Impact of Children's Migration on Health and Health Care-seeking Behavior of Elderly Left Behind

Ramesh Adhikari; Aree Jampaklay; Aphichat Chamratrithirong


BMC Public Health. 2011;11 

In This Article


Sources of Data and Study Design

This paper uses data from a cross-sectional survey conducted in 2007 among the elderly in Thailand. This nationally representative survey was conducted by the National Statistical Office (NSO) of Thailand. The NSO has conducted three nationally representative household surveys of older persons, in 1994, 2002, and 2007[24–26] to fulfill the need for adequate information to develop appropriate policies and programs to ensure the well-being of the Thai elderly. These surveys collected information on socioeconomic conditions, living arrangements, income, health status, and health care-seeking behavior of the elderly in Thai society

The survey is based on a probability sample of persons aged 50 years old or older who were usual residents of their own or family members' households. A stratified two-stage sampling procedure was employed to collect the information. The primary sampling units were blocks for municipal areas and villages for non-municipal areas. The secondary sampling units were households, using random sampling from the list of all enumerated households in each block or village selected. The number of households selected was 15 households per block in municipal areas and 12 households in non-municipal areas. In total, 56,002 persons were interviewed. However, the analysis for this paper is confined to those who were aged 60 years or above and who had at least one child (biological or step/adopted) (n = 28,677). A structured questionnaire was used by trained interviewers to interview selected subjects at the household level. This study was approved by the ethics committee of the NSO of Thailand.

Dependent and Independent Variables

Dependent Variables This study examines several aspects of the health of elderly parents. These include symptoms of poor mental health, self-assessed health status, chronic diseases, illnesses, and treatment-seeking behavior.

Symptoms of Poor Mental Health Items measuring symptoms of poor mental health experienced by elderly persons during the month preceding the survey were: i) feeling stress, ii) feeling moody, iii) feeling hopeless, iv) feeling useless, v) feeling down/unhappy, and vi) feeling lonely. One composite indicator, "symptoms of poor mental health," was developed from all the above-listed symptoms (Cronbach's α = 0.86), resulting in 4 categories: had no symptoms of poor mental health, had 1 symptom, had 2 symptoms, and had 3 or more symptoms. For the logistic regression, two further categories were created: "no symptoms poor mental health" and "at least one symptom of poor mental health".

Self-assessed Health Respondents in the survey were asked, "How has your health been in the past 7 days?" The question had five response categories (very good, good, fair, bad, and very bad). The authors categorized the response categories into two groups: "good," which included "very good" and "good," and "poor," which included "fair," "bad," and "very bad."

Chronic Diseases Individuals were asked about the presence of hypertension, heart disease, diabetes, cancer, stroke, and paralysis. One composite indicator, "chronic disease condition," was developed from all the chronic diseases, resulting in 4 categories: had no chronic disease, had 1 chronic disease, had 2 chronic diseases, and had 3 or more chronic diseases. For the logistic regression, two more categories were created: "no chronic disease" and "at least one chronic disease."

Illness The study explored whether the elderly had symptoms of an illness (self-reported) during the five years preceding the survey. This variable was split into two categories: "experienced symptoms" and "did not experience symptoms."

Treatment Sought The study explored whether the elderly who experienced symptoms of an illness during the five years preceding the survey sought treatment for the most recent illness. This variable was categorized into two categories: "sought treatment" and "did not seek treatment."

Independent VariablesMigration of Adult Children In this study, we have defined an out-migrant child as one living outside their parents' province. We have used migration of adult children as a main independent variable. This variable was split into two categories: "0 no migrant child" and "1 at least one migrant child."

The other demographic and socioeconomic variables were used as control variables in this study. Many previous studies have shown that demographic and socioeconomic variables have strong effects on health and health care-seeking behavior. Hence we needed to control for their effect to determine the independent effect of migration. Demographic variables included age (60–69 years, 70–79 years, and 80 years and above), sex (male and female), place of residence (urban and rural), and number of respondent's children. The economic variable was the average total income per year (100,000 baht or more, 30,000–99,999 baht, 10,000–29,999 baht, and less than 10,000 baht). Social variables included education (higher than secondary level, secondary level, primary/elementary level, no schooling) and living arrangements (living alone, living with children, living with other relatives).

Methods of Analysis

Analysis for this study was confined to those who were aged 60 years or above and who had at least one child (biological or step/adopted) (n = 28,677). Univariate and multivariate analysis were used to analyze the data. Initially, univariate or descriptive analysis was used to describe the respondents' socio-demographic characteristics. Then, after controlling for the other socio-demographic and economic variables, multivariate analysis in the form of logistic regression was used to identify whether migration of adult children affected the elderly's likelihood of experiencing symptoms of diseases, self-assessed health, experience of chronic diseases, illnesses, and treatment-seeking behavior.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.