Implication of Adult Out-Migration on the Health and Healthcare Seeking of the Older Parents in Indian Households: an Exploration

Abstract

The ageing of population and simultaneous increase in adult out-migration are two contemporary demographic developments that are occurring in many developing countries. Due to inadequate formal care support and social security system, older parents from these countries may experience diminution in wellbeing when their adult children migrate. This study investigates the impact of adult out-migration on various health dimensions of left-behind older parents and their treatment seeking behaviour in Indian context. We utilized survey data from the Building a Knowledge Base on Population Ageing in India (BKPAI). Analysis was restricted to a representative sample of 9263 older adults (60+), who had at least one biological child. Employing OLS and IV regression models, the impact of adult out-migration on physical and psychological health outcomes of older adults were investigated. Using Heckman Probit model, we further investigated the impacts of migration on treatment seeking behaviour of older adults. Findings suggest that the migration of adult children positively influences older individual’s subjective health (2SLS β = 0.095, p ≤ 0.05), functional ability to perform instrumental activities (2SLS β = 0.879, p ≤ 0.001) and cognitive ability (2SLS β = 0.208, p ≤ 0.05). At the same time, prevalence of chronic morbidity and depressive symptoms were found to be significantly higher among the older parents with migrant children. Findings also reveal a negative effect of migration on chronic disease related treatment seeking (β = -0.09, p ≤ 0.05), which indicates that older individuals with migrant children were less likely to receive medical and other care facilities than older persons without migrating children if they suffer from chronic diseases. Our study provides evidence that absence of adult children due to migration has both positive and negative health impacts on the older parents left behind. Targeted efforts are needed to alleviate depressive symptoms and to improve healthcare utilization among left-behind older adults.

Appendices

Appendix A

Sl. No	Tasks included in IADL list	Response Options	Points
1	Ability to use phone	Operates phone on own initiative	1
		Dials a few well known numbers	1
		Answers the phone but does not dial	1
		Cannot use phone at all	0
2	Shopping	Takes care of all shopping needs independently	1
		Shops independently for small purchases	0
		Needs to be accompanied on any shopping trip	0
		Completely unable to shop	0
3	Food preparation	Plans, prepares and serves adequate meals independently	1
		Prepares adequate meals if supplied with ingredients	0
		Heats, serves meals; does not maintain adequate diet	0
		Needs to have meals prepared and served	0
4	Housekeeping	Maintains house alone or with help for heavy work	1
		Performs light daily tasks e.g. dish washing, bed making	1
		Performs light daily tasks but cannot maintain cleanliness	1
		Needs help with all home maintenance tasks	1
		Does not participate in any housekeeping tasks	0
5	Laundry	Does personal laundry completely	1
		Launders small items, rinses socks, etc	1
		All laundry must be done by others	0
6	Transportation	Travels independently on public transport/own car	1
		Travels on public transport when accompanied by others	1
		Travel limited to car with assistance from another person	0
		Does not travel at all	0
7	Medication	Is capable of taking medicines in correct dosage at correct time	1
		Takes medicine if given in separate dosage	0
		Is not capable of dispensing own medicines	0
8	Finances	Manages financial matters independently (budget, cheques, bills)	1
		Manages day to day purchases, but need help with banking, etc	1
		Incapable of handling money	0

1. Based on 2011 BKPAI survey schedule.

Appendix B

Sl. No	Questions that were asked older adults on their social activities	Response Options
1	How often in the last 12 months have you attended a public meeting with discussion on local, comminuty or political affairs?	(a) Never (b) Rarely (c) Occasionally (d) Frequently
2	How often in the last 12 months have you attended any group, club, society, union or organizational meeting?	(a) Never (b) Once or twice per year (c) Once or twice per month (d) Once or twice per week (e) Daily
3	How often in the last 12 months have you worked with other people in your neighbourhood to fix or improve something?	(a) Never (b) Once or twice per year (c) Once or twice per month (d) Once or twice per week (e) Daily
4	How often in the last 12 months have you attended or participated in any religious programs/services etc.?	(a) Never (b) Once or twice per year (c) Once or twice per month (d) Once or twice per week (e) Daily
5	How often in the last 12 months have you gone out of the house to visit friends or relatives?	(a) Never (b) Once or twice per year (c) Once or twice per month (d) Once or twice per week (e) Daily