Adult Children’s Migration and Well-being of Left Behind Nepalese Elderly Parents

The role of family support in the self-rated health of older adults in eastern Nepal: findings from a cross-sectional study

BACKGROUND

Nepal's low fertility rate and increasing life expectancy have resulted in a burgeoning older population. For millennia, filial piety shaped family cohesion and helped Nepali older adults achieve positive outcomes, but recently, it has been eroding. Furthermore, there are not enough institutional support options or alternatives to family-based care to deal with the biosocial needs of older adults. This study explored the association between family support and self-rated health among Nepali older adults.

METHODS

A community-based cross-sectional survey in eastern Nepal's two districts, Sunsari and Morang, interviewed 847 older adults (≥ 60 years). The final analytical sample was 844. Participants were asked whether they received assistance with various aspects of daily life and activities of daily living from their families. Multivariable logistic regression examined the association between family support and self-rated health.

RESULTS

Participants who received support with various aspects of daily life had 43% higher odds of good health, but after adjusting for control variables, the result only approached statistical significance (p = 0.087). Those who received family assistance with activities of daily living had nearly four times higher odds (OR: 3.93; 95% CI: 2.58 - 5.98) of reporting good health than participants who lacked this support.

CONCLUSIONS

Given the important role of family support in Nepali older adults' health, government programs and policies should create a conducive environment to foster family-based care until more comprehensive policies for older adults' care can be put into effect. The results of this study can also help shape the global aging environment by highlighting the need for family support in older care, particularly in low-income nations with declining traditional care systems and weak social security policies.

Internal and International Migration and the Mental Health of “Left-Behind” Older Parents

Despite evidence of the impact of adult children's migration on left-behind older parents, the comparison of left-behind older parents’ mental health and psychological well-being between internal and international migration is limited. This article examines how the relationship between adult children's migration and parent's mental health differs according to the migrant's destination — only internal migration, only international migration, or hybrid migration (at least one child who migrated internally and at least one child who migrated internationally). Drawing on a 2019 cross-sectional population-based survey of 697 left-behind older adults (≥ 60 years) in Nepal, we assessed the mental health of older parents, using the 21-item Depression Anxiety Stress Scales and a range of socio-demographic, health, lifestyle, and child-related characteristics. Multilevel mixed-method linear regression was performed to examine the effect of adult children's migration on left-behind older parents’ depression, anxiety, and stress symptoms. Results showed that parents whose children had all migrated internationally were at higher risk of mental health problems, particularly anxiety and stress, compared to parents whose children had all migrated internally. Older parents from the hybrid group (having both internal and international migrant adult children) had higher levels of anxiety, compared to parents whose children had all migrated internally, with no significant difference in depression and stress symptoms. Further, mothers of internationally migrated children were at higher risk of mental health symptoms than fathers. Interventions aiming to improve left-behind older parents’ mental health and psychological well-being should specifically target parents whose children have migrated internationally.

Examining the Latent Dimensions of Social Anxiety Disorder

While the body of literature has investigated the latent dimensions of Social Anxiety Disorder (SAD), only few have directly anchored in the DSM-5 SAD symptoms. Similarly, a continuing issue on measuring mental health disorders pertains to whether a symptom's frequency, intensity, or both, are appropriate and sufficient indicators of severity. To address this gap, the present study developed and validated a DSM-5-based measurement tool, the Social Anxiety Symptom Severity Inventory (SASSI), which assesses both the intensity (intensity of disturbance) and frequency (frequency of occurrence) of SAD symptoms. In study 1 (n = 6458, college students), the results revealed a two-factor structure using exploratory structural equation modeling. In study 2 (n = 425, left-behind emerging adults), confirmatory factor analysis, measurement invariance testing, and latent class analysis were used. Findings demonstrated the importance of using both frequency and intensity of symptoms in assessing SAD severity. Moreover, a five-class solution best fitted the sample. Studies 1 and 2 demonstrated the good psychometric properties of SASSI and filled an important gap among available measures in assessing SAD severity through symptom frequency and intensity.

Left-Behind Experience and Behavior Problems Among Adolescents: Multiple Mediating Effects of Social Support and Sleep Quality

Purpose

Adolescence has always been a period prone to behavior problems. Some studies have shown that left-behind experience, social support, and sleep quality are all crucial factors influencing behavior problems, but the mechanisms of how they are influenced are unclear. This cross-sectional study investigated the prevalence of behavior problems among school-aged adolescents and explored the mediating role of social support and sleep quality in the association between left-behind experience and behavior problems.

Patients and Methods

A total of 738 school adolescent students completed this questionnaire. We collected basic information about the participants using a general demographic scale and assessed their sleep quality, social support, and behavioral problems using the Pittsburgh Sleep Quality Index scale, Social Support Rating Scale, and Strengths and Difficulties Questionnaire. The multiple mediating effects of sleep quality and social support were examined by path analysis.

Results

Among 738 school-aged adolescent students who completed the survey, a total of 198 students had behavior problems, with an overall prevalence of 26.8%. In the multiple mediation model, the mediation effect of social support and sleep quality on left-behind experience to behavior problems was 56.7% (direct effect: standardized estimate=0.946, indirect effect: standardized estimate=1.239). The model was a saturated model, and fit was no longer considered.

Conclusion

We found that social support and sleep quality had a series of multiple mediating effects in the pathway from left-behind experience to behavior problems, and both significantly moderated behavior problems. Therefore, we suggest that we should pay more attention to students' psychological status and improve their use of social support for left-behind adolescents, in addition to giving more external social support. And paying attention to their sleep problems to reduce the occurrence of behavior problems, considering that their psychological development is not mature.

Psychometric properties of the Persian version of the "Intergenerational relationship quality scale for aging parents and their children"

BACKGROUND

Investigating the status of intergenerational relationships of elderly parents with their adult childen is very important in examining issues related to the status of the elderly such as well being and quality of life and other aspects of elderly life. Giveeen the significance of the topic, the current study aimed to examine the psychometric properties of the Persian version of "Intergenerational Relationship Quality Scale for Aging Parents and Their Children" (IRQS-AP).

MATERIALS AND METHODS

A total of 463 community-dwelling elders (aged 60 years or older) in Tehran participated in this study through multistage cluster sampling method. To investigate reliability, the construct and convergent validity of the IRQS-AP, confirmatory factor analysis (CFA), and interclass correlation coefficient were done.

RESULTS

The content validity index was 0.84 for the entire tool. In the CFA, we found the instrument had a four-factor structure and adequate internal consistency. The scale had a significant and positive correlation with the two measures of loneliness and depression. Furthermore, Cronbach's alpha was estimated at 0.77, and the high value of the interclass correlation was 0.82.

CONCLUSION

The IRQS-AP is a valid and reliable scale that can be used to examine the status of intergenerational relationship quality in Iranian elder population.

Men's migration and women's mortality in rural Mozambique

Labor migration is widespread and growing across the world. As migration grows, the economic outcomes of migration increasingly diversify, and so do its consequences for the well-being and health of both migrants and non-migrating household members. A considerable body of scholarship has examined the effects of migration on the physical and mental health of 'left-behind' household members. The impact of migration on mortality, particularly of non-migrating marital partners, is less well understood. Addressing this gap, we use data from a longitudinal survey of married women conducted over twelve years in rural Mozambique to examine the association between men's labor out-migration and their non-migrating wives' mortality. The analyses detect no significant differences when comparing non-migrants' wives to migrants' wives in the aggregate but point to instructive variation among migrants' wives according to the economic success of migration, as measured by the effects of migration on the household's material well-being. Specifically, women married to less successful migrants had higher mortality risks over the project span than women married to more successful migrants, regardless of other individual and household-level factors. Importantly for this setting with high HIV prevalence, the advantage of wives of more successful migrants is significant for HIV/AIDS-unrelated deaths but not for HIV/AIDS-related deaths. We situate these findings within the cross-national scholarship on migration and health.

Social support and health among older adults – the Singapore Chinese Health Study

While having social support can contribute to better health, those in poor health may be limited in their capacity to receive social support. We studied the health factors associated with social support among community-dwelling older adults in Singapore. We used data from the third follow-up interviews (2014–2016) of 16,943 participants of the Singapore Chinese Health Study, a population-based cohort of older Singapore Chinese. Participants were interviewed at a mean age of 73 years (range 61–96 years) using the Duke Social Support Scale (DUSOCS). We first applied ordinary least squares regression to DUSOCS scores and found that those with instrumental limitations, poor self-rated health, cognitive impairment and depression had lower social support scores. We then applied latent class analysis to DUSOCS answer patterns and revealed four groups of older adults based on the source and amount of social support. Among them, compared to the ‘overall supported’ group (17%) with the highest social support scores and broad support from family members and non-family individuals, the ‘family restricted’ (50%) group had the lowest social support scores and only received support from children. Health factors associated with being ‘family restricted’ were instrumental limitations (odds ratio (OR) = 1.33, 95% confidence interval (CI) = 1.19–1.49), poor self-rated health (OR = 1.40, 95% CI = 1.28–1.53), cognitive impairment (OR = 1.19, 95% CI = 1.04–1.37) and depression (OR = 2.50, 95% CI = 2.22–2.82). We found that while older adults in poor health have lower social support scores, they were more likely to receive a lot of support from children. Our results showed that lower social support scores among Singaporean older adults in poor health may not indicate lack of social support, but rather that social support is restricted in scope and intensified around children. These results may apply to other Asian societies where family plays a central role in elder-care.

Health Care Utilization by Older Adults in Nepal: An Investigation of Correlates and Equity in Utilization

This study aims to evaluate factors associated with health care utilization (HCU) and to assess vertical and horizontal equity in utilization among Nepali older adults. Data are from an existing cross-sectional study involving systematic random sampling of 260 older adults in Far-Western (Sudurpaschim) Province of Nepal. Andersen's theoretical framework was used to assess predisposing, enabling, and need factors that have the potential to influence health care utilization. Multivariable logistic regression analyses were conducted to examine potential correlates of HCU. Horizontal and vertical equity were assessed using concentration curve and index. More than one-third of participants had not visited a health facility in the prior 12 months. Nine in 10 participants did not know about the government's free health service for older adults. Joint/extended family type, Ayurvedic/Homeopathic health care preference, higher-income tertile, and presence of chronic conditions were associated with higher odds of health care utilization in adjusted analyses. The concentration curve for HCU lies below the line of equity, and the subsequent index is positive, indicating that HCU was concentrated among richer individuals. If the government of Nepal is to achieve its goal of universal health care, the existing pro-rich inequity in HCU needs to be addressed.

Food insecurity among senior citizens in high out-migration areas: evidence from Western Nepal

Background

Food insecurity is a critical public health challenge, particularly in low- and middle-income countries such as Nepal. The demographic transition has resulted in a growing population of senior citizens. However, the determinants of food insecurity among Nepali senior citizens remain unknown. This study aims to fill this gap by assessing food insecurity among the older populations in the far-western region, one of the poorest regions of the country. Further, we also aim to assess the potential association between adult children's migration and the food insecurity status of the left behind older parents.

Methods

A community-based cross-sectional study was conducted among 260 randomly selected senior citizens in the Kanchanpur district in far-western Nepal. The short form of the household food security scale, originally developed by the United States Department of Agriculture, was used to measure household food security. Associations were examined by logistic regression.

Results

The prevalence of food insecurity in senior citizens' households was 41.1%. Senior citizen households with their adult children's migration (AOR = 0.47, 95% CI: 0.24-0.95) had lower odds of being food insecure whereas households with lower family income (<$100 compared to ≥ $100) had two times higher odds of being food insecure (AOR = 2.26, 95% CI: 1.08-4.76). Also, households owning a cultivable land/farm (AOR = 0.14, 95% CI: 0.05-0.40), primary source of income as service/pension (AOR = 0.26, 95% CI: 0.08-0.89) or business (AOR = 0.15, 95% CI: 0.03-0.59) and participants who received geriatric allowances (AOR = 0.05, 95% CI = 0.01-0.16) had lower odds of being food insecure.

Conclusion

The prevalence of food insecurity among households with a senior citizen in Kanchanpur district was high and associated with the migration status of adult children, and household socioeconomic status. This calls for a greater policy response focused specifically on households with older adults and the integration of gerontological evidence into the existing food security and nutrition strategies.

The Influence of Left-Behind Experience on College Students' Mental Health: A Cross-Sectional Comparative Study

China’s rapid development and urbanization have created large numbers of migrant laborers, with increasing numbers of young adults and couples migrating from rural areas to large cities. As a result, a large number of children have become left-behind children (LBC), who were left behind in their hometown and cared for by one parent, grandparents, relatives or friends. Some of these LBC have a chance to be college students, who are called college students with left-behind experience. Some studies have indicated that the absence of these college students’ parents during childhood may cause them to have some mental health problems. Therefore, we want to examine the effects of left-behind experience on college students’ mental health and compare the prevalence of mental health problems in left-behind students and control students (without left-behind experience). For this purpose, a cross-sectional comparative survey was conducted in a coastal city of Shandong province, Eastern China. First, 1605 college students from three universities (national admissions) were recruited, including 312 students with left-behind experience and 1293 controls. Their mental health level was measured using Symptom Check-list 90 (containing ten dimensions: somatization, obsessive-compulsion (OCD), interpersonal sensitivity, depression, anxiety, hostility, terror, paranoia, psychoticism, and other symptoms). The results showed that left-behind experience was a significant risk factor for the mental health problems of college students (OR = 2.27, 95%CI: 1.73 to 2.97). A comparison of the two groups, after controlling the confounding factors using the coarsened exact matching (CEM) algorithm, showed that the prevalence of mental health problems was 35.69% (n = 311) among the left-behind students, while it was 19.68% (n = 1194) among the controls. The two groups were significantly different in terms of these ten dimensions of the SCL-90 scale (p < 0.001), and the prevalence of each dimension among the left-behind students was consistently higher than that among the controls. In addition, different left-behind experiences and social supports during childhood had different effects on mental health problems.

Undergraduate nursing students' knowledge of aging, attitudes toward and perceptions of working with older adults in Kathmandu Nepal

Objectives

This study aims to examine Nepalese undergraduate nursing students’ knowledge of aging, attitudes towards older adults and perceptions of working with older adults, and to assess differences in these outcomes by socio-demographic characteristics as well as type of nursing program.

Methods

A cross-sectional study was conducted among 385 undergraduate nursing students in six nursing colleges located in the Kathmandu Valley. Knowledge of aging, attitudes toward older adults and perceptions of working with older adults were assessed using standardized tools, the Palmore Facts on Aging Quiz, Kogan's Attitudes towards Older People Scale, and Nolan's Intent to Work with Older People Questionnaire, respectively.

Results

The mean knowledge scores on older adults and aging were relatively low; participants scored an average of 26.9 out of 50. Scores assessing attitudes towards and perceptions of working with older adults were more favorable. Compared to students pursuing a Bachelor of Science in Nursing (BSN), students pursuing a Bachelor of Nursing (BN) had a significantly higher score on the knowledge, attitudes and perception of aging scales. Linear regression analyses showed that the students’ knowledge of aging (β = 0.55; 95% CI = 0.25–0.86) and perceptions of working with older adults (β = 0.22; 95% CI = 0.05–0.38) had a significant positive association with their attitudes toward older adults.

Conclusions

Undergraduate nursing students in the Kathmandu Valley of Nepal displayed a relatively low level of knowledge, but a positive attitude towards older adults, and a positive perception of working with older adults. Observed differences in knowledge, attitude, and perception scores between students in BSN and BN programs needs further investigation; closing this gap may be important for bolstering undergraduate gerontological preparation in Nepal.

Noncommunicable disease risk factors among older adults aged 60-69 years in Nepal: findings from the STEPS survey 2013

Both the noncommunicable diseases (NCDs) burden and the population of older adults are increasing in Nepal. This study aims to estimate the prevalence of behavioral and biological risk factors of common NCDs among Nepali older adults aged 60-69 years. A subsample analysis of data from the 2013 Nepal STEPwise approach to Surveillance (STEPS) survey was conducted with 526 older adults aged 60-69 years. STEPS sample weighting and domain analyses were used to include the entire sample for variance estimation and to obtain prevalence estimates and corresponding 95% confidence intervals (CI) for our selected population of older adults. All participants had at least one risk factor for NCDs; about one-fourth had four. Of the eight examined risk factors, inadequate fruit/vegetable intake (98.6%, 95% CI: 96.9-100.0), hypertension (57.2%, 95% CI: 51.0-63.4), and hypercholesterolemia (37.9%, 95% CI: 30.8-44.9) were ranked the three most prevalent risk factors while physical inactivity (2.5%, 95% CI: 1.0-4.0) was least prevalent. Prevalence of smoking was 31% (95% CI: 24.9-37.2), overweight/obesity was 19% (95% CI: 13.1-25.2), alcohol use was 18% (95% CI: 12.2-23.5), diabetes was 15% (95% CI: 8.5-21.4), and 36% (95% CI: 30.9-42.0) of the older participants suffered discomfort due to oral health problems. Several risk factors, including current alcohol consumption, daily servings of fruit/vegetable intake, and overweight/obesity showed signficant variation in prevalence by gender, ethnicity, and place of residence, urban vs. rural. Epidemiological and demographic transitions are two emerging public health issues in Nepal. The baseline information provided by this study on the prevalence of NCD risk factors among Nepali older adults aged 60-69 years can inform policies and programs that focus on maximizing the health and well-being of older adults.