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

Conclusion

Our study provides novel evidence on an issue of special importance to countries affected by heavy out-migration of adult children, an issue that has received little attention. Findings here show that out-migration of adult children is highly associated with poor mental health but is not associated with the physical health of elderly left behind. Out-migration of children is also highly associated with greater utilization of health facilities. Thus, in order to decrease morbidity among the elderly as well as to maintain and enhance the well-being of families, programs should focus on alleviating the symptoms of poor mental health among the elderly left behind and aim to reduce the differences in utilization of health care-seeking behavior among elderly with children present in the community and elderly left behind.

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Acknowledgements
The authors thank the National Statistical Office (NSO) of Thailand for providing access to the data. The authors would also like to thank Dr. Kerry Richter and Dr. Kusol Soonthorndhada for their valuable suggestions for this paper.

Authors' contributions
RA analyzed, interpreted the data, and drafted the manuscript. AJ and AC commented and provided suggestions on the analysis and interpretation. All authors read and approved the final version of the manuscript.

Competing interests
The authors declare that they have no competing interests.

Cite this: Impact of Children's Migration on Health and Health Care-seeking Behavior of Elderly Left Behind - Medscape - Mar 01, 2011.

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

# Only those elderly who had migrant child(ren), 1USD = approx. 30 Baht

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

Note: + = only those who felt sick during the previous 5 years

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

Notes: Logistic regression was run separately for each dependent variable.
Models were fitted after controlling for age, sex, place of residence, education, number of children, living arrangements, and household income.

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