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Background
Although a number of studies have examined the effect of the out-migration of children on the mental health of ‘left behind’ elderly parents, research on the consequences of children’s migration on the mental health and well-being of elderly parents left behind is inconclusive and a systematic review is warranted.
Objectives
To identify...
Citations
... Urban migration of younger generations in areas impacted by climate change could result in reduced support ratios and informal caregiving for those older people who are left behind and in need of informal care support [63]. This lack of intergenerational support structures may lead to increasing loneliness among older people, further exacerbating the threats to healthy ageing [64]. ...
Background
Climate change not only directly impacts older people’s longevity but also healthy ageing, which is the process of maintaining physical and mental capacities while optimising functional abilities. The urgency to address both population ageing and climate change necessitates a rethink and assessment of the impact of climate change on older people. This includes identifying what can be done to anticipate, mitigate and adapt to climate change and engage older persons.
Methods
A review of climate change and healthy ageing forms the basis of evidence in this report. We developed a comprehensive search to assess current literature, combining terms related to ageing and climate change across four major data sets and assessing articles published up to the end of 2021.
Results
We summarised the current and future impact of climate change on older people and developed a framework identifying climate change impacts on older persons, recognising social and environmental determinants of healthy ageing. Major hazards and some key exposure pathways include extreme temperatures, wildfire, drought, flooding, storm and sea level rise, air quality, climate-sensitive infectious diseases, food and water insecurities, health and social care system displacement, migration, and relocation. Strategies to address climate change require interventions to improve systems and infrastructure to reduce vulnerability and increase resilience. As a heterogeneous group, older people’s perceptions of climate change should be integrated into climate activism. Increasing climate change literacy among older people and enabling them to promote intergenerational dialogue will drive the development and implementation of equitable solutions. Pathways may operate via direct or indirect exposures, requiring longitudinal studies that enable assessment of exposures and outcomes at multiple time points, and analyses of cumulative impacts of hazards across the life course.
Conclusions
The lack of systematic reviews and primary research on the impact of most climate hazards, except for heat, on older people is apparent. Future research should include outcomes beyond mortality and morbidity and assess how older people interact with their environment by focusing on their capacities and optimising abilities for being and doing what they value.
... However, current research mostly concentrates on the general older population, neglecting the specific needs of empty-nest or solitary older adults who lack frequent interaction or cohabitation with their adult children (Huang 2015;Gui and Koropeckyj-Cox 2016). It's undeniable that older adults living alone, when neglected, face heightened risks of developing multiple chronic diseases, experiencing depression or anxiety, facing increased mortality rates, and encountering reduced access to healthcare services (Newsom et al. 2005;Zhou et al. 2015;Thapa et al. 2018;Wu et al. 2022). Additionally, Chinese scholars found that urban older adults living alone in China are not satisfied with the use of family and community services (Du et al. 2022). ...
The social changes in the new century and the shifting concept of filial piety have jointly shaped the unique intergenerational relationships in China. Intergenerational relationships are closely connected to arrangements for care of the older adults, particularly those who live alone. Based on data from the 2017 China General Social Survey (CGSS), the latent profile analysis method was used to explore the profiles of intergenerational family relationships and their influencing factors in the context of “non-co-residence” based on the five dimensions of intergenerational solidarity theory and related indicators. The study found that family intergenerational relationships can be categorised into five profiles: distant-emotional, proximity-detached, proximity-loose, distant-support, and traditional-reciprocal, which share commonalities with previous studies and have their own characteristics. The results of the multiple regression analysis showed that gender, education level, annual personal income for the previous year, self-rated happiness, and self-rated health had significant effects on the latent profiles of intergenerational relationships. Specifically, adult children who are male, living in a rural area, no legal spouse, a primary school education or less, an annual income above 50,001 RMB in the last year (2016), low or average self-rated happiness, and good self-rated health are more likely to deviate from the traditional filial support track (i.e. they are less likely to be the traditional-reciprocal) than their counterparts in these profiles. In the future, it will be important to increase attention to those families in which older parent live apart from their adult child through relevant legislation, social welfare systems, and social older-care services. This will help ensure that adult children provide intergenerational support and will enable the normal functioning of home- and community-based older adults’ care.
... Addressing these challenges and promoting generativity can play a vital role in supporting middle-aged adults in achieving a fulfilling and healthy aging process. These challenges lead to the emergence of anxiety in middle-aged adults (Abrams et al., 2021;Thapa et al., 2018). Based on previous research, it has been shown that women have a higher tendency to experience anxiety. ...
Middle-aged women are susceptible to experiencing anxiety, which, if left untreated, can lead to decreased productivity and hinder social interactions, ultimately impacting overall well-being. This study aimed to investigate the effectiveness of cognitive-behavioral group therapy in alleviating anxiety in middle-aged women. The research design employed a quasi-experimental approach with a one-group pre-test-post-test design and follow-up assessment. The participants included seven middle-aged women aged between 53 and 60 years (mean age = 56.71). They were selected based on screening results using the DASS42 anxiety scale, which indicated severe and very severe anxiety. Data collection consisted of pre-test, post-test, and follow-up assessments using the Beck Anxiety Inventory (BAI). Data were analyzed using the repeated measures ANOVA method. The results of the data analysis revealed an F-value of 120, p < .001, indicating significant differences between the pre-test, post-test, and follow-up assessments. Specifically, significant differences were found between pre-test and post-test (p < .001), pre-test and follow-up (p < .001), and post-test and follow-up (p < .001) results. These findings demonstrate the effectiveness of cognitive-behavioral group therapy in reducing anxiety among middle-aged women. Therefore, cognitive-behavioral group therapy emerges as a viable intervention for addressing anxiety in this demographic.
... Thapa et al analyzed data from developing countries, and suggested that left behind older parents had higher depressive symptoms, higher levels of loneliness, lower life satisfaction, lower cognitive ability, and poorer psychological health compared to non-left behind. Risk factors for this result included the living arrangement of staying with sons or being left behind, female sex, low education, low income, poor physical health status, especially chronic disease or conditions and loss of hearing or vision, lack of regular physical activity, lack of family and social support, older age, rural residence and low frequency of children's visit [12]. ...
Mental health issues have been widely proven crucial for social and economic development and well-being, remaining a significant challenge for developing countries. This paper aims to explore and discuss a number of social and cultural factors that contribute to the prevalence of mental illnesses in developing countries, including low social and economic status and low income, high unemployment and emigration levels, poorly developed mental healthcare system, high birth rate and fertility rate, high dependence on primary industry, low educational level, and stereotypes within society. Mechanisms of the above key risk factors are evaluated. This paper can be used to understand the current obstacles for developing countries to improve citizens mental well-being and livelihood and provide information for further interventions and policies to address mental health issues.
... While evidence on HRQOL in older Nepali adults is limited, evidence from around the globe suggests that adult children's migration may be positively associated with depressive symptoms and loneliness in left-behind parents (Mosca & Barrett, 2016;Song, 2017;Thapa et al., 2018;Torres et al., 2018), especially mothers (Mosca & Barrett, 2016;Torres et al., 2018). A study in China, however, found no significant differences in HRQOL or chronic comorbidities (e.g., diabetes, dyslipidemia, and stroke) among older parents who were and were not left behind (Chang et al., 2016). ...
... Statistically significant beta coefficients and 95% CIs are bolded mental health of left-behind older parents (Bohme et al., 2015;Gibson et al., 2011;Thapa et al., 2020), our findings are consistent with several studies reporting a significant adverse relationship (Antman, 2010;Mosca & Barrett, 2016;Song, 2017;Torres et al., 2018). In addition, an integrative review of 25 studies, mostly cross-sectional, concluded that older adults with a migrant child experience poor mental health outcomes such as depression and loneliness (Thapa et al., 2018). While we did not find a significant association with the physical domain, less favorable physical health was observed in Mexico among left-behind parents relative to parents living with their children (Antman, 2010). ...
Traditionally, adult children have served as primary caretakers and providers for older Nepali adults. However, out-migration of adult children for employment and other opportunities is increasing. Health-related quality of life (HRQOL) in older Nepali adults in general and in the context of adult children’s migration is poorly understood. This study aims to assess HRQOL of older Nepali adults and its relationship with adult children’s migration. We used existing cross-sectional survey data on 260 older adults from Krishnapur municipality, which has witnessed a high rate of adult migration. HRQOL, quantified using the SF-12 scale, is expressed in terms of a physical (PCS) and mental (MCS) health component. A higher PCS and MCS score, each ranging from 0 to 100, indicates better physical and mental health, respectively. The correlates of HRQOL were assessed in simple and multiple linear regression. Participants had suboptimal HRQOL [mean (± SD): PCS = 40.4 ± 9.2 and MCS = 45.2 ± 7.7]. After adjusting for covariates, adult children’s migration was associated with lower MCS scores (β: -2.33, 95%CI: -4.21, -0.44). Individuals with more than one child had higher MCS scores (β: 2.14, 95%CI: 0.19, 4.09). Females (β: -3.64, 95%CI: -7.21, -0.06) and those with a history of unemployment (β: -6.36, 95%CI: -10.57, -2.15) had lower PCS scores than their respective counterparts. The presence of chronic conditions was associated with significantly lower PCS and MCS scores. Our findings suggest that adult children’s migration may negatively affect HRQOL among older Nepali adults, specifically their psychological well-being. Further research investigating potential moderating factors that may serve as important buffers is needed.
... The impact of SP on health vary by gender. Some studies suggest that male empty-nest olderly people have better physical health, mental health (Thapa et al., 2018) and SRH . For female, the frequency and autonomy of SP are more positively correlated with health than male (Tomioka et al., 2017). ...
Background
The growing population of middle-aged and older empty nesters is characterized by poorer health, and social participation (SP) has been shown to improve this situation. However, few studies have investigated specific performance and gender differences between SP and health. The present study aims to address these issues.
Methods
A total of 1207 middle-aged and older empty nesters over 45 years old were selected from the China Health and Retirement Longitudinal Study (CHARLS, 2011–2018). Random-effects analyses were used to explore the association between changes in SP (diversity, frequency, type) and changes in health status. Health status include physical health, mental health, self-reported health (SRH).
Results
Female middle-aged and olderly empty nesters have significantly poorer health and participate in SP more frequently. The higher the diversity of SP, the better the health of middle-aged and olderly empty nesters, while higher frequency is beneficial to SRH. Female's participation in sports and Internet had better mental health and SRH, and mahjong helped female's mental health. Clubs are helpful for male's SRH.
Conclusions
This study reveals the specifics of the association between SP and health status of middle-aged and older empty nesters. Therefore, all aspects of SP and gender differences should be taken into account when predicting and improving the health status. Help the government to better formulate policies to better cope with the increasing empty nest phenomenon and build a harmonious and stable society.
... Accompanied with the rapid increase of aging population in China, many older people enter the phase of "empty nest". A large body of literature describes the period in the family lifecycle when children leave the parental home, often referred to as the empty nest phase [1][2][3]. These older people either live alone (empty-nest singles) or with a spouse (empty-nest couples) [4]. ...
... Alongside physical inconveniences or irreversible declines in functional capacity that come with aging, empty nest older adults are more likely to develop empty-nest syndrome, triggering negative emotions and psychological problems such as such as absentmindedness, loneliness, depression, anxiety, pessimism, and others, which are mainly caused by the lack of affection and emotional support from their children for an extended period of time [8]. A recent meta-analysis found that the empty nest parents had higher levels of mental health problems compared to their non-empty nest counterparts [2]. ...
Background: China has the world's largest aging population and the number of empty-nest older adults is on the rise. In comparison to the aging population in general, empty-nest older adults have a lower level of subjective well-being and poorer mental health status due to a lack of emotional support from their children. The aim of this study is to conduct an empirical study to evaluate the efficacy of the 'Path-oriented Psychological Self-help Intervention' (P-oPSI) led by nurses on the mental health of empty-nest older adults in the community, to provide a scientific foundation for improving their quality of life.
... Furthermore, a multi-country study shows that the elderly with migrant children had more social capital, enhancing older adult's Body Mass Index (BMI) and selfreported health [29]. This study focuses on "left-behind" older parents, applying the operational definition of "leftbehind, " used in prior studies, which is older parents reside in their country of origin or place of origin with one or more biological or adoptive emigrant children or out migrants [31,32]. ...
Background
The study aims to examine the association between individual forms of social capital and the well-being of the elderly ‘left-behind’ parents and to determine if there is a gender difference within the possible relationship.
Methods
This study applied the first wave of the Longitudinal Ageing Study in India (LASI, 2017-18) data. In this study, the respondents were 4,736 older parents ‘left-behind’ by their migrant adult sons. We employed descriptive statistics and bivariate analysis to assess the study sample’s characteristics. The proportion test was performed to examine if there was a significant gender difference among older adults regarding depression, ADL, and IADL impairments. In addition, binary logistic regression was utilized to investigate the associations between social capital and elderly parents’ health outcomes.
Results
This study found a significant gender difference in depression (male: 8.26%; female:11.32%; P < 0.001), ADL (male:20.23%; female:25.75%; P = 0.032), and IADL (male: 33.97% female: 54.13%; P < 0.001) limitations. Elderly parents who did not participate in any social activity had a higher odd of ADL (aOR: 2.44; 95%CI: 1.882–3.171; P = < 0.001) and IADL (aOR: 1.22; 95%CI: 1.034–1.766 ; P = < 0.001) limitations. Networking with friends through phone/email conversations has a substantial impact on lowering depression in older parents. Older adults with good personal social capital were less likely to have depression, ADL, and IADL limitations.
Conclusion
Personal social capital is closely associated with the well-being of left-behind older parents. More efforts should be in place to increase the stock of social capital in this group with focused gender disparity.
... We examined relationships where the spouse or child migrated as previous studies suggest that spousal migration may impact sexual behavior and 6 networks for the non-migrant spouse; (10,12,13) and a child migrating may impact the support available for the parent. (16) Four types of relationships between non-migrant and migrants were evaluated: (i) non-migrants with an in-migrating spouse; (ii) nonmigrants with an out-migrating spouse; (iii) non-migrant parents with an in-migrating child; and (iv) non-migrant parents with an out-migrating child. Those who experienced both an in and out-migration of their spouse or child in the same visit-interval contributed to both in-and out-analyses. ...
Background
The impact of migration on HIV risk among non-migrating household members is poorly understood. We measured HIV incidence among non-migrants living in households with and without migrants in Uganda.
Methods
We used four survey rounds of data collected from July 2011-May 2018 from non-migrant participants aged 15-49 years in the Rakai Community Cohort Study, an open, population-based cohort. Non-migrants were individuals with no evidence of migration between surveys or at the prior survey. The primary exposure, household migration, was assessed using census data and defined as 1 or more household members migrating in or out of the house from another community between surveys (~18 months). Incident HIV cases tested positive following a negative result at the preceding visit. Incidence rate ratios (IRR) with 95% confidence intervals were estimated using Poisson regression with generalized estimating equations and robust standard errors. Analyses were stratified by gender, migration into or out of the household, and the relationship between non-migrants and migrants (i.e., any household migration, spouse, child).
Findings
Overall, 11,318 non-migrants (5,674 women) were followed for 37,320 person-years. 28% (6,059/21,370) of non-migrant person-visits had recent migration into or out of the household, and 240 HIV incident cases were identified in non-migrating household members. Overall, non-migrants in migrant households were not at greater risk of acquiring HIV. However, HIV incidence among men was significantly higher when the spouse had recently migrated in (adjIRR:2.12;95%CI:1.05-4.27) or out (adjIRR:4.01;95%CI:2.16-7.44) compared to men with no spousal migration. Women with in- and out-migrant spouses also had higher HIV incidence, but results were not statistically significant.
Interpretation
HIV incidence is higher among non-migrating persons with migrant spouses, especially men. Targeted HIV testing and prevention interventions such as pre-exposure prophylaxis could be considered for those with migrant spouses.
Funding
National Institutes of Health, US Centers for Disease Control and Prevention
... Empty nest elderly. According to previous studies, empty nest elderly are defined as those aged 60 years or older, having no children or living alone without their children for 12 months [16,[20][21][22][23][24][25]. It is a self-reported living arrangement mainly based on the questions of "Where does [XChildName[i]] live?" "During last year, how long had [XChildName[i]] lived with you and your spouse?", regardless the consideration of physical distance and time duration with home leavers. ...
Background
The number of empty nest elderly in China has gradually increased in recent years. There is growing concern about the physical and mental health of this population as empty nest elderly are commonly at the risk of compromising health, home safety and quality of life. This study reported the health and well-being of empty nest elderly with regards to their health status, depression and satisfaction, lifestyle as compared to non-empty nest elderly in China.
Methods
Data was collected from the 2018 follow-up interviews of China Health and Retirement Longitudinal Survey. We included 4,630 empty nest elderly and 6,188 non-empty nest elderly. Chi-square Test and Logistic Regression were used to compare the differences between these two groups.
Results
As compared to the non-empty nest elderly, there was higher proportion of empty nest elderly who suffered from dyslipidemia, diabetes, chronic lung diseases, heart attack (27.0% vs. 25.0%; 16.6% vs. 15.1%; 19.4% vs. 16.4%; 26.3% vs. 23.4%, P < 0.05). The empty nest elderly had higher proportion of participants who drank more than once a month (25.3% vs. 23.9%, P < 0.05), who felt satisfied with their marriage (71.6% vs. 66.2%, P < 0.001), who were satisfied with their children’s relationship (85.2% vs. 83.2%, P < 0.001). However, these significances disappeared in the Logistic Regression analysis (P > 0.05).
Conclusion
Our study showed that significant between-group difference was found between empty nest elderly and non-empty nest elderly in their health and wellbeing. However, disappearance of such difference in the multivariable analysis may indicate improved health and wellbeing among the empty nest elderly. Even though our study still suggested the importance of improving the health, lifestyles and family dynamics of the elderly and promoting the integration of health and social care for the elderly, especially among the empty nest elderly.
