Children's Migration: Health Seeking of Elderly Left Behind

Methods

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 Variables Migration 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.

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

Comments

Commenting is limited to medical professionals. To comment please Log-in.

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.