Children's Migration: Health Seeking of Elderly Left Behind

Results

Sociodemographic and Economic Characteristics of the Sample Population

More than half of the sampled respondents were aged 60–69 while about one out of seven were aged 80 or above, and nearly three out of five were female. The large majority had only an elementary-level education. Respondents had an average of 4 children. About three in five respondents were from rural areas. Half reported that their household income per year was about 30,000 baht or less. Only about one in ten elderly lived alone, and two-thirds had at least one migrant child. About four in five elderly (79%) who had at least one migrant child had received money from their child(ren) during the 12 months preceding the survey (Table 1).

Health Status and Health Care-seeking Behavior

Table 2 shows that a slightly higher proportion of elderly who had migrant child(ren) had at least one symptom of poor mental health during the month before the survey compared to those whose children had not migrated (56%). Furthermore, more than half (56%) of the elderly rated their health as poor, and nearly half (44%) reported that they suffered from at least one chronic disease. Overall, about two-thirds of the elderly had symptoms of an illness (65%) during the five years preceding the survey. No observed differences were found among elderly (by migration status of children) in terms of self-assessed health, number of chronic diseases, or illnesses during the previous 5 years.

It is encouraging to note that an overwhelming majority of elderly who felt sick (88%) had sought treatment for their most recent illness. Interestingly, a higher proportion of the elderly who had migrant child(ren) had sought treatment for the last illness compared to those whose children did not migrate (Table 2).

Multivariate Analysis

Logistic regression was used to assess the net effect of the migration of children on the health of the elderly left behind and their treatment-seeking behavior after controlling for the other control variables in the model.

Separate logistic regressions were run for 5 dependent variables. The odds ratio is presented in Table 3. Control variables used in this logistic analysis were categorical indicators of age (60–69, 70–79, and 80 or above), sex (male, female), place of residence (rural, urban), level of education (higher than secondary, secondary, and primary and below), living arrangements (living alone, with children, with other relatives), number of children respondents had, and average household income per year (100,000 baht or more, 30,000–99,999 baht, and less than 30,000). In the model, the reference group of the independent variable is "no migration of adult children."

Migration of children was found to have a strong association with poor mental health symptoms among the elderly left behind. Those elderly who had at least one migrant child were more likely (OR = 1.10; 95% CI 1.05–1.17) to have poor mental health symptoms than those whose children had not migrated. On the other hand, no significant association was observed with physical health, such as experience of chronic disease, self-rated health status, or experience of symptoms of illness during the previous 5 years.

Furthermore, the results show that the migration of children is a significant predictor of treatment-seeking behavior among the elderly left behind. For instance, those elderly who had at least one migrant child were more likely (OR = 1.22; 95% CI 1.11–1.33) to seek treatment for their most recent illness than were those who had no migrant children (Table 3).

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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