Feb 23, 2026
Scoping review protocol: Diversity and intergenerational caregiving burdens of sandwich generation in Asia
- Hang Thi Thuy Do1,
- Pataporn Sukontamarn1,
- Truc Ngoc Hoang Dang2
- 1College of Population Studies, Chulalongkorn University, Bangkok, Thailand;
- 2Institute for Population and Social Research, Mahidol University, Nakhon Pathom, Thailand
- Diversity and Intergenerational Caregiving Burdens of the Sandwich Generation in Asia
Protocol Citation: Hang Thi Thuy Do, Pataporn Sukontamarn, Truc Ngoc Hoang Dang 2026. Scoping review protocol: Diversity and intergenerational caregiving burdens of sandwich generation in Asia. protocols.io https://dx.doi.org/10.17504/protocols.io.bp2l6eyb1gqe/v1
License: This is an open access protocol distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited
Protocol status: Working
We use this protocol and it's working
Created: February 20, 2026
Last Modified: February 23, 2026
Protocol Integer ID: 243724
Keywords: sandwich generation, intergenerational caregiving burden, dual roles, intergenerational conflict, Asia, intergenerational caregiving burdens of sandwich generation, intergenerational caregiving burdens of the sandwich generation, asia the sandwich generation, intergenerational caregiving burden, sandwich generation, demographic transitions in asia, various profiles of the sandwich generation, intergenerational conflict, asian context, younger family member, asian region, asia, unique finding in asian context, diverse need, family, academic interest in asia, sociocultural context, demographic transition, unique burden, social isolation, eligible study, design intervention, mental burden, financial burden
Funders Acknowledgements:
The Second Century Fund, Chulalongkorn University
Tuition fee support, College of Population Studies, Chulalongkorn University
Abstract
The sandwich generation—individuals simultaneously having both older and younger family members—is gaining increasing academic interest in Asia. This scoping review explores the diversity and intergenerational caregiving burdens of the sandwich generation. Guided by PRISMA-ScR, six academic databases (Google Scholar, Scopus, Web of Science, PubMed, EBSCO, ProQuest) were systematically searched, yielding 67 eligible studies published between 1999 and 2024 in 16 countries across five Asian regions. The review identified various profiles of the sandwich generation, reflecting key social-demographic transitions in Asia. Six intergenerational caregiving burdens were identified—physical, mental, and financial burdens; social isolation; role conflict; and intergenerational conflict. Mental burden was most frequently reported, while intergenerational conflict emerged as a unique finding in Asian contexts and remains underexplored in prior reviews. Policymakers should recognize the diverse needs of subpopulations within the sandwich generation and design interventions that align with their unique burdens and sociocultural contexts.
Troubleshooting
1. Introduction
Overview of the topic of interest
- “Sandwich generation,” coined by Dorothy Miller in 1981, refers to the “adult children of the aging” – who are in between their parents and their own maturing children. This population has attracted growing academic interest in Asia – a diverse region with variations in demographic, socio-cultural and policy contexts.
- In this scoping review, the sandwich generation in Asia is defined as “individuals simultaneously having both older and younger family members”.
Rationale for the review
- Previous systematic reviews about the sandwich generation have primarily focused on the problems faced by the sandwich generation, the positive and negative impacts of caregiving, and protective mechanisms for caregivers, with most evidence from Western contexts and limited studies of Asian countries.
Explicit objective statement
- This scoping review aims to comprehensively synthesize the diversity of the sandwich generation and the intergenerational caregiving burdens they experienced across Asia.
2. Methods
Identify research questions
(1) How does the sandwich generation in Asia vary in its demographic and caregiving profiles?
(2) What intergenerational caregiving burdens does this population experience?
Identify relevant studies
5.1 PCC framework and search key words
- Population: Sandwich generation
“sandwich generation” OR “sandwiched generation” OR “informal sandwich
caregiver” OR “baby boomer” OR “sandwich family” OR “sandwich effect” OR
“sandwiched situation” OR “women in the middle” OR “squeezed generation” OR
“middle generation” OR “dual caregiver” OR “dual earner” OR “G2 generation”.
- Concept: Intergenerational caregiving burdens
“Intergenerational caregiving” OR “older care” OR “multigenerational care”
OR “caregiver stress” OR “caregiver burden” OR “burnout in caring for older
parents” OR “adult children caregivers”.
- Context: Asian countries
“China” OR “Hong Kong” OR “Macao” OR “North Korea” OR “Japan” OR “Mongolia” OR “South Korea” OR “Taiwan” OR “Kazakhstan” OR “Kyrgyzstan” OR “Tajikistan” OR “Turkmenistan” OR “Uzbekistan”
OR “Afghanistan” OR “Bangladesh” OR “Bhutan” OR “India” OR “Iran” OR “Maldives” OR “Nepal” OR “Pakistan” OR “Sri Lanka” OR “Brunei” OR “Cambodia” OR “Indonesia” OR “Lao” OR “Malaysia” OR “Myanmar” OR “Philippines” OR “Singapore” OR “Thailand” OR “Timor-Leste” OR “Vietnam” OR “Armenia” OR “Azerbaijan” OR “Bahrain” OR “Cyprus” OR “Georgia” OR “Iraq” OR “Israel” OR “Jordan” OR “Kuwait” OR “Lebanon” OR “Oman” OR “Quatar” OR “Saudi Arabia” OR “Palestine” OR “Syrian Arab Republic” OR “Turkey” OR “United Arab Emirates” OR “Yemen”.
5.2 Academic search platforms:
- Google Scholar, Scopus, Web of Science, PubMed, EBSCO, ProQuest.
- ResearchGate, a social media platform, was used to obtain full text of an article identified through Google Scholar when direct access via journal platforms was unavailable.
Study selection
- Inclusion criteria:
(1) Studies were original, peer-reviewed, English research articles
(2) The primary target population was the sandwich generation, who simultaneously has both older and younger family members
(3) Findings were reported on caregiving burdens experienced by the sandwich generation
(4) Research was conducted in Asian countries.
- Exclusion criteria:
(1) Grey literature: theses/dissertations, working papers, reports, information notes, international briefs, research summaries, research briefs, policy reviews, policy analyses, preprints/postprints, conference proceedings, analysis articles. Non-empirical publications: book chapters/books, letters to the editor, commentaries, correspondence.
(2) Non-English studies
(3) Studies in which the sandwich generation was not the primary research target
(4) The definition of the sandwich generation adopted in the study was inconsistent with this review’s definition of sandwich generation
(5) The studies did not focus on the caregiving burdens of the sandwich generation
Data charting
- Data were charted using a standardized extraction form developed by the research team, including four main components:
(1) author, year of publication, and country;
(2) methodology;
(3) target population;
(4) types of caregiving burden.
- The first author independently charted the data, while second and third authors verified the extracted information for accuracy.
Collating, summarizing and reporting the results
Collating the results
- There are 6 types of intergenerational caregiving burdens in total:
(1) physical burden
(2) mental burden
(3) social isolation
(4) financial burden
(5) role conflict
(6) intergenerational conflict
Summarizing the results
9.1 Descriptive numerical summary
- Number of studies included and study design distribution
- Geographic distribution across Asian countries
- Year of publication trends
- Frequency of reported burdens across studies
9.2 Thematic synthesis
- Diversity of the sandwich generation in Asia
- Intergenerational caregiving burdens among the sandwich generation in Asia
Reporting the results
10.1 Results are presented clearly and transparently using:
- Tables: Table A1 - Definitions and classifications of the sandwich generation in Asia, Table A2 - Summary of intergenerational caregiving burdens among the sandwich generation in Asia.
- Figures: Figure 1 - PRISMA flow diagram of studies identified, screened, assessed for eligibility, and included in this review, Figure 2 - Number of studies, by countries, Figure 3 - Number of studies, by year, Figure 4 - Types of burden.
10.2 Discussion:
- To highlight the key findings
- To provide examples illustrating the diversity of the sandwich generation as a product of significant socio-demographic transitions in Asia
- To highlight intergenerational conflict as an aspect not examined in prior systematic reviews and a distinctive feature of the Asian context
- To explain the finding of mental burden - the most frequently reported strain by the stress process model
- To compare the similarities and differences of the findings with the Western contexts
10.3 Conclusion:
- To propose several evidence-based policy recommendations
- To provide the limitations of the scoping review
- To identify research gaps and suggest directions for future research