The study, published on 23 September 2026, used grounded theory procedures, a qualitative method in which categories emerge from the data rather than being imposed in advance. Participants were recruited from an online questionnaire pool of 2,064 valid responses collected between March and June 2024, and eligibility required simultaneous unpaid care for at least one child aged 0 to 6 years and at least one older adult aged 60 or above, with at least six consecutive months of eldercare. The final interview sample comprised 17 women and six men aged 32 to 72 years, with a mean age of 44.5 years; 15 were employed. Ten face-to-face interviews were conducted in Xi’an and 13 telephone interviews followed, each lasting 50 to 90 minutes and transcribed verbatim. Three researchers coded the transcripts line by line using constant comparison, and by interview 20 no new higher-order category emerged, with three additional interviews confirming theoretical sufficiency.

The analysis generated four interrelated modules that together describe dual caregiving as a recursive process rather than a linear one. First came continuous and competing care demands: young children required feeding, transport, supervision, and educational support, while older adults could need household help, medication management, hospital accompaniment, and mobility assistance. Although the tasks followed different rhythms, they competed for the same time, attention, and physical capacity. A 55-year-old woman caring for a three-year-old grandchild told the interviewer that looking after a child was even more tiring than caring for an older person, because you have to watch the child constantly and follow them everywhere. A 46-year-old woman caring for two children and her father identified the hardest moment as when an older person becomes completely bedridden and cannot care for themselves, requiring constant presence at their side.

The central issue, the study found, was not that one generation consistently demanded more care, but the coincidence, urgency, and limited substitutability of needs. Young children require continuous supervision, while illness or medical appointments among older relatives interrupt established routines without warning. The researchers described this as a state of sustained availability and coordination, not literal uninterrupted care for every participant. Some considered child supervision more exhausting; others regarded loss of mobility among older adults as the greater pressure. What mattered was that urgent needs were difficult to predict and difficult to delegate, which meant that even small non-deferrable tasks accumulated into a compressed daily schedule with minimal rest.

From these primary demands, stress proliferated into what the study calls secondary strains across four domains: work, finances, psychological wellbeing, and family relationships. Employed participants arranged work around school pick-ups, medical appointments, and eldercare emergencies. A 41-year-old divorced woman explained that if she could not stand out at work, the only thing she could do was stay longer, leaving early and returning late every day, leaving almost no time during the working week to care for her parents. Financial capacity was similarly constrained. One participant described paying a mortgage and a child’s tuition every month, noting that many ordinary families have no savings now, which makes life even harder to manage. Psychological strain appeared as worry, irritability, guilt, and the loss of time for self-care. An older woman summarized the constraint starkly: spending every day looking after other people and having no time to care for herself, getting ill was simply not an option.

Family relationships themselves became a secondary strain when responsibility was unclear or tasks were unequally distributed. One participant observed that the more family members there are, the more likely disagreements become. Care also narrowed social roles as participants reduced leisure, declined invitations, and avoided long-term commitments. At the same time, some caregivers valued closeness to children or older relatives and rejected an entirely burden-centered account. One grandmother said she did not expect anything in return for caring for her grandchild, doing it entirely willingly, because respecting older people and caring for children is a Chinese tradition and her responsibility. Meaning and fatigue, the study emphasized, coexisted in the same households and often in the same person.

The third module examined conditional resources, and here the study made its most theoretically important contribution. Participants combined three types of resources: family support from spouses, siblings, older relatives, and adult children; formal and market services such as paid domestic help, community services, and public assistance; and self-regulation, including adjusted expectations, reduced spending, protected personal time, exercise, and emergency savings. The critical finding was that these resources widened caregivers’ room for action only when they were accessible, reliable, affordable, and matched to the specific task and time. A relative may provide emotional reassurance but be unavailable for hospital accompaniment; money can purchase help only where an acceptable service exists at the required hour; and flexible work protects employment only when tasks and supervisors permit its use.

Resources also substituted for one another in ways that kept current care from breaking down while transferring unresolved costs elsewhere. When formal services were unavailable or distrusted, households relied more heavily on spouses and siblings. When relatives could not help, caregivers used savings or purchased services. When neither was sufficient, participants tightened schedules, reduced expenditure, or lowered achievement expectations. One participant combined self-reliance with conditional openness to formal help, saying that they did not expect too much from any person or organization and mainly relied on themselves, but if they genuinely could not manage and the government or society happened to provide such a service, it would save them enormous trouble. Substitution, the study concluded, buffered strain only conditionally, and its value depended on accessibility, reliability, affordability, timing, and the negotiation costs attached to seeking help.

When time, money, and available helpers were insufficient, caregivers negotiated along two axes: generational priority when the needs of older adults and children conflicted, and the intensity of child-rearing investment that could be sustained. Their intersection produced four illustrative strategy configurations, which the study stressed are analytical combinations rather than fixed personality types or estimates of prevalence. Configuration A, child-first with intensive investment, was illustrated by a comparatively well-resourced Shanghai household where paid childcare and extended-family support enabled extracurricular education while eldercare was shared. Configuration B, child-first with basic provision, appeared in a lower-resource Xi’an household that prioritized children’s immediate food, schooling, and safety while reducing extracurricular spending. Configuration C, older-adult-first while maintaining intensive child-rearing, was embodied by a Shanghai father who valued his children’s diet and early education but prioritized his mother, explaining that with older people every day together is one day less and every day is precious, while his child still has a long road ahead. Configuration D, balanced generations with basic provision, was illustrated by a single mother in Xi’an who set no fixed priority and raised her child in a relaxed and free way, as she herself was raised.

These configurations were temporary couplings among the urgency of needs, family norms, educational goals, and substitute resources, and participants could move between them as older adults’ functioning, children’s needs, employment, or available help changed. Neither configuration membership nor generational priority determined a single employment or fertility response. Work adjustments depended on job flexibility, income needs, household task-sharing, and whether substitute care could cover specific hours; some participants improved efficiency or chose employment close to home, while others reduced hours, experienced stalled advancement, or left paid work entirely. Further-childbearing decisions were shaped by perceived future capacity as well as current demands. One 40-year-old participant said she had ruled out having a second child because at 40 she was already overwhelmed, and raising another child from infancy while caring for ageing parents was beyond what she could manage. These accounts indicate perceived constraints rather than a uniform fertility response, but they connect present care arrangements directly to demographic futures.

Even when current arrangements were relatively stable, perceived control over the future eroded under the weight of possible functional decline among older adults, educational costs, and health emergencies. One participant said that when thinking about parents possibly becoming completely bedridden one day, they were terrified and could not imagine how they would cope. Another said their family could not withstand a serious illness or accident. A third described daily life as firefighting rather than long-term planning. Perceived future control therefore connected current strategies to the next cycle of stress: short-term adjustments maintained care but could limit savings, career development, and preparation for future needs, completing the feedback loop that the study identified as the core of dual caregiving.

The findings refine Pearlin’s classic stress process model in three ways. First, primary stressors cannot be understood only through total care volume; temporal overlap, urgency, and task substitutability jointly shaped perceived competition. Second, secondary strains operated as feedback: employment reduction and financial strain were consequences of care but also reduced later income, time, and room for action, a cumulative dynamic supported by longitudinal studies of financial strain, employment, and care intensity. Third, negotiated outcomes had a dual character, protecting basic care in the short term while transferring risk to health, careers, children’s opportunities, or future care capacity. The interpretation also shifts attention from the amount of support to task-resource fit, explaining why nominally similar households could retain very different rooms for action.

Fatigue, time conflict, financial strain, and family negotiation have been reported across societies and should not be presented as uniquely Chinese, the study cautioned. What was distinctively Chinese in these interviews lay mainly in how participants interpreted shared pressures through intergenerational reciprocity, filial responsibility, and educational expectations, and in which substitutes were available where formal care was uneven. Child-first, older-adult-first, and balanced arrangements should therefore be understood as contextual responses rather than stable cultural types. The predominantly female sample reflects, but cannot quantify, the gendered task allocation that shapes caregiving burden; career contraction, reduced consumption, or postponed childbearing should not be interpreted as a culturally fixed preference but as the narrowing of choices under particular resource conditions.

For policy, the study suggests three directions, presented as implications rather than prescriptions derived directly from 23 interviews. First, financial support should be linked to an adequate supply of substitute care: flexible allowances or service vouchers could help high-intensity, lower-income households purchase accredited childcare, home-based eldercare, or temporary respite, but only where services are available and trusted. Evidence from China’s long-term care insurance pilots indicates that greater access to formal care can reduce some informal-care burden and influence labor participation. Second, time protection should cover both childcare and eldercare, through caregiver-inclusive leave, reversible reductions in hours, and flexible or hybrid work where job tasks permit, with public or social-insurance financing to reduce employer resistance and safeguards to prevent caregiving responsibilities from reinforcing women’s employment penalties. Third, communities need a coordination point capable of identifying gaps across both care domains, connecting childcare, home-based eldercare, respite, psychological support, and emergency back-up care, with opening hours aligned to work, medical visits, and school transport.

Several limitations constrain interpretation. The online questionnaire used non-probability recruitment, and interviewees self-selected by leaving contact details, so the sample may overrepresent people with digital access who were willing to discuss family experiences. The 23 participants came only from Shanghai and Xi’an and were predominantly women; they cannot represent all dual caregivers in China or support prevalence, statistical significance, or causal claims. Interview mode coincided partly with collection phase and location and may have affected rapport or disclosure, and translation of Chinese narratives into English may have reduced semantic nuance. The explanation is grounded in 23 interviews and requires examination across other regions, household structures, and stages of care.

Yet the core message travels far beyond two Chinese cities. As population ageing, lower fertility, and changing family structures widen the gap between care needs and families’ capacity to meet them in many settings, the sandwich generation is becoming a global demographic reality, from the United States, where national evidence shows dual caregivers more often report role overload and financial and emotional strain than caregivers of older adults alone, to Europe and beyond. The study’s feedback model suggests that what looks like individual resilience is actually a resource-allocation process with visible and invisible costs, and that continuous, affordable, and time-matched support may be the single most important lever for strengthening families’ capacity to sustain care. For the millions of adults caught between a child’s first day of school and a parent’s last years, the finding is both a diagnosis and a quiet warning: the squeeze is survivable, but only if the support arrives when it is needed, in the form it is needed, and stays long enough to matter.

Subject of Research: Stress and coping among dual caregivers in China: a grounded theory study of intergenerational caregiving

Article Title: Stress and coping among dual caregivers in China: a grounded theory study of intergenerational caregiving

Article References: Hu, H. (2026). Stress and coping among dual caregivers in China: a grounded theory study of intergenerational caregiving. International Journal of Public Health, 71, Article 1610111. https://doi.org/10.3389/ijph.2026.1610111

Image Credits: AI Generated

DOI: 10.3389/ijph.2026.1610111

Keywords: Stress, coping, dual, caregivers, China, grounded, theory, intergenerational, caregiving, scientific research