.

Compared to Kartseva (2021), we investigate the health of Russian sandwich caregivers using a wider range of indicators and an alternative data source (RLMS-HSE). Additionally to health status we consider the effect of sandwich caregiving on the health behavior and well-being of caregivers.

5.1.1. Medical check-up

On average, female SGСs are less likely to undergo medical check-ups in comparison with non-SGCs. The mean marginal effect for medical check-up is –6.99 p.p. But in the kernel density plot of the ME_i distribution (Fig. 2a) we see a two-mode distribution, which means that the distribution of ME_i is a mixture of two distributions.

Fig. 2.

Distribution of ME_i for Medical check-up for the whole sample (a) and for employed and non-employed (b).

Source: Compiled by the authors.

We try various factors which could explain this mixture. Visual analysis shows that the best splitting of the distribution is achieved by separating the sample in two subsamples: employed and non-employed. Perhaps the regularity of a medical check-up depends on the employment status of the respondent. In Russia, many firms provide their employees with regular annual medical examinations.

The graphs of the marginal effect distribution for employed and non-employed respondents are shown in Fig. 2b. In each of the two subgroups, the distribution is close to normal. The descriptive statistics for the distribution of the marginal effect for the indicator medical check-up separately by subgroups are shown in Table 4. Mean value ME for employed is –8.1 p.p., which is twice as large as the mean ME for non-employed, –4.0 p.p. Accordingly, the standard errors are smaller in each of the subgroups, since the mixture standard error includes the difference between the means. This can lead to a situation where the effect is significant in each subgroup, but it can be concluded that the effect is insignificant in the population due to the failure to take into account the fact that the distribution is a mixture of two (or more) distributions.

Note that for all observations, the values are negative (the minimum and maximum values are of the same sign). The same is true for other indicators that we discuss below.

Although, to the best of our knowledge, there is no research on the effect of sandwich caregiving on preventive medicine use, there is some evidence on preventive health behavior of caregivers. Some studies find that caregivers are more likely to forget to take prescription medicine or to keep appointments with doctors than non-caregivers (Burton et al., 1997; Wang et al., 2015). The effect is more pronounced for high-intensity caregivers. These findings are consistent with our results, especially considering the fact that sandwich caregiving is usual­ly associated with a higher care burden.

The sandwich care burden has a significant negative effect on the eating behavior of women. SGCs are significantly less likely to have regular meals than non-SGCs. On average, sandwich caregiving reduces the proportion of respondents who have regular meals by 10.1 p.p. (–11.5 p.p. for the employed and –7.5 p.p. for non-employed).

Plots of the distribution of the marginal effect ME_i for the indicator regular meals are presented for the whole sample (Fig. 3a) and separately by subgroups employed/non-employed (Fig. 3b). In each subgroup distribution is close to normal.

Fig. 3.

Distribution of ME_i for Regular meals for the whole sample (a) and for employed and non-employed women (b).

Source: Compiled by the authors.

The descriptive statistics for the distribution of the marginal effect for the indicator regular meals separately by subgroups are shown in Table 5.

As for medical check-ups, the sandwich caregiving effect is higher for the employed: among SGCs 11.5 p.p. more respondents neglect regular meals. The employed woman is constantly pressed for time and has to sacrifice her lunch break, to do other things, among others — pick up children from kindergarten or school, buy and bring food to her parents.

For the case with the regular meals indicator it is also possible to split the sample­ by pensioner status (see Table 6).

Thus, the largest by absolute value average marginal effect (–12.1% p.p.) is achieved for employed and not receiving pensions, and the smallest for non-employed pensioners (they can allocate their time more flexibly). All four estimates are significant at 5% level.

We found that sandwich caregiving negatively affects the eating behavior of individuals, reducing the regularity of meals. In general, our findings are consistent with Chassin et al. (2010) who found that SGCs are less likely to check food labels and choose food based on health values.

We do not find a substantial effect of sandwich caregiving on alcohol consumption. The effect is negative, with a mean –1.34 p.p. and varies in the range [–1.50; –0.07] p.p. The plot of the ME distribution is presented in Fig. 4. We do not find any significant effect of sandwich caregiving on the alcohol consumption for any subgroups. A similar finding was also reported by Gottschalk et al. (2020) who studied the effect of caregiving on the drinking behavior of individuals­. They found the drinking frequency of high intensive caregivers (dementia caregivers) does not differ from that of non-caregivers.

Fig. 4.

Distribution of ME_i for Alcohol.

Source: Compiled by the authors.

The plot of the marginal effect distribution is presented in the Fig. 5a. The mean effect is negative and is –5.0 p.p., it varies in the range [–10.1; –0.4] p.p. Only 12.9% of sandwich caregivers smoke, compared to 18.9% of non-SGCss. There is a slight difference in ME_i of smoking by age (see Fig. 5b): the effect is more pronounced in women under 50. This could be explained by the larger proportions of female smokers 50 (22.0%) compared to the proportion of female smokers in ages above 50 (11.7%).

Fig. 5.

Distribution of ME_i for Smoke for the whole sample (a) and for the age groups < 50 and ≥ 50 (b).

Source: Compiled by the authors.

This outcome is contrary to that of Chassin et al. (2010) who found that on average SGCs smoke more in comparison with non-SGCs. Our result differs from some of the adult caregiving literature as well. Most researchers found that caregiving may increase the probability of smoking or has no significant effect on smoking (Gottschalk et al., 2020; Tough et al., 2020; Lambert et al., 2017; Rabinowitz et al., 2007).

The difference in the results could be explained by using different indicators of smoking. Chassin et al. (2010) used the number of cigarettes per day, while we used a dummy variable. Thus, our results cannot be directly compared with the former.

The low probability of smoking among SGCs could be also explained by their wanting to protect the dependents from second-hand smoking.

5.2.1. Good health

We found a positive effect of sandwich caregiving on the self-assessed health of individuals. The mean marginal effect of sandwich caregiving on the self-assessed health is 10.6 p.p., varying in the range [0.5; 13.0] p.p. The density plot of this marginal effect is two-mode (Fig. 6a), and could be presented as a mixture of two distributions by subsamples of pensioners and non-pensioners (Fig. 6b). Descriptive statistics of ME_i for good health are presented in Table 7. Mean marginal effect is higher for non-pensioners (12.1 p.p.) compared to pensioners (6.8 p.p.).

Fig. 6.

Distribution of ME_i for Good health for the whole sample (a) and for pensioners and non-pensioners (b).

Source: Compiled by the authors.

Thus, we found that sandwich caregiving is positively correlated with the self-assessed health of individuals. This finding is contrary to previous studies which have suggested sandwich care has a negative or no effect on self-assessed health. This inconsistency may be due to self-selection. Women with poor health are less likely to be SGCs. Another possible explanation is that kinship care is highly recognized in Russia. SGCs have a sense of accomplishment and receive social recognition. Through caring for relatives SGCs could get satisfaction from strengthening connections in the family. The positive moral aspects of care could have a positive impact on the perception of life in general and the perception of one’s own health in particular. In our view, however, conclusions about the positive effect of sandwich caregiving on women’s health must be treated with caution. As we showed above, sandwich caregiving significantly negatively influences health behavior (reducing preventive care and the regularity of meals) that could result in worsening of SGCs’ health in the future. For example, Coe and Van Houtven (2009) show that adult caregiving has a significant negative impact on a caregiver’s health two years after the end of the caregiving period.

Surprisingly, the effect of sandwich caregiving on the presence of chronic conditions is negative (mean ME = –2.7 p.p.). Most likely, there is reverse causali­ty here — people with chronic diseases simply do not have the strength to take care of two generations. Again, we have a two-mode distribution (Fig. 7a) which could be presented as a mixture of two distributions (see Fig. 7b) by subgroups of pensioners (ME = –1.7 p.p.) and non-pensioners (ME = –3.2 p.p.). The descriptive statistics of ME_i for chronic condition are presented in Table 8.

Fig. 7.

Distribution of ME_i for Chronic condition for the whole sample (a) and for pensioners and non-pensioners (b).

Source: Compiled by the authors.

Thus in general SGCs are less likely to experience chronic conditions. A possible explanation is that chronic disease in SGCs is not less frequent but undiagnosed, due to the fact that they pay less attention to their own health in caring for two generations. In particular, as shown above, they are less likely to see a doctor for medical check-ups. Our outcome is contrary to that of Kartseva (2021) who showed positive correlation between chronic morbidity and SGC status for Russia. This discrepancy could be partially attributed to research dif­ferences: the sample of Kartseva (2021) includes both males and females and uses a different empirical dataset.

Being overweight (measured as BMI > 25) can be considered as one of the indicators of health, and as a consequence of a decrease in attention to their own health behavior. Descriptive statistics of ME_i for chronic condition are presented in Table 9. The ME of sandwich caregiving on the indicator overweight is positive and varies in the range [1.3; 7.6] p.p. This means that SGCs are more likely to be overweight than non-SGCs. This effect is more pronounced for non-pensioners (ME = 6.8 p.p.), than for pensioners (ME = 4.8 p.p.).

This difference could be partially explained by the initial state — the average age of pensioners is higher, and by this age many women are already overweight. In our sample, 48.4% of women under 50 years are overweight and 76.9% of women aged 50 or over. Corresponding ME density plots are presented at Fig. 8.

Fig. 8.

Distribution of ME_i for Overweight for the whole sample (a) and for pensioners and non-pensioners (b).

Source: Compiled by the authors.

To the best of our knowledge there are no studies of the effect of sandwich caregiving on BMI for women. A strong relationship between adult caregiving and overweight/obesity has been reported in the literature for adult caregivers (Reeves et al., 2012; Gottschalk et al., 2020; Turgeman-Lupo et al., 2020), however. Our result supports these findings. The effect is not surprising — as shown above SGCs in Russia are less likely to follow a healthy diet.

The effect of sandwich caregiving on depression in our data is negative but not pronounced. The average ME is –0.75 p.p. varying in the range [–1.8; –0.04] p.p. The density plot of the marginal effect is close to normal (Fig. 9). In general, our results are in accord with recent studies indicating that SGCs have nearly the same depression risk as non-SGCs (Loomis and Booth, 1995; Williams, 2004). As we note in the discussion of the marginal effect of sandwich caregiving on self-assessed health, the psychological burden and strain induced by caregiving could be compensated by a sense of accomplishment, social approval and enhanced intergenerational relationships. The positive effect of care could be more pronounced in Russia as there are strong stereotypes and traditions of informal family care.

Fig. 9.

Density of ME_i on Depression.

Source: Compiled by the authors.

With age, the absolute magnitude of the effect slightly increases. Fig. 10 shows the non-parametric regression of ME on the age of respondent. This relationship may partly be explained by the fact that older individuals are less likely to recognize depression in comparison with younger ones (Connery and Davidson, 2006; Polenick and Martire, 2013). Another possible explanation for this is that younger females could experience more strain due to stronger conflict between family and work. Finally, older females could have more traditional views on care that allow them to adapt to the situation more easily.

Fig. 10.

Nonparametric regression of ME_i on Depression by age.

Source: Compiled by the authors.

How does sandwich caregiving affect life satisfaction? The answers are divided­ into 3 categories according to the results of the answer to the question “How satisfied are you with your life in general at the present time?” (see Table A1 in Appendix). The answers were distributed as follows: Satisfied (45.5%); Dissatisfied (27.4%); Neutral (27.1%).

An interesting effect is observed: sandwich caregiving has a positive effect on the “satisfied” response (mean ME = 0.84 p.p.) and on “neutral” (mean ME = 1.53 p.p.) but negative on “dissatisfied” (mean ME = –2.01 p.p.). Thus, on average, satisfaction with life slightly increases. Kernel density estimates of the density of the marginal effect of sandwich caregiving on these three categories are presented in Fig. 11. Descriptive statistics of ME_i for the gradation of life satisfaction are presented in Table 10.

Fig. 11.

Density of ME_i on Satisfied (a), and Dissatisfied and Neutral (b).

Source: Compiled by the authors.

These results reflect those of Künemund (2006), Daatland et al. (2010) who also found that sandwich care was positively related to general life satisfaction. The negative effects of sandwich caregiving could be compensated by positive effects on psychological well-being caused by the strengthening of intergenerational relationships, and strengthening the family. Caring for relatives is recognized by society and could be considered by caregivers as meaningful and rewarding work that brings a sense of accomplishment that is positively correlated with life satisfaction (Zdravomyslova and Savchenko, 2020). The psychological motives of sandwich caregivers in Russia are discussed in Sheresheva et al. (2015).