Physical and mental well-being of older adults: examining the impact of financial support from male migrant children on Indian left-behind parents

Abstract

Background

Amid high youth out-migration, India’s older parents face severe social, economic, psychological, and health crises due to their children’s separation. However, remittances from their migrant children alleviate economic hardships, improve healthcare access, and partially compensate for their absence. So, this study examines how adult-child migration affects older parents’ physical and mental health and how remittance support helps mitigate these challenges.

Methodology

This study used 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 older adult health.

Results

The findings indicate that approximately 43% of the study populations were left behind, meaning they have at least one migrant child. Notably, 20% of these left-behind older adults report poor health conditions, and 17% exhibit depressive symptoms, while the poor health and having depressive symptoms were lower among the non-left-behind older adults i.e., 13% and 12% respectively. The mediation analysis indicates that the likelihood of good self-rated health increased 1.35 times through the effect of remittance, which compensates for around 55% of the total adverse 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 fully replace the physical presence of adult children, especially in terms of caregiving.

Text box 1. Contributions to the literature
1. There is a scarcity of literature examining the impact of migration through remittances on the health outcomes of older parents.
2. This study finds that continuous financial assistance significantly improves the physical health of older parents; however, emotional health cannot be determined solely through remittances.
3. Policymakers, should not only be emphasizing providing financial support to older adults but also on ensuring emotional support from their children.

Background

The demographic transition and increasing life expectancy in India have led to substantial growth in the older adult population, with over 150 million individuals aged 60 and above [1]. In 1961, around 5.6% of the population was aged 60 years or above, and the proportion has increased to 10.1% in 2021 and further likely to increase to 13.1% by 2031 [2]. However, this extension in life expectancy also brings up the risk of chronic illnesses such as diabetes, heart disease, cancer, and arthritis among the older adult population [3,4,5]. 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 [6]. This predicament becomes even more severe when these older adult individuals find themselves alone or living without adult children’s support due to the absence of the children [7,8,9].

Traditionally, the responsibility of caring for older adults in Indian families has primarily fallen on their male adult children, as female children typically move to their in-laws’ homes after marriage [10]. However, like other Asian countries India, witnessing a major demographic shift where the out-migration of the working-age (male) population and rapid growth of the older population occurring simultaneously. With the extensive out-migration of young males in pursuit of better job opportunities, the older parents live without the presence of their children (left-behind older adults) [11,12,13]. For instance around 22% of older adults live alone or with their spouse, which has escalated to 27% as per LASI’s 2021 findings [1].

This changing family structure (7), brought by youth migration, poses significant challenges for the older adult population regarding access to healthcare and support [13, 14]. Sometimes it 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 older adults [13]. Antman (2010) found that migration of adult children is associated with the declined physical and mental health of older adult parents [15]. Research-based on Mexico-US migration identified a causal link between the migration of children to the US and adverse health outcomes among older adults [16]. On the other hand, a study based in South Africa, and China, indicated that temporary internal migration and income through remittance played a significant role in promoting both physical and mental health [17,18,19] outcomes of their family members, including older adult parents who stayed behind at the home.

Financial support (remittances) sent by migrants to their families is vital in enhancing the quality of life, as extra cash smoothens the consumption-expenditure pattern and alleviates household poverty [20]. 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 [21,22,23]. Literature suggests that when there is a continuous flow of remittances from migrants, there are notable improvements in nutrition, reduced morbidity, and lower mortality rates among left-behind older adults. For instance, studies based in Nigeria [22] 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 for their family members, including older adult parents who stayed behind at home. Furthermore, the gender of migrants also shapes parental caregiving dynamics significantly. In rural China, both sons and married daughters are key sources of financial and emotional support for older adults [24]. Women, including married daughters, often contribute remittances, albeit in smaller amounts [25]. However, sons traditionally bear the primary responsibility for parental care, reflecting entrenched cultural norms [26]. In India, migrant women contribute significantly to their families’ socio-economic well-being through remittances [27], despite low workforce participation (10% according to the 2011 census). This study focuses on male children, aligning with the traditional view that sons are the primary long-term caregivers for older adults in Indian culture.

From the above discussion, it is evident that the migration of male adult children poses health challenges for older adults [7, 28,29,30,31], with additional income providing some relief. However, there remains a lack of research on how financial support through remittances sent by migrant children specifically impacts the health of older adults. Therefore, the present study aims to investigate the current impact of male adult-child migration on the health of older parents, exploring to what extent remittance-based financial support compensates for the absence of male adult children and enhances the physical and mental well-being of left-behind older adults in India. Below is the conceptual framework illustrating the relationship between the migration of male adult children and the well-being (Physical and mental health) of older adults through remittances (Fig. 1).

Fig. 1

Conceptual framework

Data and methodology

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 a collaboration of the 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 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 [32]. Although this dataset may not be the most recent, but it remains the latest available for analysing the specific research questions.

The survey has interviews with 9,852 older adult respondents aged 60 and above from 8,329 households. Of them, 5122 older adults with at least one alive male child were included in this study. The details of the sample distribution are shown in Fig. 2.

Fig. 2

Framework for selecting the study sample

Study population

The study population consisted of respondents with 60 or more aged population with at least one male child aged 18 or above. This study defines the older adult population with 60 or more age and having male children living within or outside the household. This study considers only ‘male migrant children’ both internal and international to determine left-behind older adults as in Indian society male children are the primary long-term caregivers for older parents [33]. Majority of females in India migrated for marriage and they are not considered permanent members of the family, but rather they are part of the husband’s family once they married [34].

Outcome variable

This study examines major two aspects of older adult well-being. These include physical health (self-rated health) and mental health (depression).

Physical health: 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 [35, 36]. 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”.

Mental health: 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 older adults was calculated using 12 questions from the general health questionnaire (GHQ) asked in the survey (Annexure 1). Each item of the 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’. The author computed an aggregate score by summing up these values which has a range between 0 and 12. Older adult with a composite score of 9 and above was considered as depressed.

Explanatory variable

Having adult male migrant children

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

Mediator variable

Financial support from male migrant children

This study took receiving remittance as an indicator of financial support from male 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 asked to older adults who have migrant children. The response “yes” is coded as 1 and “no” as 0.

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 and 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 classes, and others), and wealth index (poorest, poor, middle, rich and richest) are taken as household characteristics.

Statistical analysis

Analysis for this study was confined to 60 years or above older adult parents having at least a male child (n = 5122). Initially, descriptive statistics is used to describe the respondents’ socio-demographic characteristics. Further, binary logistic regressions and mediation analyses were performed.

Logistic regression model

Logistics regression models were fitted (adjusted odds ratios [aORs]) to examine the association between poor self-rated health and depression of older adults with the migration status of their children and several socio-demographic variables. In this model, Self Rated Health (SRH) and depression symptoms were the outcome variables.

Model

$$\:{l}_{n}\left(\frac{\pi\:}{1-\pi\:}\right)=\alpha\:+{\beta\:}_{1}{X}_{1}+{\beta\:}_{2}{X}_{2}+{\beta\:}_{3}{X}_{3}+\dots\:+{\beta\:}_{n}{X}_{n}$$

In this equation.

• X₁ was a primary independent variable of interest which was the migration status status of the male children of older adults (1 = Having male migrant children e, 0 = Having no male migrant children).

• X_2, X_3, X_4, …… X_n were additional independent variables representing socio-demographic covariates to control for their effects on the outcome variable.

• Each covariate X_2, X_3, X_4, …… X_n has its own regression coefficient (β₂, β₃, β₄,. . ., β_n)

Mediation analysis

Mediation analysis is employed to understand a known relationship by exploring the underlying mechanism or process in which one variable influences another through a mediator variable. However, in this study, we employed to measure the effect of remittance on the physical and mental health of their left behind older adult parents when adult male children are away from home. In this study, remittances play a mediator through which adult children’s migration indirectly affects the health of their older adult parents. Notation of this analysis is given below.

Total treatment effect

δ = E [Y_i (1)] – E [Y_i (0)] = E [Y_i (1; M_i (1))] – E [Y_i (0; M_i (0))]

Natural indirect effect (NIE)

NIE (t) = E [Y_i (t; M_i (1))] – E [Y_i (t; M_i (0))], t ∈ {0, 1}.

Natural direct effect (NDE)

NDE (t) = E [Y_i (1; M_i (t))] – E [Y_i (0; M_i (t))], t ∈ {0, 1}.

In this model,

• Y_i was the main outcome variable which was Self Rated Health (SRH) and depression symptoms.

• M_i was the mediator variable which was the received remittance.

• t was the treatment effect.

Results

Socio-economic background of the study population

This study focuses on two sets of older adult populations: those with male migrated children (left behind older adults) and those without (non-left-behind older adults) and result of this study shows that in India 43% of left behind older adults and 57% non-left behind older adult. Despite an even distribution of respondents by gender, it’s pertinent to note that a higher percentage of females (53%) in the left-behind older adult group. The mean age of the left-behind older adult is nearly 70 years while in the case of non-left-behind older adults, it was 66 years. The majority of respondents belong to the Hindu and general caste categories. There is no significant difference between the two groups in the level of education, but in overall 40% of the older adults 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 older adults belong to the rich and richer category, with no major distinction between the two groups. However, it’s noteworthy that left-behind older adults predominantly reside in rural areas (54%), whereas non-left-behind older adults are more commonly in urban areas (57%) (Table 1).

Table 1 Socio economic characteristics of the study population, India 2011

Health status of the older adult

The study’s findings unveil that 20% of left-behind older adults rated their health condition as poor, in contrast to only 12% among the non-left-behind older adults. Furthermore, a higher prevalence of depression is observed among the left-behind older adult (17%) compared to their non-left-behind counterparts (11%). (Fig. 3)

Fig. 3

Health status of older adult by migration status of their children, India 2011. Source Building a Knowledge Base on Population Ageing in India (BKPAI),2011

Determinants of the self-rated health and depression of the older adult

The results of binary logistic regression analysis revealed significant socio-economic and demographic factors influencing self-rated health and depression among older parents. Older adults from the Muslim community were 2.06 times more likely to report poor self-rated health compared to their Hindu counterparts. In contrast, Sikh older adults exhibit significantly lower depression rates (OR = 0.29, CI = 0.26–0.53) compared to Hindus and other communities. Scheduled Tribe parents show a low likelihood of poor health conditions (OR = 0.59, CI = 0.36–0.94) compared to other categories. Additionally, higher wealth is associated with a reduced likelihood of experiencing poor health and depression. Individual factors such as age, sex, years of schooling, living arrangements, and economic dependency also significantly influence older adult health. With increasing age, there is a substantial increase in the likelihood of both poor self-rated health (80 + age: OR = 3.50, CI = 2.77–4.42) and depression (80 + age: OR = 2.49, CI = 1.91–3.26). Females have a higher likelihood of poor self-rated health compared to males. Older adults who have never attended school are more likely to report poor health and depression compared to those with 12 or more years of schooling. Living with a spouse is associated with lower odds of poor health (OR = 0.72, CI = 0.55–0.94) and depression (OR = 0.64, CI = 0.48–0.86), whereas economic dependency increases the likelihood of both conditions.

After adjusting for socioeconomic and demographic factors, the migration status of older adult offspring significantly impacts the health and depression of older parents. Left-behind older adults experience higher rates of poor health conditions (OR = 1.47, CI = 1.24–1.74) and depression (OR = 1.20, CI = 0.89–1.47) compared to those whose children reside with them. However, no significant impact of place of residence on self-rated health and depression was observed (Table 2).

Table 2 Factor determining health status of older adult, India 2011

Role of remittance of physical and mental health

Results of the mediation analysis show that remittances play a significant role in determining the self-rated health of older adults. The first part of the mediation analysis estimated a total effect (TE) of 1.65, indicating that older adults who received remittances from migrant children had a higher likelihood of good self-rated health compared to those who did not receive remittances. In other words, the chance of experiencing good self-rated health increases by 1.65 times if every left-behind older adult receives remittances from migrant children. Out of the total effect (TE), 1.35 times is indirectly through the mechanism of remittance, while the rest of the effect is direct, through mechanisms other than remittance.

Generally, adult-child migration has a negative impact on the self-rated health of older adult individuals. However, continuous financial support through remittances significantly reduces the negative effect of children’s absence. The second part of the mediation analysis (PM 0.55) shows that out of the total negative effect of adult-child migration on lowering self-rated health, 55% is minimized by the effect of remittances. In other words, financial support through remittances can successfully compensate for 55% of the overall negative effect of children’s absence through monetary support (remittance). However, there is no significant mediation of remittances on depression (Table 3).

Table 3 Role of remittance on self-rated health and depression of older adult, India 2011

Discussion

The United Nations Population Fund (UNFPA) projects that by 2050, the older adult population will double, and with one in every five individuals being 60 years old or older [37]. Drastic falls in fertility and increased life expectancy are booming in the older adult population; however, it is more worrying that nearly three-fourths of them are economically inactive and fully or partially depending on their family member [38,39,40] and a significant portion of them are living without adult children. Using BKPAI 2011-12 data, this study aims to understand the impact of adult male children’s migration on the health of older adults and explore the role of remittances in securing physical health (self-rated health) and mental health (depression).

Traditionally, in Indian society, joint family, kinship, and community are significant sources of support and care for the older adult [41]. 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, thus having severe repercussions on the older adult care and support system [42]. The present study found that 43% of older adults had a male migrant child living outside the district, leaving their parents behind at the origin. These migrants are mainly from rural areas (54%), moving due to poverty and compulsion, often working as wage labourers in the informal sector [43]. Consequently, it’s very difficult for them to move with entire family members and sustain themselves at their destinations like big cities. However, in urban areas, the percentage of youth migration is relatively low due to existing economic opportunities and the affordability of providing care for parents. This probably lowers the likelihood of older parents being left behind in urban areas [44].

Following earlier research [45, 46] the present study also revealed that the absence of a male child has a negative impact on self-rated health and major depression among older adults. This may be because they view male children as their primary caregivers in later life. The absence of these male children can result in significant stress, which may directly impact their health. Additionally, the migration of adult male children often causes increased loneliness and isolation for older parents, which can lead to major depression and, consequently, deteriorate their overall health [47,48,49].

Further, several socioeconomic factors, age, sex, wealth, and economic dependency, intensify the level of poor self-rated health and depression. Consisting with other studies [7, 50] our study also found that age is a significant determinant of poor self-rated health and depression among older adults, regardless of the migration status of their children. These issues are more severe among female and illiterate older adults. Higher economic dependency on a population has the potential to strain a country’s resources due to expenditure on food, health, and social security [51] and there is a high dependency ratio due to the rapid growth of the older adult population in India [52]. For instance, Kumar & Kumar, 2019 found that around 70% of Indian older adults economically depend on other family members. Thus, the responsibility of caring for older adults falls on adult earning members. Consistent with the [52] 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 [53].

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 older adults. This direct financial support of remittance helps meet the older adults’ needs, such as food, healthcare, and other essential expenses, leading to better self-rated health. Additionally, there are other indirect mechanisms at play. These could include reduced stress from financial security, improved living conditions, and enhanced social status due to the financial contributions from their migrant children. Aligned with the findings of Tachibana et al. (2019), our study also found that receiving remittances significantly enhances the self-rated health of left-behind older adult parents [54]. 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 [55]. However, long-term separation from children has severe mental health costs for the left behind older adult members, as it increases the probability of suffering from loneliness and depression [56,57,58,59]. 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 [60]. Finally, our study findings conclude that although remittance significantly compensates 55% 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.

Conclusion

There is an urgent need to examine youth migration, changing family dynamics, and health outcomes of older people in India. The rapid growth in the aged population, coupled with shifting family dynamics due to youth migration, poses a challenge to achieving sustainable aging in India. This study investigates the impact of adult-child migration and the compensatory effect of remittances on the physical and mental health of left-behind older adults. It is well established that the migration of male children deteriorates the health status of left-behind parents. However, a regular flow of remittances from migrant children can mitigate the absence of children by improving self-rated health through stabilizing the household economy, ensuring food security, and covering medical expenses. Despite these benefits, remittances cannot replace the physical presence and care provided by male children and fail to address the mental health needs of older adults. The emotional connection between parents and children is crucial in bridging the physical distance and offering emotional support and reassurance, contributing significantly to the overall well-being of older family members. The findings of this study provide valuable insights for policymakers that the focus should not only provide financial support to older adults but also ensure emotional support for their children to achieve sustainable aging in near future.

Limitation

However, it is important to acknowledge some limitations of this study. First, the study relies on cross-sectional data collected in 2011, which may not fully reflect the societal changes that have occurred since then. Second, the cross-sectional nature of the data limits the ability to establish causal relationships. Third, the study focuses exclusively on male migrant children, excluding the potential impacts of female migrant children. Future research with more up-to-date data could further validate or expand upon these findings. Despite these limitations, the study still provides valuable insights into the phenomena under investigation.