Physical and Mental Well-being of the Elderly: Examining the Impact of Financial Support from Migrant Children on Indian Left-behind Parents

doi:10.21203/rs.3.rs-4336848/v1

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Physical and Mental Well-being of the Elderly: Examining the Impact of Financial Support from Migrant Children on Indian Left-behind Parents

https://doi.org/10.21203/rs.3.rs-4336848/v1

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Background:

This study aims to examine the impact of adult child migration on physical and mental health of elderly parents and further how received financial support (remittance) compensate the absence of adult child.

Methodology:

Using the 2011 Building a Knowledge Base on Population Ageing in India (BKPAI) dataset, the current study (n=5122) employs bivariate statistics, logistic regression, and mediation analysis to address the objectives. Logistic regression determines the factors of self-rated health and depression, while mediation analysis is implied to understand the intermediate effect of financial support i.e. remittance on left behind elderly health.

Results:

The findings indicate that approximately 43 percent of the study population are left behind, meaning they have at least one migrant child. Notably, 20 percent of these left-behind elderly report poor health conditions, and 17 percent exhibit depressive symptoms, while the poor health and having depressive symptoms is lower among the non-left behind elderly i.e., 13 and 12 respectively. The mediation analysis indicate that the likelihood of good self-rated health increased 1.35 times due to the effect of adult child migration via remittance which contribute around 55 % of total effect of migration.

Conclusion:

The consistent inflow of remittances serves to alleviate the impact on household finances, ensure food security, and address medical expenses. However, it is crucial to recognize that while remittances contribute significantly to economic stability, they cannot replace the physical presence of adult children, especially in terms of caregiving. Consequently, the study highlights that emotional bonds between parents and children play a pivotal role in bridging the emotional gap caused by physical separation, offering vital emotional support and reassurance to elderly family members and ultimately contributing to their holistic well-being.

Left behind elderly

Remittance

Physical and Mental Health

BKPAI

India

Mediation analysis

The demographic transition and increasing life expectancy in India have led to a substantial growth in the elderly population, with over 150 million individuals aged 60 and above (1). However, this extension in life expectancy also brings up the risk of chronic illnesses such as diabetes, heart disease, cancer, and arthritis among the elderly population (2–4). According to the Longitudinal Ageing Survey of India (LASI) conducted in 2021, approximately 75 million individuals aged 60 and above in India are grappling with chronic health conditions (5). This predicament becomes even more severe when these elderly individuals find themselves alone or living without adult children's support due to the absence of the children (6–8).

Traditionally, the responsibility of caring for the elderly in Indian families has been taken on by their adult children (9). However, in India, due to the extensive out-migration of young people in pursuit of better job opportunities, the older parents are live without the presence of their children (left-behind elderly) (10–12). For instance around 22% of older adults live alone or with their spouse, which has escalated to 27% per LASI's 2021 findings (1). This changing family structure (6), brought about by youth migration, poses significant challenges for the elderly population regarding access to healthcare and support (12, 13). Migration of adult children may lead to a reduction in intergenerational social and emotional support, an increase in daily hassles for older adults, and heightened social isolation, all contributing to elevated chronic stress among the left-behind elderly(12). Antman (2010) found that migration of adult children is associated with the declined physical and mental health of elderly parents (14). Research-based on Mexico-US migration identified a causal link between the migration of children to the US and adverse health outcomes among the elderly (15). Studies conducted in China found that migration could markedly diminish the self-rated health and mental and physical wellbeing of the elderly kin associated with migrants (16). Along with physical health concerns, financial instability is a significant problem for older adults in India (17) and several developing countries. Financial crisis is associated with higher levels of depression due to poor diet and healthcare expenditure (18). It became more severe in countries like India, where a considerable number of older adults belong to backward or marginalized communities and become left behind due to adult children's migration for employment and survival.

However, financial support sent by migrants (remittances) to their families is vital in enhancing the quality of life, as extra cash smoothens the consumption-expenditure pattern and alleviates household poverty (19). Along with improving the household economic status, remittances also improve the health status of family members through increased food supply, medical expenditure, and access to healthcare services (20–22). Literature suggests that when there is a continuous flow of remittances from adult-child migration, there are notable improvements in nutrition, reduced morbidity, and lower mortality rates among left-behind older adults. For instance, studies based on Nigeria (21) and China (22) also show that an increment of income among temporary internal migrants plays a significant role in promoting both physical and mental health outcomes not only for migrants but also for their family members, including elderly parents who stayed behind at home.

In this context, studies in India show that the migration of adult children has a negative impact on the physical and mental well-being of left-behind older people. However, there is a dearth of research on how the financial support in terms of remittance sent by migrant children impacts the elderly health. Thus, the present study aims to explore the existing effect of adult-child migration on elderly health and to what extent the financial support in terms of remittance compensates for the absence of adult children and improves the physical and mental health of the left-behind elderly in India.

2.1. Data:

The study used data from the Building a Knowledge Base on Population Ageing in India, 2011 (BKPAI) a nationally representative study carried out by collaboration of Institute for Social and Economic Change, Bangalore, Institute of Economic Growth, New Delhi, and Tata Institute of Social Sciences, Mumbai. The stratified two-stage sampling approach was used to choose the sample households, representing the distribution of 80 primary sampling unit (PSU) households by districts in in seven selected states (Punjab, Himachal Pradesh, Maharashtra, Odisha, West Bengal, Kerala, and Tamil Nadu) in India. The survey has gathered in-depth information from older participants (aged 60 and above) regarding their living situation, family connections, the situation of their sons and daughters, income, current work status, and various aspects of their health and overall well-being (23). The survey has interviews with 9,852 elderly respondents aged 60 and above from 8,329 households. Of them 5122 elderly with at least one alive male child were included in this study. The details of the sample distribution are shown in Fig. 1.

Figure 1 is subject to be here

2.2. Study population

The study population consisted of respondent with 60 or more aged population. This study defines elderly population with 60 or more age and having male alive children living within or outside household. This study considers only male children migrants’ as female migration due to marriage is integral part of Indian society.

2.3. Outcome variable

This study examines major two aspects of the elderly health status. These include self-rated health and chronic depression.

Self-rated health

Self-rated health (SRH), also known as self-perceived health, is a simple and easy way to assess a person’s general health (Jylh¨ a, 2009). Respondents in the survey were asked, “How do you rate your general health condition? Is it excellent, very good, good, fair or poor?”. The authors categorized the response categories into two groups: “good,” which included “excellent”, “very good” and “good,” while “fair” and “poor” grouped as “poor”.

Depression

The other outcome variable for this study is major probable depression coded as 0 for “not diagnosed with depression” and 1 for “diagnosed with depression”. Major depression among elderly was calculated using 12 questions of a general health questionnaire (GHQ) asked in survey. Each item of GHQ-12 instrument has four response categories: ‘less than usual’, ‘no more than usual’, ‘rather more than usual’ coded as “0” and ‘much more than coded as ‘1’. Author, compute an aggregate score by summing up these values which has a range between 0 and 12. Elderly with a composite score of 9 and above was considered as depression.

2.4. Explanatory variable

Having adult male migrant children

Having an adult migrant child was main explanatory variable in this study. The BKPAI (2011) survey asked elderly respondent about the current place of residence of non-residing children. This response has four responses: (i) within district; (ii) outside the district but within the state; (iii) outside the state but within India; and (iv) outside India. Author has identified the elderly respondents with male migrant children (not residing in household) residing outside district categorised as “having migrant children” (coded as 1) On the other hand elderly without any migrant children as “having no migrant children” (coded as 0).

2.5. Mediator variable:

Financial support from migrant children

This study taken receiving remittance as an indicator of financial support from migrant children. Information is obtained through the survey questions “Is there any regular transfer of money to you from migrant children?”. This question has been only asking to elderly who having migrant children. The response “yes” is coded as 1 and “no” as 0.

2.6. Socio-demographic variables

Several demographic and socioeconomic variables were used as control variables in this study. Demographic variables included age (60–69 years, 70–79 years, and 80 years and above), sex (male and female), educational status (never going to school, 1–5, 6–8, 9–10, 11–12 and above 12), Living arrangement (living alone, living with children living with spouse an others), and economic dependency (Yes and no). Further, residence (rural and urban), religion (Hindu, Muslim, Sikh and others), social category (scheduled caste, scheduled tribe, other backward class and others) and wealth index (poorest, poor, middle, rich and richest) are taken as household characteristics.

2.7. Statistical analysis

Analysis for this study was confined to 60 years or above elderly parents having at least a male child (n = 5122). Initially, descriptive statistics is used to describe the respondents’ socio-demographic characteristics. Further, two binary logistic regressions were performed to examine the association between poor self-rated health and having depression with migration and several socio-demographic variables. The mediation analysis is performed to understand the relationship by exploring the influences of one variable through another mediator variable (Kemp, 2003). Mediation analysis is employed to understand a known relationship by exploring the underlying mechanism or process in which one variable influence another through a mediator variable (Kemp, 2003). However, in this study we employed to measure the effect of remittance on the physical and mental health of their left behind elderly parents when adult children are away from home. In this study, remittances play as a mediator through which adult children’s migration indirectly affects the health of their elderly parents.

3.1. Socio-economic background of the study population:

This study focuses on two sets of elderly population: those with migrated children (left behind elderly) and those without (non-left-behind elderly) and result of this study shows that in India 43% of left behind elderly and 57% non-left behind elderly. Despite an even distribution of respondents by gender, it's pertinent to note that a higher percentage of females (53%) in the left behind elderly group. Mean age of the left behind elderly is nearly 70 years while in the case of non-left behind elderly its 66 years. The majority of respondents belong to the Hindu and general caste category. There is no significant difference between the two groups in the level of education, but in overall 40% of the elderly have never attended school, 20% have received up to 5 years of education, and the proportion with 12 or more years of education is very minimal (8%). The study's findings suggest that nearly 45% of the elderly belong to the rich and richer category, with no major distinction between the two groups. However, it's noteworthy that left-behind elderly predominantly reside in rural areas (54%), whereas non-left-behind elderly are more commonly in urban areas (42%) (Table 1).

Table 1

Socio economic characteristics of the study Population
Background Characteristics	No Migrant Children		Having Migrant Children		Total
Background Characteristics	n	%	n	%	n	%
Residence
Rural	1222	42.1	1194	53.7	2416	47.2
Urban	1678	57.9	1028	46.3	2706	52.8
Religion
Hindu	2389	82.4	1612	72.5	4001	78.1
Muslim	170	5.86	241	10.85	411
Sikh	222	7.66	26	10.17	448
Others	119	4.10	143	6.44	262	21.9
Social category
Scheduled Caste	465	16	409	18.4	874	17.1
Scheduled Tribe	151	5.2	71	3.2	222	4.3
Others Backward Class	1024	35.3	698	31.4	1722	33.6
None of the above	1260	43.4	1044	47	2304	45
Wealth index
Poorest	402	13.9	367	16.5	769	15
Poor	547	18.9	358	16.1	905	17.7
Middle	575	19.8	403	18.1	978	19.1
Rich	679	23.4	492	22.1	1171	22.9
Richest	696	24	602	27.1	1298	25.3
Age Group
60–69	2122	73.2	1228	55.3	3350	65.4
70–79	579	20	685	30.8	1264	24.7
80+	199	6.9	309	13.9	508	9.9
Sex of respondent
Male	1513	52.17	1035	46.58	2548	49.75
Female	1387	47.83	1187	53.42	2575	50.25
Years of schooling
Never going to school	1,083	37.3	956	43	2,039	39.8
1–5	508	17.5	470	21.2	978	19.1
6–8	446	15.4	231	10.4	677	13.2
8–10	537	18.5	295	13.3	832	16.2
10–12	111	3.8	83	3.7	194	3.8
12 and above	21885	7.4	187	8.4	402	7.8
Living arrangements
Living alone	88	3	146	6.6	234	4.6
Living with children	2497	86.1	1346	60.6	3843	75
Living with spouse	214	7.4	526	23.7	740	14.4
Others	101	3.5	204	9.2	305	6
Total	2900	100	2222	100	5122	100

Table 1 Subject to be here

3.2. Health status of the elderly:

The study's findings unveil that 20% of left-behind elderly rated their health condition as poor, in contrast to only 12% among the non-left-behind elderly. Furthermore, a higher prevalence of depression is observed among the left-behind elderly (17%) compared to their non-left-behind counterparts (11%). (Fig. 2)

Figure 2 to subject to be here

3.3. Determinants of the self-rated Health and depression of the elderly:

Result of binary logistic regression analysis shows that age, wealth quintile and education have impact on the health status and depression of elderly. Increase with the age probability of suffering poor health and depression also increase. Scheduled Tribe elderly were less likely to suffer in poor health condition (OR = 0.59, CI = 0.36, 0.94) than the none of any caste category. The likelihood of experiences poor health condition and depression is lower among the elderly belong to poor, middle, rich, richest than the poorest elderly. However, after controlling this Socio-economic and demographic indicator migration status of the offspring of the elderly significantly determine the health status as well depression of the elderly. Study finding suggest that left-behind elderly experience more poor health condition (OR = 1.47, CI = 1.24, 1.74) and depression (OR = 1.20, CI = 0.89, 1.47) than the non-left behind elderly parents (Table 2).

Table 2

Factor determining health status of elderly
Background Characteristics	Self-Rated Health (Poor SRH = 1)		Depression (Yes = 1)
Background Characteristics	OR	CI [95%]	OR	CI [95%]
Place of Residence
Rural®
Urban	1.07	[0.87–1.32]	1.01	[0.79–1.30]
Religion
Hindu®
Muslim	2.06***	[1.51–2.80]	1.04	[0.69–154]
Sikh	1.37	[1.00-1.90]	0..29***	[0.16–0.53]
Others	1.49	[0.99–2.23]	0.85	[0.48–1.51]
Social Category
None of the above®
Scheduled Caste	1.15	[0.92–1.44]	1.04	[0.80–1.36]
Scheduled Tribe	0.59*	[0.36–0.94]	1.09	[0.75–1.58]
Other Backward Class	1.2	[1.00-1.44]	0.95	[0.74–1.22]
Wealth Index
Poorest®
Poor	0.52***	[0.40–0.68]	0.78	[0.61-1.00]
Middle	0.55***	[0.41–0.74]	0.61**	[0.45–0.84]
Rich	0.52***	[0.38–0.70]	0.61**	[0.43–0.85]
Richest	0.49***	[0.35–0.69]	0.51**	[0.33–0.78]
Age Group
60–69®
70–79	1.52***	[1.26–1.84]	1.60***	[1.30–1.97]
80+	3.50***	[2.77–4.42]	2.49***	[1.91–3.26]
Sex of respondent
Male®
Female	1.42***	[1.14–1.76]	1.17	[0.91–1.50]
Year of schooling
12 & above®
Never going to school	2.05**	[1.26–3.35]	3.54***	[1.70–7.38]
1–5	2.16**	[1.32–3.52]	2.13*	[1.01–4.48]
6–9	1.29	[0.76–2.17]	1.22	[0.56–2.68]
9–10	1.36	[0.82–2.25]	1.1	[0.50–2.42]
11–12	1.21	[0.62–2.39]	1.09	[0.38–3.13]
Living arrangements
Living with children®
Living alone	0.8	[0.52–1.25]	0.96	[0.62–1.49]
With Spouse	0.72*	[0.55–0.94]	0.64**	[0.48–0.86]
Others	0.94	[0.69–1.29]	0.96	[0.63–1.46]
Economic dependency
No
Yes	2.73***	[2.13–3.50]	2.54***	[1.89–3.41]
Migration Status of elderly
No migrant child®
Having migrant children	1.47***	[1.24–1.74]	1.20**	[0.89–1.47]
Observations: 5122 Exponentiated coefficients; 95% confidence intervals in brackets * p < 0.05, p < 0.01, * p < 0.001

Table 2 to subject to be here

3.4. Role of remittance of physical and mental health

Results found that adult child migration and financial support i.e. remittance has plays positive impact on self-rated health. The estimated total effect (TE) is 1.65 indicate that odds of good self-rated health is 1.65 times higher among elderly with migrated children (left-behind elderly) as compared to those who did not have migrant children. The odds of direct effect (NDE) of adult child migration on good self-rated health is 1.23 times more through mechanisms other than remittances. However, the extent of effect of migration on good self-rated health increased to 1.35 times through the remittance. Finally, results (PM 0.55) shows that the indirect that out of total effect remittance sent by migrants’ children contribute 55% of total good self-rated health among left behind elderly. However, there is no significant mediation of remittance on depression (Table 3).

Table 3

Role of remittance on self-rated health and depression
Migration		SRH			Depression
Migration		Odds ratio	P > z	CI 95%	Odds ratio	P > z	CI 95%
Remittance	NIE	1.35	0.00	1.22–1.49	0.96	0.34	0.88–1.04
	NDE	1.23	0.07	0.99–1.53	1.18	0.07	0.99–1.42
	TE	1.65	0.00	1.36-2.00	1.14	0.12	0.97–1.34
	CDE	3.83	0.00	1.93–7.59	1.72	0.16	0.81–3.66
	PM	0.55	0.00	0.23–0.88	-0.33	0.42	-1.13-0.47
NIE: Natural indirect effect; NDE: Natural direct effect; TE: Total effect; CDE: Controlled direct effect; PM: Proportion mediated.

Table 3 subject to be here

The United Nations Population Fund (UNFPA) predicted, the elderly population will double, and one in every fifth person will 60 plus individuals by 2050 (24). Thus, it is essential to secure the economic and health stability of older individuals to achieve sustainable aging. It is a fact that drastic falls in fertility and increase life expectancy are booming in the elderly population; however, it is more worrying that nearly three-fourths of them are economically inactive and fully or partially depending on their family member (25–27). Literature suggests that economic stability is essential for good physical and mental health (28) for older adults, ultimately leading to sustainable aging through securing the health dimension. Using BKPAI 2011-12 data, this current study aims to explore the role of remittance in securing physical (self-rated health) and mental health (depression) among left-behind elderly in India.

In recent years, there has been a significant increase in scholarly interest regarding migration and its association with the health of left-behind parents. Traditionally, in Indian society, joint family, kinship, and community are significant sources of supporting and caring for the elderly (29). However, in the last few decades, Indian society witnessed a change in family structure from a joint to a nuclear family system due to adult-child migration and a change in the value system and thus has severe repercussions on the elderly care and support system (30). The present study found that two-fifths (43%) of the elderly sample had a male migrant child living outside the district. Following earlier research (16, 31) the present study also found that the absence of a male child has a negative impact on self-rated health and major depression among the elderly.

Further, several socioeconomic factors, age, sex, wealth, and economic dependency, intensify the level of poor self-rated health and depression. Higher economic dependency on a population has the potential to strain a country's resources due to expenditure on food, health, and social security (32). Therefore, there is a high dependency ratio due to the rapid growth of the elderly population in India (28). For instance Kumar & Kumar, 2019 found that around 70 percent of Indian elderly economically depend on other family members. Thus, the responsibility of caring for the elderly falls on adult earning members. Consistent with (28) study, our result also shows that around a fourth of the study population economically depends on other family members, leading to poor physical and mental health (33).

Moreover, our study also tries to find the impact of financial support or compensation effect of remittance on self-rated health and depression among left-behind elderly. Consistent with other studies (Tachibana et al., 2019) our study also found that elderly parents who receiving remittance has a significant impact on improve self-rated health. In other words, remittance sent by migrant children contributes to their left-behind family members' well-being in India. The possible explanation is that their children's remittances enable spending on food or medical expenditures, and extra money enables them to take time off from farming to leisure activities and relaxation (35). However, long-term separation from children has severe mental health costs for the left behind elderly members, as it increases the probability of suffering from loneliness and depression (36–39). In this context, the communication between left-behind parents and their migrant children plays a crucial role in maintaining the psychological health of older parents (40). This connection helps bridge the physical distance and emotional separation, offering emotional support and reassurance to the elderly family members, thereby contributing to their overall well-being (41). Finally, our study findings conclude that although remittance significantly compensates 50 percent of the impact of migration on self-rated health, the overall cost of adult child migration on physical and mental health is much greater than the effect of remittance.

There is an urgent need to look upon youth migration, changing family dynamics and health outcomes of older people in India. The changing demographic transition that is rapid growth in aged population along with changing family dynamics due to youth migration hinders India to achieve sustainable aging. Thus, the present study shows the impact of adult child migration and compensation effect of remittance on physical or mental health of left behind elderly. It is well established that absence of children i.e.; adult child migration has deteriorated the health status of left behind parents. Regular flow of remittance from migrant children can minimize the absence of children and improve self-rated health through stabilizing household economy, food security and medical expenditure. However, remittance sent by migrant children cannot replace the physical presence of children, their care and thus failed to compensate with mental health. This emotional connection between parents and children helps bridge the physical distance and emotional separation, offering emotional support and reassurance to the elderly family members, thereby contributing to their overall well-being. This study findings can provide an important finding to policymakers with supporting evidence to achieving sustainable aging through ensuring economic and health status. Government should not focus on improving economic status of elderly but also promoting filial piety among Indian Youth.

Ethics approval and consent to participate:

Not applicable

Consent for publication:

Not applicable

Data availability Statement:

Raw data were generated by the collaboration of Institute for Social and Economic Change, Bangalore, Institute of Economic Growth, New Delhi, and Tata Institute of Social Sciences, Mumbai. Derived data supporting the findings of this study are available from the corresponding author on request.

Competing interests:

The authors declare that they have no competing interests.

Funding:

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Authors' contributions:

SM: Conceptualization, Methodology, Formal analysis, Supervision, Writing – Original Draft, Writing - Review & Editing. MP: Supervision, Writing – Original Draft, Writing - Review & Editing.

Acknowledgement:

Author cordially acknowledges Institute for Social and Economic Change, Bangalore, Institute of Economic Growth, New Delhi, and Tata Institute of Social Sciences, Mumbai. for providing the BKPI dataset to conduct this study.

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No competing interests reported.

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Physical and Mental Well-being of the Elderly: Examining the Impact of Financial Support from Migrant Children on Indian Left-behind Parents

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Version 1

Abstract

Figures

1. Background

2. Data and Methodology

2.1. Data:

2.2. Study population

2.3. Outcome variable

2.4. Explanatory variable

2.5. Mediator variable:

2.6. Socio-demographic variables

2.7. Statistical analysis

3. Results

3.1. Socio-economic background of the study population:

3.2. Health status of the elderly:

3.3. Determinants of the self-rated Health and depression of the elderly:

3.4. Role of remittance of physical and mental health

4. Discussion

5. Conclusion

Declarations

References

Additional Declarations

Status:

Version 1