How VCU Health is helping the sandwich generation
Cognitive decline brings challenges to caregivers who are caring for aging parents as well as their own children.
April 09, 2026
VCU Health experts recognize that the demands of caring for a loved one with dementia is placing emotional and logistical pressures on adults caring for two generations at once. (Getty Images)
By Shea Wright
Juggling careers, carpools and aging parents is often the reality of midlife. It is marked by a time of stability and a new type of controlled chaos. But for millions of Americans, it also becomes a season of transition.
According to the Pew Research Center, about half of Americans in their 40s and 50s have a child under 18 and parents older than 65, and 1-in-7 middle-aged adults is providing financial support to both an aging parent and a child. For those individuals suddenly caring for both generations at once, the middle years become something else entirely: life in the sandwich generation.
The “sandwich generation” is a term coined in the 1980s to identify individuals in midlife who were taking care of their own children, careers and their elderly parents or extended family members.
In the United States, there are an estimated 11 million unpaid family caregivers of patients with dementia, including Alzheimer’s disease, vascular dementia, Lewy Body Dementia, Parkinson’s-related dementia, HIV-associated dementia, and other forms of the disease. Dementia is the umbrella term for acquired disorder of cognitive decline and activities of daily life (ADLs).
“Alzheimer’s is the most common cause of dementia. It often starts with short-term memory loss, then progresses to confusion, disorientation, and difficulty with ADLs,” said James Bateman, M.D., MPH, director of the VCU Health Alzheimer’s disease and cognitive disorders clinic. “And when dementia appears, sometimes suddenly, sometimes happening for years in the background, the squeeze becomes more than logistical. It becomes an emotional, financial and deeply personal experience for everyone involved."
While neurologists diagnose and treat dementia, families and caregivers are often left asking a different question: What happens next?
At VCU Health, those questions are most often answered by Brittany Gibson, MSN, CRRN, a nurse navigator with VCU Health Care Coordination, which includes the GUIDE Center for Dementia Care. It’s a federally funded program that helps both patients and caregivers navigating treatment plans or planning for long-term care.
“A diagnosis can feel overwhelming,” Gibson said. “Families are processing medical information while also trying to understand how this changes daily life. My role is to help them navigate those next steps.”
Through the GUIDE Center, Gibson coordinates care across VCU Health specialties including setting up appointments with speech pathologists, physical therapy, occupational therapy, psychiatry, etc. She also connects families with community resources, screens caregivers for stress and burnout, and helps establish comprehensive care plans.
“We’re not just focused on the patient,” Gibson said. “We’re looking at the whole family system.”
Feeling the squeeze: Changes in family dynamics due to dementia
Unlike many chronic illnesses, cognitive decline does not follow a predictable timeline. There could be a flatline of symptoms for months, even up to a year, and then a sharp decline in cognitive ability. There is no cure for Alzheimer’s disease, and no single path for how quickly symptoms may progress.
“In early to middle dementia, we often see patients coming in themselves and asking questions about their diagnosis, especially younger patients (under 65), but as the disease progresses into middle and late dementia we typically see a lot of caregivers who are juggling their loved one who has dementia, their families, and other responsibilities,” Gibson said.
Cognitive decline is a very scary thing that people go through, and there are a multitude of reasons for that decline. Starting early detection is paramount, especially when you first notice things are off with a parent or loved-one.
James Bateman, M.D., MPH, director of the VCU Health Alzheimer’s disease and cognitive disorders clinic
Stress is another factor in caregiver burnout throughout every stage. Sleep routines can be interrupted, causing fatigue, anticipatory grief knowing the finality of a loved one with chronic illness, and growing financial strain due to the cost of finding and/or providing 24/7 care. The GUIDE program homes to alleviate some of those pressure points.
"Our goal as nurse navigators is to help reduce the burden on patients and caregivers,” Gibson said. “It’s common for families to reach out after appointments with questions about symptom changes, safety concerns, or community resources like adult day programs and care at home. We provide guidance, coordinate support and work to build a sense of connection during what can be an incredibly difficult time.”
Why early detection matters for Alzheimer’s disease and dementia
Early detection can change the course of both treatment and caregiving, yet many families do not receive a diagnosis until the disease is well underway. Without early guidance, families may find themselves forced into rushed decisions about assisted living or memory care, often under emotional and financial strain.
Women are more likely than men to be diagnosed with dementia, and many are diagnosed later due to barriers in health care access, lack of information and stigma.
“Cognitive decline is a very scary thing that people go through, and there are a multitude of reasons for that decline. Starting early detection is paramount, especially when you first notice things are off with a parent or loved-one,” Bateman said.
It’s common for families to reach out after appointments with questions about symptom changes, safety concerns, or community resources like adult day programs and care at home. We provide guidance, coordinate support and work to build a sense of connection during what can be an incredibly difficult time.
Brittany Gibson, MSN, CRRN, nurse navigator with VCU Health
An individual with Alzheimer’s or other forms of dementia might live with the condition for years or even decades before it is diagnosed.
“For the families and caregivers, I always tell them my goal is to maximize the amount of quality of life they have over the course of the illness that can span many years,” Bateman said.
Signs and symptoms: When to seek care for cognitive disorders
Bateman and Gibson both agree that it’s important to seek out a neurologist when you start to notice something is wrong with a family member or loved one. Mild cognitive decline is typical for adults over the age of 75. However, when the decline starts to impact activities of daily living, such as bathing or using the toilet, you will want to consult a doctor for further evaluations.
Other cognitive disorder symptoms include:
- Increased frequency of forgetfulness and decision-making
- Missing appointments or social events
- Difficulty remembering names or words in conversation
- Getting lost, especially in places that are familiar
- Frequently misplacing items
- Short temper or aggression
- Mood swings
“Whether you are at the beginning stages or planning end of life care, you want to have an official diagnosis so that you have the capacity to make financial decisions, document timeline of decline, and get any imaging on a disk or hard copy if and when possible,” Bateman said. “These can be hard, but necessary conversations to have.”
There is no single test to diagnose dementia. Instead, neurologists use a series of tests for memory, problem-solving or language skills deficiencies, such as:
- Cognitive tests that focus on recall, counting, reasoning and communication
- Brain scans (MRI, CT, and PET scans)
- Psychiatric evaluation
- Lab tests
Gibson encourages adults with aging parents to attend as many primary care appointments as they can in-person. "During early cognitive decline, it’s not uncommon for patients to downplay their symptoms, so attending appointments and not being afraid to recount what you have been seeing or experiencing whenever possible is strongly encouraged.”
The difficult balance of caring for loved ones and yourself
It's often said that we cannot pour from an empty cup. And for members of the sandwich generation, it's all too easy to find your cup is run dry. Experts like Bateman say it's important that caregivers don't forget about taking care of themselves in the process.
“Caregivers should seek support and share responsibilities where possible, maintain and revisit family memories, prioritize emotional connection over correction and use respite care to prevent burnout,” Bateman said.
For families in the sandwich generation, that means having a team that not only treats the disease but supports the people living alongside it. Through coordinated specialty care and nurse navigation services, like GUIDE, VCU Health is helping caregivers have a structured path forward, built on planning, education and ongoing support rather than uncertainty alone.
“We are here to support patients and caregivers all the way through the end of life,” Gibson said.
