Smoking and Drinking Behaviors among Older Adults: A Comparative Analysis of Three Southeast Asian Countries.

Studies on the two major health-risk behaviors of smoking tobacco and drinking alcohol among older populations, particularly in Southeast Asia, are limited. This paper provides comparative analyses of the prevalences and correlates of smoking tobacco and drinking alcohol among older people in Myanmar, Vietnam, and Thailand, using data from the latest available national aging surveys in the three countries. The analyses were conducted within a multivariate framework. Gender-specific results show that smoking tobacco and drinking alcohol are more common among older men than women in all three countries. However, the prevalence of smoking and drinking among men declines at older ages. The multivariate analyses reveal that a higher level of education has a significant negative association with smoking and drinking in all three settings, but the magnitude and the direction of associations vary considerably between countries and genders. Area of residence is correlated with smoking among men in all three countries, whereas co-residential arrangements with spouse, children, or both significantly reduce alcohol consumption among men in Myanmar and among men and women in Thailand. In all three settings a significant complementary relationship between smoking and drinking is observed. From a policy perspective this implies that a successful reduction in smoking could be achieved through anti-drinking campaigns and vice versa.

Long-Term Care Needs in the Context of Poverty and Population Aging: the Case of Older Persons in Myanmar.

Myanmar is one of the poorest and least healthy countries in Southeast Asia. As elsewhere in the region, population aging is occurring. Yet the government welfare and health systems have done little to address the long-term care (LTC) needs of the increasing number of older persons thus leaving families to cope on their own. Our study, based on the 2012 Myanmar Aging Survey, documents the LTC needs of persons aged 60 and older and how they are met within the context of the family. Nearly 40% of persons in their early 60s and 90% of those 80 and older reported at least one physical difficulty. Spouses and children constitute the mainstay of the financial and instrumental support of elderly including those with LTC needs. Nearly two-thirds of older persons reported receiving assistance with daily living activities. More than three quarters coreside with children, a living arrangement that in turn is strongly associated with receiving regular assistance in daily living. Daughters represent almost half and spouses, primarily wives, one-fourth of primary caregivers. Unmet need for care as well as inadequate care decline almost linearly with increased household wealth. Thus elderly in the poorest households are most likely to experience gaps in LTC. Given mounting concerns regarding health disparities among Myanmar's population, this pattern of inequality clearly needs to be recognized and addressed. This needs attention now rather than later given that reduced family size and increased migration pose additional challenges for family caregiving of frail elderly in the coming decades.

Intergenerational living arrangements in Myanmar and Thailand: a comparative analysis.

The present study compares living arrangements and related intergenerational support in Myanmar and Thailand based on recent national surveys of older persons in both countries and prior surveys in Thailand. The countries share relatively similar cultural contexts but differ radically in economic development. Substantially higher percentages of older persons in Myanmar currently coreside with their children and are considerably more likely to have non-coresident children living in the same locality. They are also less likely to live with a spouse and to have children living at a substantial distance. Older persons in Myanmar are much less likely to have phone contact with children living away and less likely to receive visits. Thai elders are considerably more likely to provide custodial care to grandchildren with absent parents and to live in skip generation households. Older Thais are also considerably more likely to receive substantial remittances from non-coresident children. The living arrangements of older age Thais in the past, however, more closely resembles the current situation in Myanmar. It appears that current differences are largely attributable to the more advanced Thai economic development through its associated impacts on migration, fertility and mortality. Contrasting political situations and government priorities also likely play a role. The results provide insights into the implications of development for older persons and suggest that if the recent course of political transformation and opening to the global economy continues in Myanmar, living arrangements there may well follow the trends in Thailand over past decades.

The changing impact of the AIDS epidemic on older-age parents in the era of ART: evidence from Thailand.

Previous research makes clear that before antiretroviral therapy (ART), when HIV led to disabling illness and certain death, many older persons as parents of infected adults experienced adverse emotional, material and social consequences. The present study examines how widespread access to ART is transforming the situation in Thailand. Interviews with parents of adult ART recipients reveal that major improvements in the health of their adult children under treatment is associated with major reductions in parental caregiving and expenses associated with their HIV-infected child although parents continue to provide psychological support. Parents own worry about their child's health also declines. Most adult children on ART are able to continue or resume economic activity and many contribute to support of the parental household. ART appears to reduce negative community reaction. Nevertheless, given uncertainty surrounding how long ART can protect against fatal illnesses, whether the adverse impacts of the AIDS epidemic on parents are being eliminated or only postponed remains an open question.

Parents and family members in the era of ART: evidence from Cambodia and Thailand.

Ensuring treatment adherence is critical for the success of antiretroviral therapy (ART) programs in developing countries. Enlisting NGOs or persons living with HIV/AIDS (PLHA) group members as treatment supporters is one common strategy. Less attention is given to family members and especially older-age parents. Yet ART patients often live with other family members who are highly motivated to ensure treatment success. This study examines the role of family members and especially parents in assisting adherence in Cambodia and Thailand among adult ART patients. Most have a living parent and many live with or near a parent. Family members including parents commonly remind patients to take medications, particularly if coresident in the same household. Parents also remind patients to get resupplies and accompany them to appointments. Some contrasts between Cambodia and Thailand emerged. Fewer Cambodian than Thai patients had a living parent. However, among those who did, equal shares lived with parents. Cambodian parents more commonly reminded patients to take medications and get resupplies and accompanied them when doing so. In both countries correct knowledge of ART among parents was associated with the amount of advice from program personnel. The results underscore both the need to more explicitly incorporate close family members, including parents, into efforts to promote adherence and need for PLHA peers and home based care teams to provide them with adequate information, training and resources to increase their effectiveness.

Productive aging in developing Southeast Asia: Comparative analyses between Myanmar, Vietnam and Thailand.

Alarmist views regarding the burden that older persons pose for family and society are prevalent; yet, such views are not necessarily warranted. To fill the research gap, this study examines prevalence and differentials in later-life productive engagement in developing Southeast Asia with a focus on the roles of educational attainment and gender. Based on analyses of recent aging surveys in Myanmar, Vietnam and Thailand, we assess three major dimensions of productive engagement among persons aged 60 and above, i.e. their economic activity, assistance to family members, and caregiving. Results suggest that elders in all three countries make important contributions to their families-consistent with Southeast Asia's prevailing norm of reciprocity in intergenerational support. Across the three countries, assistance in household chores is the most common contribution that older persons make, followed by caregiving and economic activity. We find that education is an important factor influencing productive aging. For example, elderly Thais with some educational attainment are more likely than those without any education to participate in the labor force and in turn are able to provide financial assistance to their children. Across the three countries, we find gender differences in later-life productive engagement. While older women tend to provide non-economic contributions to family, older men provide economic contributions more than their female counterparts. Our cross-country comparison additionally indicates that societal contexts such as economic development are likely to have important implications for the extent of productive engagement among older persons with different levels of educational attainment. We discuss policy implications of our empirical findings.

Overlooked potential: older-age parents in the era of ART.

The advent of widespread ART provision in low- and middle-income countries requires not just medical attention, but also social and psychological support to encourage and monitor strict adherence to drug regimens. Developing innovative approaches to providing this broad support is a major challenge, especially within the financial constraints of resource-limited countries hardest hit by the epidemic. In this study, we examine the role of older-age parents in monitoring ART treatment and caring for their HIV-infected children and grandchildren in Cambodia. Our results are based on 25 open-ended interviews with older-age parents of people with AIDS (PWHA). A high level of co-residence when PWHA become ill and a sense of parental responsibility and emotional attachment facilitate high parental involvement in their children's and grandchildren's illness, care and treatment. Our interviews indicate that parents play an important role in encouraging their children to get tested and to access treatment if they test positive. They consistently monitor antiretroviral therapy (ART) adherence and opportunistic infections and remind PWHA to attend medical appointments and support-group meetings. Parents also provide for the nutrition and hygiene of PWHA essential to the success of ART treatments. We find that despite low levels of education, older parents were able to express clear, correct and detailed knowledge of complicated ART treatment regimens, nutrition and hygiene. Overall, our findings show that older parents play a pivotal role in care and treatment if they are provided with proper resources and training and have the ability to understand the necessity and details of ensuring strict adherence to medications. Based on these results, we suggest that explicitly including older parents in policy and programs for care and treatment would allow Cambodia and other countries to take advantage of this unique and effective but overlooked asset in AIDS care and treatment.

Caring for Thai Older Persons With Long-Term Care Needs.

OBJECTIVE: To provide a situation analysis of recent long-term care (LTC) needs among older persons in Thailand. METHOD: The 2014 Survey of Older Persons in Thailand (SOPT) provides data to assess patterns of caregiving, whether care needs are met, and who are main caregivers for older Thais. We examine how types of familial and nonfamilial caregivers are associated with the well-being of older persons. RESULTS: The need for LTC increases sharply with age and is more common among women than men. Spouses and children constitute approximately 90% of main caregivers. The association of a family member as the main caregiver and education or value of assets is quite weak underscoring the general normative prescription for family members to serve as care providers. DISCUSSION: Thailand is experiencing acute population aging but empirical evidence to support LTC needs remains lacking. This analysis helps close the gap.

Aging in Myanmar.

This spotlight provides an overview of the situation of older persons in Myanmar, an understudied country of over-50-million population. Myanmar is of particular interest to researchers and policy makers, given its overall level of poverty and modestly rapid population aging. Research on older persons, while increasing in recent years, remains sparse. Empirical evidence indicates that Myanmar older persons are in relatively poorer health compared to those in neighboring countries. Many live in abject poverty and depend on their families for material support. Coresidence is very common and facilitates reciprocal exchanges across generations. Looking ahead, Myanmar confronts important challenges including demographic shifts that reduce availability of family support for older persons and increasing burden from chronic illnesses. Currently, government measures are essentially absent, although a law on aging was drafted and is in the process to become legislation.

Continuity and change in premarital sex in Vietnam.

CONTEXT: Premarital sexual activity is thought to be rising in Vietnam. However, there is little evidence documenting such an increase, and it is unknown whether levels of premarital sex differ between northern and southern Vietnam and whether premarital sex occurs primarily with a future spouse. METHODS: Surveys conducted in northern Vietnam (Red River Delta) and southern Vietnam (Ho Chi Minh City and surrounding environs) in 2003-2004 among individuals married during one of three important periods in Vietnamese history (1963-1971, 1977-1985 or 1992-2000) were used to assess trends and regional differences in the prevalence and context of premarital sex. RESULTS: In both regional samples, 31% of men who married in 1992-2000 reported having had premarital sex. The proportion was much lower among women (8% in the South, 12% in the North). The prevalence of premarital sex rose markedly across cohorts in the North but only modestly in the South. Relatively few men had premarital sex with someone other than a future spouse (3-23%). The proportion of the rise in the prevalence of premarital sex that was due to sex exclusively with a future spouse was greater in the North (42%) than in the South (25%). CONCLUSIONS: These results suggest that premarital sex is becoming more common in Vietnam but is still not widespread. Better information about the sexual networks of men in the general population and their contacts with high-risk groups (e.g., commercial sex workers) is needed to ascertain the likelihood that HIV/AIDS will spread to the general population.

Economic Status and Old-Age Health in Poverty-Stricken Myanmar.

OBJECTIVE: We examine the association between poverty, economic inequality, and health among elderly in Myanmar. METHOD: We analyze 2012 data from Myanmar's first representative survey of older adults to investigate how health indicators vary across wealth quintiles as measured by household possessions and housing quality. RESULTS: Poverty and poor health are pervasive. Self-assessed health, sensory impairment, and functional limitation consistently improve with higher wealth levels regardless of socio-demographic controls. Differentials in self-rated health and sensory impairment between the bottom and second quintiles are clearly evident, suggesting that relative economic inequality matters even among very poor elders and that a small difference in wealth can matter in an extreme poverty setting. DISCUSSION: Findings support a global theory of economic gradients in health regardless of level of societal poverty. Modest efforts to improve the standard of living among elderly may improve not only their material well-being but also their health.

Return migration in the context of parental assistance in the AIDS epidemic: the Thai experience.

Most persons with AIDS (PWAs) eventually require demanding caregiving. This can prompt changes in living arrangements during the course of the illness. Few studies have attempted to examine the potential links between AIDS and migration from this perspective. The present study uses both direct and indirect approaches to examine the extent of return migration of adults with AIDS in Thailand and explores how this is linked to residence with and care by older aged parents. Methodological challenges and various approaches to the study of this phenomenon are discussed. Despite differences in the nature of information available from our samples and in basic sample characteristics, the findings show a consistent pattern suggestive of extensive return migration among PWAs. The fact that most return migrants die within a few months of their return indicates that they are seeking parental caregiving during the final stages of the illness. The vast majority of PWAs who returned home after becoming ill did so because of their illness, particularly due to a need for care.

The economic consequences for parents of losing an adult child to AIDS: evidence from Thailand.

An examination of the economic consequences for older-age parents of losing an adult child to AIDS in Thailand based on quantitative data derived from a key informant study and a direct interview survey with parents yielded the following main findings: (1) parents frequently paid for their children's care and treatment, but government health insurance and to a lesser extent welfare measures helped alleviate these expenses; (2) parental caregiving often disrupted economic activity, although the resulting opportunity costs were limited by the typically short duration of caregiving; (3) parents commonly paid for funeral costs but benefited from funeral society memberships and customary contributions from those attending; (4) only a minority of parents supported AIDS orphans although orphaned grandchildren often ended up with their grandparents; (5) most deceased children had contributed financially to the parental household but only a minority were main providers. Poorer parents, however, were most likely to lose a main provider and experience severe financial hardship; and (6) although poorer parents spent much less on expenses related to the illness and death of their children, they were much more likely than better-off parents to be seriously burdened by these expenses. Programs are needed to address the plight of AIDS parents but should target those who are most susceptible to resulting economic hardship.

HIV/AIDS-related knowledge and attitudes: a comparison of older persons and young adults in Thailand.

Levels of AIDS related knowledge are widely assumed to be high in Thailand, a country with probably the most effective response to the HIV/AIDS pandemic to date in the developing world. But efforts to verify these levels are sparse in recent years, and very little attention has ever been paid to AIDS knowledge and attitudes within the Thai older population. Because many Thai older persons (aged 50 and over) remain sexually active late in life, and because many more will be involved in interactions with and care taking of young adult persons suffering from AIDS, we explore AIDS knowledge and attitudinal data we collected during 1999 from a sample of 773 older Thais from four provinces and Bangkok. The sample provinces were chosen to include a wide range of prevalence levels and social contexts regarding the epidemic. We compare the results with data from a sample of 398 young adults using the same questionnaire, collected at the same sites, at the same time (total N = 1,171). We find an overall high level of awareness about AIDS across our age groups of interest, but also identify important deficiencies among the young adults and especially among the older Thais. Implications of the findings are discussed.

Tradition and Change in Marriage Payments in Vietnam, 1963-2000.

Trends and determinants of marriage payments have rarely been examined at the population level despite their plausible implications for the welfare of family and the distribution of wealth across families and generations. In this study, we analyze population-based data from the Vietnam Study of Family Change to document prevalence and directions of marriage payments in Vietnam from 1963 to 2000. We investigate the extent to which structural and policy transformations (particularly market reform and the socialist policy that banned brideprice) influenced the practice of marriage payments as well as estimate how societal changes indirectly impacted payments via their effects on population characteristics. Results indicate that marriage payments surged following market reform but also reveal more nuanced trends and regional differences during earlier years. While the socialist attempts to eradicate brideprice appear to have been moderately successful in the North prior to economic renovation the evidence suggests they were largely unsuccessful in the South. Results suggest that structural and policy change explained most of the observed variations in marriage payments and that changing characteristics of the individuals who married mattered relatively little. We interpret the reemergence of marriage payments as attesting to resilience of traditional values and the unraveling of the socialist agenda, especially in the North, but also as a reflection of economic prosperity associated with market reform.

Return migration and the health of older aged parents: evidence from rural Thailand.

OBJECTIVE: To examine the extent to which an association exists between health of older parents and return migration of children in rural Thailand. METHOD: Data come from the 2006 Migration Impact Survey specifically designed to obtain information on the impact of migration on older adults in rural areas. Associations are examined from both the perspectives of parents (N = 883) and migrating children (N = 2,150) using equations that adjust for demographic characteristics of parents and children and factors that may indicate unmet support needs. RESULTS: A robust association with poor health promoting migration returns from both parent and child perspective exists and remains even with controls that might attenuate the relationship. DISCUSSION: Although media discussions have pointed out dangers of out-migration for older adults, little systematic evidence exists. This study supports the viewpoint that accommodations for older adults can be made despite social changes promoting out-migration and demographic aging of the population.

The role of parents and family members in ART treatment adherence: Evidence from Thailand.

High levels of treatment adherence are crucial for the success of expanding ART treatment programs everywhere. Augmenting adherence through treatment supporters is one promising strategy. Most discussions focus on peers, especially members of PHA groups, for this purpose. Far less attention is given to family members and especially older age parents. Yet ART recipients often live with or nearby parents and other family members who are highly motivated to ensure the treatment's success. This study examines the extent that family members, especially parents, assist adherence in Thailand. Results indicate that most adult ART patients live with family members and over half live with or in the same locality as a parent. Family members, including parents, commonly remind ART patients to take medications, especially if coresident. Moreover, parents often remind patients to get resupplies and sometimes accompany them to appointments. Clearly close family members, including parents, should be explicitly incorporated into adherence augmentation programs and provided adequate information to facilitate their role as long-term adherence partners, not only in Thailand but wherever ART recipients are closely linked to family members through living and caregiving arrangements.

Community Reaction to Older-age Parental AIDS Caregivers and their Families: Evidence from Cambodia.

Accounts of community reaction to persons with HIV/AIDS and their families typically focus only on negative reactions stemming from stigmatization with little acknowledgement of variation over time and across settings. To usefully guide local interventions, a broader view is needed that also encompasses attitudes and actions stemming from sympathy and friendship. We examine community reaction in Cambodia to families from the perspective of parents of adults who died of AIDS or currently receive antiretroviral therapy. Survey evidence and open-ended interviews reveal a mixture of reactions with respect to social relations, interactions with local officials, gossip, business patronage, funeral participation, and orphaned grandchildren. Positive support is often dominant and reactions typically improve substantially over time. Misplaced fears of contagion through casual contact underlie most negative reactions. Moral condemnation or blame is not evident as a source of negative reactions. Overall a sufficiently supportive atmosphere likely exists in many localities to facilitate community based efforts to mitigate the epidemic's impact on affected families.