Children's Migration: Health Seeking of Elderly Left Behind

Discussion

This study has attempted to investigate the impact of out-migration of adult children on health issues and health care-seeking behavior of the elderly left behind in a society in which, traditionally, children take responsibility for older parents. Findings show that the majority of the elderly (68%) have at least one out-migrant child and that an overwhelming majority (79%) received money from their migrant children.

Out-migration of adult children was highly associated with poor mental health symptoms among the elderly left behind. It is likely that out-migration of children reduces opportunities for face-to-face interaction. This finding is similar to other studies^[22,23] that found that out-migration of young people increased the loneliness felt by their aging parents. However, the findings of present study conflict with those of Abas et al., which found that out-migration of children was associated with less depression in parents.^[18] This could be due to the fact that in their study most of the parents with migrant children were male, better educated, and married which would reduce the risk of depression.

Our study found that the migration status of children was not associated with the physical health of the elderly left behind (as measured by self-rated health, experience of chronic diseases, and illnesses during the 5 years preceding the survey). It should be noted that this may be because adult children are less likely to migrate when a parent is ill.^[27] However, out-migration of adult children was independently associated with higher utilization of health facilities among the elderly left behind. It is encouraging to note that a significantly higher proportion of the elderly who had migrant children sought treatment compared to those who had no migrant child. This may be a result of remittances from migrant children, which make healthcare affordable. Indeed, about four-fifths of the sampled elderly had received money from their migrant children in the year preceding the survey.

An earlier national survey in Thailand also found that 77% of Thai elderly reported receiving financial support from children during the previous year.^[28] Furthermore, after controlling the demographic, and socio-economic variables^a, we also found that those who had received remittances from their children were more likely (OR = 1.43, 95% CI 1.30–1.57) to seek treatment than those who had no migrant children. This could be due to the fact that the benefits of remittances offset the potential negative effect of migrant children living apart from their parents. The financial support provided by migrant children may operate primarily through amelioration of financial hardship of their parents. Studies have also found that most elderly Thai parents are getting financial support from their children and that this contributes positively to their material well-being.^[29,30] Many families with migrant members moving within and between low- and middle-income countries tend to benefit economically^[31] and to enjoy improved general health.^[20] The other reason could be that adult migrant children can provide emotional support to their parents back home (by visiting home or via frequent telephone calls, mail, etc.) or provide both emotional and financial support^[32] that help parents maintain good health through improvement of emotional and psychosocial well-being.^[33] Yet another reason could be health knowledge transfers between migrants and their parents who are left behind.

There are some limitations in the interpretation of the results of this study. Because of the survey's cross-sectional design, all of the factors analyzed in the study were measured at a single point in time. Thus, the analysis can only provide evidence of statistical association between those items and the health status of the elderly left behind and health care-seeking behavior; it cannot show a cause-effect relationship. Besides, we have to be careful while comparing the results of this study with those of other research studies that have used pre-existing validated questionnaires to measure mental and physical health.

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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