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


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 variablesa, 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.

a. We were unable to keep both 'remittances' and 'out migration of children' in the same model as it is highly correlated. Therefore, we run separately to see the association between 'remittance' and 'treatment seeking' variables after controlling for other demographic and socio-economic variables.


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