Migration and The Left Behind: The Puerto Rican Exodus and The Health of Non-Migrant Older Adults

Abstract

The combined effects of emigration, increased life expectancy, and low birth rate has accelerated the aging of the Puerto Rican population and resulted in increased burdens associated with age-related diseases and risk factors. Previous studies suggest that out-migration affects not only the migrant itself but those left behind in the sending country through the reduction of social ties and, consequently, increased isolation. Studies in China, Mexico, Thailand, among others, have estimated the positive and detrimental consequences of out-migration on the health and well-being of older adults left behind. However, there are no such studies in Puerto Rico. This dissertation examined the impact of migration and psychosocial factors on the health and well-being of older adults left behind in Puerto Rico in three separate aims. In the first aim, using a multilevel approach, we estimated the initial consequences of net migration rate on depression and all-cause mortality of older adults. We found that there were urban-rural disparities in the effect of out-migration on depressive symptoms. As the municipal net migration rate changes from negative to positive among urban municipalities the levels of depressive symptoms decrease (β = -0.08; pvalue < 0.05). Older adults in urban municipalities who experienced high negative net migration rates had a higher average of depressive symptoms. We found no association between net migration rate and all-cause mortality. In the second aim, we examined the association between adult-children migration, parental depression, and prevalent disability among older adults residing in Puerto Rico and found that older adults with migrant adult-children were more likely to report a history of depression than older adults with no children residing outside of Puerto Rico (PR=1.20; CI:0.99-1.46). However, we incorporated an Instrumental Variable (IV) analysis and did not find a causal relationship between depression and adult-children migration. In the third aim, we examined the prospective relationship between social support, living alone, and incident physical disability among older adults. Results indicate a significant association between both psychosocial measures and incident disability. Receiving more social support (OR=1.17; CI:1.02-1.35) and living alone (OR=1.58; CI:1.01-2.46) were both associated with higher odds of developing a disability. Taken together, the results from this dissertation suggest there may be some negative consequences of out-migration on the mental health of older adults in Puerto Rico. It also highlights the uncertainty of the impact of out-migration on the physical health of non-migrant older adults. With the accelerating pace of out-migration over the last 14 years, it is essential to continue monitoring the effect migration has on the physical and mental health of older Puerto Ricans. This dissertation represents a first attempt to understand migration as a social determinant of health for older adults left behind.