Children's Migration: Health Seeking of Elderly Left Behind

Background

In modern times, many factors have intensified migration. Improvement in transportation infrastructure, advances in communications technology (which makes keeping in contact with left-behind over much easier and cheaper), increased trade between countries (including the impact of trade resulting from globalization), political instability, poverty, and unemployment in economically disadvantaged areas/countries are some of the important factors that contribute to this phenomenon.^[1]

The interaction between health and migration is complex and dynamic. Migration can have an impact on physical, mental, and emotional health and well-being of migrants themselves, on those left behind in the place of origin, and on those at the destination.^[2] The connection between health status and migration is clearly bidirectional. In one direction, the act of migration may influence health outcomes. In the other direction, a person's health may influence one's propensity to migrate or the destination one chooses.^[3]

In many places, and especially in most developing countries, the growing proportion of aging individuals challenges public and social institutions responsible for elderly care. These countries face an additional burden of accelerated population aging and a lack of institutional support to meet the needs of older individuals.^[4] Changes in demographic events, especially sharp declines in fertility and mortality, have resulted in rising life expectancies and increasing rates of population aging.^[5] As is the case in most other countries in Asia, the elderly in Thailand have traditionally relied on their children for personal care and financial support.^[6] Trends in declining fertility and increasing internal migration have prevailed in Thailand since 1985, when a period of sustained economic development began.^[7,8] These patterns have resulted in decreasing numbers of children available to care for their elderly parents. Increasing out-migration of young adults has created concerns about whether the absence of children in the household or community affects the health of elderly left behind or their health care-seeking behavior. Existing literature on the consequences of migration has focused mainly on the impact of migration on receiving areas and on migrants themselves but has paid little attention to the effects of migration on sending communities and of the family members "left behind" by migrants.^[9–11]

Evidence from the literature shows that migration can affect the health of those left behind both positively and negatively. With additional money coming from remittances, people have easier access to health services, can buy expensive medicine, and eat better quality food.^[12] Thus, migration can benefit both migrants and left-behind family members as it would enhance their well-being.^[13,14] Remittances received from migration could support the family left behind by minimizing economic risk and overcoming capital constraints.^[14,15] A study in South Africa found that temporary internal migrants, by increasing their household income, were able to bring positive health outcomes not only for themselves but also for family members^[16] including elderly parents left behind.^[17] Other research also shows that migration can lead to better health among the population left behind.^[18–20] Similarly, a study conducted by Abas et al.^[21] found that out-migration of children was independently associated with less depression in parents.

On the other hand, some research notes that out-migration of young adults has severe negative consequences for ageing parents, namely, loneliness, isolation, and the loss of basic instrumental and economic support.^[22] A study of Mexico-US migration found evidence of a causal link between poor elderly health outcomes and children's migration to the US.^[23] Research in Bangladesh has found that those left behind by adult migrant children face risks stemming from the loss of personal support and care.^[18]

Although the separation of families due to migration might have serious implications on the health status of elderly left behind and their health care-seeking behavior, the possible health effects on elderly left behind in Thailand remain unclear. This study aims to explore the impact of migration of adult children on the health of the elderly left behind and on their health care-seeking behavior. In-depth examination of these issues will provide policy makers and program planners with needed information and will raise public attention to this public health issue. The findings of this study will help fill the gap in the literature and provide the understanding necessary for advocacy and for the design of appropriate interventions related to migration in Thailand.

Table 1. Selected background characteristics of the sampled elderly
Characteristics		%	N
Age group	60–69 years	52.6	15,089
	70–79 years	34.3	9,824
	80 years or +	13.1	3,764
Sex	Male	44.0	12,626
	Female	56.0	16,051
Place of residence	Rural	57.1	16,365
	Urban	42.9	12,312
Level of education	Higher than secondary	3.8	1,080
	Secondary level	7.1	2,026
	Primary or below	89.2	25,571
Number of children	One	8.0	2,303
	Two	16.3	4,688
	Three	19.7	5,653
	Four	17.5	5,030
	Five or more	38.4	11,003
	Mean no. children	4.2
Living arrangement	Alone	7.5	2,151
	With child (ren)	61.9	17,742
	With other relatives	30.6	8,784
Average household income per year	100,000 baht or more	16.0	4,578
	30,000–99,999 baht	33.9	9,715
	Less than 30,000 baht	50.1	14,363
Migration of child(ren)	No	32.8	9,402
	Yes	67.2	19,275
Total		100.0	28,677
Received money (baht) during the preceding 12 months from migrant children#	None	20.9	4,031
	Up to 4999 baht	21.8	4,199
	5000–9999 baht	17.8	3,424
	10000–29999 baht	25.6	4,930
	30000 or above baht	14.0	2,691
Total		100.0	19,275

Table 1. Selected background characteristics of the sampled elderly

Characteristics

Age group

60–69 years

52.6

15,089

70–79 years

34.3

9,824

80 years or +

13.1

3,764

Sex

Male

44.0

12,626

Female

56.0

16,051

Place of residence

Rural

57.1

16,365

Urban

42.9

12,312

Level of education

Higher than secondary

3.8

1,080

Secondary level

7.1

2,026

Primary or below

89.2

25,571

Number of children

One

8.0

2,303

Two

16.3

4,688

Three

19.7

5,653

Four

17.5

5,030

Five or more

38.4

11,003

Mean no. children

4.2

Living arrangement

Alone

7.5

2,151

With child (ren)

61.9

17,742

With other relatives

30.6

8,784

Average household income per year

100,000 baht or more

16.0

4,578

30,000–99,999 baht

33.9

9,715

Less than 30,000 baht

50.1

14,363

Migration of child(ren)

32.8

9,402

Yes

67.2

19,275

Total

100.0

28,677

Received money (baht) during the preceding 12 months from migrant children#

None

20.9

4,031

Up to 4999 baht

21.8

4,199

5000–9999 baht

17.8

3,424

10000–29999 baht

25.6

4,930

30000 or above baht

14.0

2,691

Total

100.0

19,275

Table 2. Health status and healthcare-seeking behavior among elderly according to migration status of child(ren)
	With migrant child(ren)	Without migrant child	Total
Symptoms of poor mental health
No symptom	41.0	44.1	42.0
1 symptom	14.3	13.3	14.0
2 symptoms	16.1	15.4	15.9
3 or more symptoms	28.5	27.3	28.1
Self assessed health
Good health	43.8	44.5	44.0
Poor health	56.2	55.5	56.0
Number of chronic diseases
No	55.9	56.2	56.0
1 disease	29.1	29.2	29.1
2 diseases	11.7	11.6	11.7
3 or more diseases	3.3	3.0	3.2
Illness during the previous 5 years
Yes	64.6	64.7	64.7
No	35.4	35.3	35.3
Total	100.0	100.0	100.0
N	19,275	9,402	28,677
Treatment sought for the most recent illness+
Yes	89.0	86.5	88.2
No	11.0	13.5	11.8
Total	100.0	100.0	100.0
N	12,455	6,086	18,541

Table 2. Health status and healthcare-seeking behavior among elderly according to migration status of child(ren)

With migrant child(ren)

Without migrant child

Total

Symptoms of poor mental health

No symptom

41.0

44.1

42.0

1 symptom

14.3

13.3

14.0

2 symptoms

16.1

15.4

15.9

3 or more symptoms

28.5

27.3

28.1

Self assessed health

Good health

43.8

44.5

44.0

Poor health

56.2

55.5

56.0

Number of chronic diseases

55.9

56.2

56.0

1 disease

29.1

29.2

29.1

2 diseases

11.7

11.6

11.7

3 or more diseases

3.3

3.0

3.2

Illness during the previous 5 years

Yes

64.6

64.7

35.4

35.3

Total

100.0

19,275

9,402

28,677

Treatment sought for the most recent illness+

Yes

89.0

86.5

88.2

11.0

13.5

11.8

Total

100.0

12,455

6,086

18,541

Table 3. Odds ratio (OR) and 95% confidence interval (CI) for the effect of children's out-migration on elderly's experience of health problems (symptoms/diseases), perceived health status, chronic disease, illness and treatment-seeking behavior
	No out-migration of adult children = reference category
Dependent variables	OR	CI	Cox & Shell R square
Mental health status (n = 28, 677)
Symptoms of poor mental health (ref: No symptom)
At least one poor mental health symptom	1.10***	1.05–1.17	0.124
Perceived health status within previous 7 days (n = 28, 677)
Self-assessed health (ref: Good)
Poor	1.03	0.98–1.09	0.128
Chronic diseases (n = 28, 677)
Chronic disease (ref: No)
At least one chronic disease	1.02	0.97–1.08	0.161
Illness (n = 28, 677)
Felt sick during the previous 5 years (ref: No)
Yes	1.00	0.95–1.07	0.116
Healthcare-seeking behavior (n = 18, 541)
Treatment sought for the last illness (ref: No)
Yes	1.22***	1.11–1.33	0.113

Table 3. Odds ratio (OR) and 95% confidence interval (CI) for the effect of children's out-migration on elderly's experience of health problems (symptoms/diseases), perceived health status, chronic disease, illness and treatment-seeking behavior

No out-migration of adult children = reference category

Dependent variables

Cox & Shell R square

Mental health status (n = 28, 677)

Symptoms of poor mental health (ref: No symptom)

At least one poor mental health symptom

1.10***

1.05–1.17

0.124

Perceived health status within previous 7 days (n = 28, 677)

Self-assessed health (ref: Good)

Poor

1.03

0.98–1.09

0.128

Chronic diseases (n = 28, 677)

Chronic disease (ref: No)

At least one chronic disease

1.02

0.97–1.08

0.161

Illness (n = 28, 677)

Felt sick during the previous 5 years (ref: No)

Yes

1.00

0.95–1.07

0.116

Healthcare-seeking behavior (n = 18, 541)

Treatment sought for the last illness (ref: No)

Yes

1.22***

1.11–1.33

0.113

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