Abstract: The increasing life expectancy of older adults and the postponement of female reproductive age have made the coexistence of older adults and young children within families increasingly common. The multigenerational family structure, represented by “G1 → G2 → G3 → G4,” has become more prevalent, accounting for approximately 25% of households in China. Within these families, G2 constitutes the typical sandwich generation, simultaneously addressing the caregiving needs of both G1 (old adults) and G4 (young children). This caregiving dynamic can be categorized into four patterns: caregiving for parents, caregiving for grandchildren, dual caregiving for both parents and grandchildren, and providing no care. This study examines the influences of intergenerational caregiving patterns on health outcomes among the sandwich generation through a mixed-methods research design that integrates both quantitative and qualitative approaches. Specifically, it explores three key questions: (1) How are caregiving resources allocated within the sandwich generation? (2) What are the effects of different intergenerational caregiving patterns on the health outcomes of the sandwich generation? (3) What are the underlying mechanisms through which intergenerational caregiving patterns influence caregivers' health outcomes?
Study 1 investigates two key sub-questions. First, it examines the overall intergenerational caregiving patterns and the underlying factors influencing resource allocation. This section serves as a preliminary analysis, leveraging multi-wave data from the China Health and Retirement Longitudinal Study (CHARLS) to assess the current state of the sandwich generation and their intergenerational caregiving responsibilities. The analysis focuses on empirically identifying caregiving patterns across various demographic groups, including gender, urban-rural residence, age, and employment status. Second, the study explores the competitive dynamics of resource allocation, specifically examining whether providing care for either parents or grandchildren diminishes the likelihood of simultaneously caring for the other.
Study 2 investigates the impacts of intergenerational caregiving patterns on the health outcomes of the sandwich generation, drawing on three interrelated theoretical frameworks: intergenerational solidarity theory, the intergenerational stake hypothesis, and the intergenerational conflict perspective. These frameworks provide a conceptual foundation for analyzing how intergenerational caregiving patterns influence the health outcomes of the sandwich generation and guide the formulation of hypotheses for empirical analysis. Furthermore, Study 2 examines the role of care providers' cultural orientation (individualism vs. collectivism) in shaping caregiving experiences. Specifically, it explores the moderating effect of cultural orientation on the relationships between intergenerational caregiving patterns and the health of the sandwich generation.
Study 3 develops a multiple mediation model grounded in role enhancement and role strain theories, incorporating both role enhancement (reciprocity and psychological mechanisms) and role strain (stress mechanisms) to examine the pathways through which intergenerational caregiving patterns influence the health of the sandwich generation. This analysis is conducted using quantitative research methods. Furthermore, Study 3 constructs an integrated analytical framework that encompasses the coercive effects of policy systems, the soft constraints of community sentiment, and the cultural identity of family responsibilities. Through qualitative research, this framework seeks to provide a deeper understanding of the mechanisms linking intergenerational caregiving patterns to the health outcomes of the sandwich generation. Finally, by integrating quantitative and qualitative approaches, the study offers a more comprehensive and nuanced explanation of these mechanisms, ensuring methodological complementarity and mutual validation.
This study makes several key contributions. First, by examining the intergenerational caregiving responsibilities of the sandwich generation within multigenerational families, this research provides empirical evidence for understanding the simultaneous demands of elderly care and child-rearing in Chinese families amid modernization. Second, by investigating the effects and underlying mechanisms of intergenerational caregiving patterns on the health of the sandwich generation, this study establishes a comparative framework for evaluating how different caregiving patterns influence caregivers' health outcomes. Finally, addressing the influences of intergenerational caregiving patterns on health not only advances the goal of healthy aging but also informs the development of population service strategies that support both elderly care and child-rearing, with an emphasis on safeguarding caregiver health.

Key words: intergenerational relationships, intergenerational caregiving, older adults, young children, health outcomes.