Nearly two-thirds of midlife working women in the sandwich generation — those caring for both children and aging relatives — are at a caregiving breaking point, according to Cleo's third annual Family Health Index survey of more than 19,200 assessments. The study highlights escalating mental health strain, rising health care costs and hidden productivity losses that disproportionately affect women balancing careers and caregiving.
"Caregiving strain is no longer invisible, and neither are its health consequences," said Madhavi Vemireddy, CEO of Cleo. "Critically, our findings revealed an urgent need for women in midlife, especially those in the sandwich generation, who are experiencing measurable declines in self-care, mental health risk, and overall wellbeing, alongside rising medical costs."
Women ages 40 to 54 face the highest individual risk, a period often marked by perimenopause and menopause, peak career responsibilities and overlapping caregiving demands. Nearly half of women in this age group are classified as high risk for burnout. Certain subgroups experience even higher stress, including women caring for teens and parents of neurodivergent children.
The survey also shows that women's risk for depression and anxiety rises with age, peaking at 63% among those 55 and older. Menopause symptoms intensify burnout risk, correlating with lower overall scores on the index. High-risk caregivers are far more likely to report feelings of isolation, poor self-rated health and low confidence in accessing support, with only 36% of high-risk members feeling able to get the help they need compared with 82% of low-risk members.
Burnout risk is not confined to midlife. Working parents across all stages saw increases in 2025, with the sharpest proportional rises among parents of infants (+36%) and preschoolers (+45%), though high-risk prevalence remains significant among parents of older children and adult dependents.
Employees experiencing high caregiving strain drive higher healthcare costs and persistent presenteeism, a hidden productivity drain in which staff are present but not fully functioning. The survey found that high-risk caregivers who improved their Family Health Index scores reported measurable gains in productivity, self-care, confidence and family wellbeing, including an average of 64 hours of saved productivity.
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