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      Alaka M. Basu is Professor, Development Sociology, Cornell University, and a member of the Guttmacher-Lancet Commission on Sexual and Reproductive Rights and Health
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      Professor of Demography and Director, Center for Applied Statistics in Business and Economics, Università Cattolica del Sacro Cuore
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      Head of Statistical Analysis Directorate, Bank of Italy
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      Professor of Demography, University of Louvain, Belgium
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      Research Professor Emeritus, Population Studies Center, Institute for Social Research, University of Michigan (USA) and International staff, College of Populations Studies, Chulalongkorn University (Thailand)
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      Associate professor of Demography, Bocconi University - Dondena Centre for Research on Social Dynamics and Public Policy & Collegio Carlo Alberto; P.I. ERC P.I. ERC project n. 313617 (2013-2018) SWELLFER
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      Research Professor of Sociology, University of Maryland, USA
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      Università di Bologna.
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Caregiving: there’s more than meets the eye
Prestation de soins aux proches : des situations plus complexes qu’il n’y paraît

Sarah E. Patterson, Rachel Margolis

Women are more likely to provide care to multiple family members or friends simultaneously at most ages throughout the life course except at the very oldest ages when gender differences decrease and men are slightly more likely to provide care. Most research on caregiving includes personal care and financial help, but Sarah E. Patterson and Rachel Margolis highlight the importance of emotional support, which women are more likely to provide across the life course.

Gender differences in caregiving for multiple generations at once

Many adults provide care for other family members or even friends, and sometimes they care for more than one person at a time. The “sandwich generation” is a term coined in the 1980s to describe how many baby boomers were caring for young children and aging parents simultaneously. However, today’s caregivers may not just be helping parents and children like the “sandwich” generation, but also people of their own generation like spouses, siblings, and friends, or even their grandparents or grandchildren. We investigate how the prevalence of multigenerational caregiving changes depending on the type and direction of care given.

Measuring all aspects of caregiving accurately is important. It is well known that providing care can have both positive outcomes for caregivers, like closeness and mental health benefits, as well as negative outcomes, like health or financial problems. We argue that we need to take a step back and understand what caregiving looks like in order to better understand the implications of providing care. For instance, in order to understand how providing care may impact younger or older adults specifically, it is important to understand the types and directions of care being given at different life stages.


In a recent paper (Patterson and Margolis 2019), we use data from the Generations and Gender Survey (GGS) to establish caregiving patterns by age and gender across 11 European countries (Belgium, Bulgaria, Czech Republic, France, Georgia, Germany, Lithuania, Norway, Poland, Russia, and Sweden). The survey spans 2003 to 2013. We make three contributions. First, we examine the importance of emotional caregiving, a type of caregiving that is generally undercounted in research and thus undervalued. Second, we examine patterns of caregiving over all adult ages, and find that its prevalence is higher than previously thought among younger adults. Last, we show that sandwiched caregiving (to parents and children simultaneously) underestimates caregiving to multiple generations, because many adults are providing care to people other than parents and children. For the purposes of this overview, we focus on averages across all countries in our sample to understand broad patterns of caregiving by gender across the life course. In the journal article, we also examine country-level differences.

Types and directions of caregiving

Caregiving is a multifaceted activity and one that can include a variety of tasks and transfers of resources. We examine three self-reported measures of different forms of caregiving given by the respondent in the last year. They include personal care (i.e. bathing or helping someone get dressed), financial transfers (i.e. providing a gift or loan), and emotional support (i.e. listening to someone about their personal experiences or feelings). Much like helping someone physically with particular tasks like bathing or dressing, emotional support can also help family members and friends to function and maintain well-being. Emotional support is also important because a lack of such support is associated with adverse health outcomes (Sorkin, Rook, and Lu 2002). Providing emotional support at home can also spill over into the caregiver’s workplace and is associated with reduced well-being and increased stress (Wharton and Erickson 1995). Although the measure of emotional support in the GGS is quite broad, it captures variability across gender and age.

Figure 1A illustrates the percentage of adults who provided caregiving over the last year by the direction of care, age and gender, including only personal care and financial transfers. The lines represent averages across the sample of 11 countries (country weights are used). Figure 1B also includes emotional support as a type of caregiving in addition to personal care and financial transfers. Comparing these two figures, we can see that women provide more care in all directions at most ages, and that the gender differences are much greater when we take into account emotional support. Both men and women offer emotional support across the life course, but women do so at much higher rates.

Capturing caregiving for multiple generations

Another main finding is that while many adults are providing care for people in multiple generations, they would not be characterized as “sandwiched”. This is illustrated in Figure 2 which shows the percentage of “sandwiched” adult carers (providing care to a parent and child at the same time) compared to adults providing care to any two generations (upward, downward, or horizontal). We see that both types of caregiving have a similar pattern over age, with the highest rates occurring in young adulthood and then slowing decreasing with age. However, the levels of care given by men and women are different depending on how we define multigenerational caregiving. If, for example, we only measure caregiving as care provided to a child and an older adult, 26.7 percent of women aged 30 to 34 are sandwiched, but this rate increases to 64.8 percent when including care given in any two directions. For men aged 35 to 39, 12.5 percent are sandwiched, compared to 45.4 percent being multigenerational caregivers.


First, we show that rates of caregiving at all ages, and gender gaps in caregiving are both underestimated when emotional support is not captured. These high rates of caregiving across the life course have implications for both women and men in their family relationships and their ability to balance responsibilities. For instance, providing emotional support has the potential to increase family bonding, but it can also have negative implications for work-family balance. Second, we find high rates of caregiving among young adults, especially emotional caregiving to older family members. If young adults are active in caregiving at the same time as establishing their own families and entering the labor force, this could have implications for their ability to accumulate human capital. Finally, it is important to measure caregiving to multiple family members beyond the traditional “sandwich” generation, as life expectancy has increased and people share longer periods of their lives with more family members. At most ages, women are more likely to be providing multigenerational care. Older women are more likely to be in poverty than older men, and higher rates of multigenerational caregiving across the life course may help explain this phenomenon.

The original study mentioned in this article was part of the multi-country project “Care, Retirement & Wellbeing of Older People Across Different Welfare Regimes ” (CREW). This work was supported by the Joint Programming Initiative, More Years Better Lives funding from the Canadian Institute of Health Research (MYB-150262) and Social Sciences and Humanities Research Council of Canada (435-2017-0618, 890-2016-9000).


Albertini, M. (2016) Ageing and Family Solidarity in Europe: Patterns and Driving Factors of Intergenerational Support. World Bank Policy Research Working Paper, May:1–40

Arpino B. and Gómez-León, M. (2019) Consequences on depression of combining grandparental childcare with other caregiving roles. Aging & Mental Health, Doi: 10.1080/13607863.2019.1584788, published online: 14 March 2019

Da Roit, Barbara, Marcel Hoogenboom, and Bernhard Weicht. (2015) The Gender Informal Care Gap. European Societies, April:1–20.

Patterson, S. E. and Margolis, M. (2019) The demography of multigenerational caregiving: a critical aspect of the gendered life course. Socius: Sociological Research for a Dynamic World, published online: 25 July 2019

Kalmijn, Matthijs. (2019). The Effects of Ageing on Intergenerational Support Exchange: A New Look at the Hypothesis of Flow Reversal. European Journal of Population, 32(2):263–84.

Ruppanner, Leah and Georgiana Bostean. (2014) Who Cares? Caregiver Well-Being in Europe. European Sociological Review, 30(5):655–69.