Scholarly article on topic 'From whom do older persons prefer support? The case of rural Thailand'

From whom do older persons prefer support? The case of rural Thailand Academic research paper on "Sociology"

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Academic journal
Journal of Aging Studies
OECD Field of science
{"Kin preference" / "Elderly care" / "Family support" / Caregiver / "Social closeness" / "Matrilocal residence"}

Abstract of research paper on Sociology, author of scientific article — Jongjit Rittirong, Pramote Prasartkul, Ronald R. Rindfuss

Abstract This study explores rural elderly preferences for support across a multi-dimensional measure of elderly care needs. Applying a framework developed in the U.S. to Thailand for the first time, five diverse types of support are considered: meal preparation, personal care, transportation, financial support, and emotional support. The emphasis is on preferences for care and not actual care received. The data are from focus group discussions conducted in seven villages in Nang Rong district, northeastern Thailand. Thailand and the study site represent the social and economic conditions faced by many rapidly industrializing places—where there has been a dramatic demographic transition (lowered fertility and substantial out-migration), growing numbers of older persons remaining in rural settings, and limited publically-financed elderly care or market-based elder care available for purchase. For this study, in each village, male and female older persons aged 60 and over participated in the focus group discussions. As part of the discussion, focus group participants were asked to rank their first four preferences by type of support. Male and female older persons' preferences were slightly different for genderized tasks. In addition, social closeness and geographical proximity mattered. Traditional matrilocal residence patterns contributed to the perceptions of the older persons. Neighbors were preferred when kin were not available. Preferences inform strategic choices by older persons given the context of available resources. Understanding preferences and strategic choices among the older persons can help policy makers tailor programs more effectively and efficiently, without jeopardizing elderly well-being.

Academic research paper on topic "From whom do older persons prefer support? The case of rural Thailand"


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Journal of Aging Studies

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From whom do older persons prefer support? The case of rural Thailand

Jongjit Rittirong a'*, Pramote Prasartkula'1, Ronald R Rindfuss b'2

a Institute for Population and Social Research, Mahidol University, 999 Institute for Population and Social Research, Mahidol University, Salaya, Phutthamonthon, Nakhornpathom 73170, Thailand

b Department of Sociology and Carolina Population Center, University of North Carolina at Chapel Hill, Campus Box8120,206 W. Franklin St, Chapel Hill, NC 27516, USA


This study explores rural elderly preferences for support across a multi-dimensional measure of elderly care needs. Applying a framework developed in the U.S. to Thailand for the first time, five diverse types of support are considered: meal preparation, personal care, transportation, financial support, and emotional support. The emphasis is on preferences for care and not actual care received. The data are from focus group discussions conducted in seven villages in Nang Rong district, northeastern Thailand. Thailand and the study site represent the social and economic conditions faced by many rapidly industrializing places—where there has been a dramatic demographic transition (lowered fertility and substantial out-migration), growing numbers of older persons remaining in rural settings, and limited publically-financed elderly care or market-based elder care available for purchase. For this study, in each village, male and female older persons aged 60 and over participated in the focus group discussions. As part of the discussion, focus group participants were asked to rank their first four preferences by type of support. Male and female older persons' preferences were slightly different for genderized tasks. In addition, social closeness and geographical proximity mattered. Traditional matrilocal residence patterns contributed to the perceptions of the older persons. Neighbors were preferred when kin were not available. Preferences inform strategic choices by older persons given the context of available resources. Understanding preferences and strategic choices among the older persons can help policy makers tailor programs more effectively and efficiently, without jeopardizing elderly well-being.

© 2014 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND

license (


Article history:

Received 18 February 2014

Received in revised form 17 October 2014

Accepted 17 October 2014

Available online 9 November 2014

Keywords: Kin preference Elderly care Family support Caregiver Social closeness Matrilocal residence


Research on caregivers for older people in developing countries tends to examine who actually provides care rather than from whom older people would prefer to receive help. These two may not be isomorphic. And when they are not, even when the elderly are receiving support and care, they may be

* Corresponding author. Tel.: +66 081 420 4889; fax: +66 02 441 9333. E-mail addresses:, (J. Rittirong), (P. Prasartkul), (R.R. Rindfuss).

1 Tel.: +66 081 867 9097; fax: +66 02 441 9333.

2 Tel.: +1 919 962 3532; fax: +1 919 966 6638.

dissatisfied with their caregivers, which, in turn, could affect their psychological and even physical health. Thus, in addition to knowing who actually provides care to older individuals, it is important to know from whom these older individuals would prefer to receive care.

Concomitantly, in many developing countries rapid demographic changes are occurring, affecting the availability of potential caregivers with the preferred kin, gender and geographic proximity characteristics, including major declines in fertility, increased longevity, and the movement of young people from rural areas (where their parents live) to urban areas (where better paying jobs are available). Declining fertility means that individuals will have fewer sons and

0890-4065/© 2014 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (

daughters alive when they reach the age when they might need assistance. As many developing countries are approaching replacement level fertility or even lower, the likelihood that individuals will have even one son or daughter diminishes sharply. Increasing longevity means that people will have an even longer period in their lives when they need assistance. And finally, most developing countries are undergoing rapid and massive shifts from rural to urban areas. Typically it is the young adults who are moving to urban areas, and this creates a geographic mismatch in the locations of older individuals and their children.

In addition, in most developing countries, neither government support nor employer provided pensions, health care and various support services are widely available or sufficiently funded. This is particularly the case in rural areas and means that rural, elderly Thais, if they need care, must rely on kin, friends and neighbors. The changing demographic situation coupled with the lack of comprehensive, government-provided social services for older individuals highlights the important question: from whom do older persons prefer to receive support, and that is the focus of this paper. Given the demographic trends, older persons may not be able to find their preferred caregivers.

In this paper, relying on the life course framework (Bengtson, Elder, & Putney, 2005; Elder, 1977, 1983; Elder, Johnson, & Crosnoe, 2003) and the task-specific model of care provision (Iecovich et al., 2004), using qualitative methods we examine the preferences older individuals have from whom they would prefer to receive support in five different domains: meal preparation, personal care, transportation, financial support and personal support. The setting is a rural district in Northeast Thailand.

Conceptual framework

The life course framework has five principles (Bengtson et al., 2005; Elder, 1977,1983; Elder et al., 2003). The first, and most central to this paper, is the interconnectedness of lives, linked by kinship ties, friendship ties, neighbor ties, and so forth. They are linked over time and place. The question for this paper is from which of these links do older individuals prefer to receive support. The second principle involves the importance of the specifics of historical time and place; this is the context within which lives are lived. Below we provide relevant specifics for Thailand in general and rural Northeast Thailand in particular. The third principle emphasizes the importance of transitions and their timing. This third principle exists alongside the second, such that the timing of transitions is influenced by the context within which the transitions occur. For example, in rural Northeast Thailand, rice farming is the dominant occupation and certain aspects have only recently been mechanized. It is physically exhausting work and rice farmers beginning in their 50s find it difficult to farm. Hence the transition out of full-time work begins at an early age relative to the West.

The fourth principle involves human agency, with the idea that plans made by individuals affect the outcomes they experience. So, for example, in the present case, the plans today's senior citizens made about childbearing years earlier affect the number of children available to help them now. The final principle is that human development is a life-long process, and that behavior and events of earlier life stages can have

consequences in later life. Just because they are older, does not mean that they are not still learning and developing. For example they need to learn how to navigate in the health care system, and, as we learn below, they frequently want a child with them to help in this learning process.

We join the life course framework with the task-specific model of care provision (Iecovich et al., 2004). The basic idea is that the elderly might need help with quite different types of assistance, and that a person with skills in one care domain, say help with meals, might not have skills or resources to help in another domain, say help with financial assistance. Similarly, older individuals themselves might have preferences that differ across tasks. For example, a consistent finding is that older men and women would prefer females (wife, daughter, granddaughter) to help them with meal preparation when such assistance is needed. There is a pervasive perception that men cannot cook. We elaborate on this below in the section: Dimensions of care giving and receiving.


As noted above, older individuals are living their lives in a specific historical time and geographic setting, and hence it is crucial to describe that setting. We begin with Nang Rong, which is the setting for our empirical work. Then within the more general Thai culture we discuss the impact of religion on filial obligation and the norm of post-nuptial residence.

Nang Rong is a district in Buriram Province, Northeast Thailand. In 2012, a population of 181,748 resided within its 1300 square kilometers. The smallest administrative units are villages, with each village containing about 100 households on average. People live in nucleated villages, with dwelling units clustered and farm parcels scattered around the perimeter. Nang Rong is in one of the poorest areas of Thailand and the majority of the population works in agriculture, typically as subsistence rice farmers. Since cultivation is rain-fed, yields are affected by droughts and floods. The main crop is rice, grown in paddy fields. It is important to recognize that the tasks involved in paddy rice farming are labor intensive and very strenuous— especially transplanting young rice plants. The wear and tear on paddy rice farmers generally means that they must cut back and then retire from rice farming at a relatively young age, typically mid- to late-50s.

Older persons in Nang Rong mainly settled there in the 1950s and 1960s when Nang Rong was a frontier area. Their neighbors may be their relatives. At present it is very difficult to buy land because a real estate market has not yet emerged. A combination of limited economic and educational opportunities has created migration push factors. Further, if parents do not have enough land to share with their children, their children may consider migrating. A substantial number of adult children have moved to work in Bangkok or the industrial Eastern Sea Board where more job opportunities are available for them and where jobs are less arduous than paddy rice farming. In addition, some migrating adult children leave their own children with their elderly parents (the grandparents) because working and living conditions in destination are not appropriate for raising children. While migrating adult children are not living with their elderly parents, many realize that they have responsibility to their origin household's economic circumstances. Remittances are often sent back to their family left behind in Nang Rong to

both take care of their parents and raising grandchildren (Curran, Garip, Chung, &Tangchonlatip, 2005; Piotrowski, 2009; Vanwey, 2004). Although public transportation between Bangkok and the origin villages is available, traveling back to the origin village requires taking time off from work, losing wages in the process. During Songkran festival in April (celebrated as traditional new year from 13 to 15 April), migrants return to their origin village, and usually bring special presents, such as new clothes and food, for their parents. Depending on their economic conditions, some may bring more valuable presents such as a gold necklace or a motorcycle.

The broader Thai society, including Nang Rong, is characterized by Theravada Buddhism (Cassaniti, 2006; Keyes, 1984; Kirsch, 1996; Nilsen, 2011) and social norms springing from her agricultural history. In Theravada Buddhism merit is the intangible result of doing good acts or having good thoughts. It can be carried over one's life. There are several ways to earn merit, so called "making merit," depending on his/her roles. Lay persons can make merit, for example, by providing food or goods to monks, praying, and practicing meditation. Monks can gain merit though mindfulness. Gender is an important factor influencing roles occupied by Thais. Young men are expected to be ordained in the monkhood. Even though the monkhood period is short for most men—typically about 3 months—it is a critical component in the life course of young adult males and a way to make merit, giving thanks to one's parents for having raised them. Women do not have the option of becoming a monk. Although women could be a nun or bhikkhuni, this is not equivalent to being a monk in the Thai context (McDaniel, 2006). Instead, for women becoming a mother and nurturing their family is an important way to pay back their parents for having raised them (Keyes, 1984; Kirsch, 1996). In addition, as Embree has noted, there are rules for parents and children's duty (Embree, 1950) quoting (Chandrung, 1940).

"These are the duties of parents to their children: giving food, clothing, and shelter, forbidding wrongdoing, encouraging right conduct, giving education, assisting them in matrimony, and transferring properties to them in good time. The duties of children toward their parents are: taking care of them when they are old, helping them in their work, keeping the good name of the family, obedience, trustworthiness, using their properties sensibly, and remembering them after their death"

The cultural norm regarding post-nuptial residence in Northeastern Thailand is that newly married couples are expected to live in the wife's parental house, at least temporarily (Potter, 1979). After they have collected sufficient resources, the couple may build a house within the same compound (if there is sufficient space) and leave the parental dwelling unit. If there is not sufficient space to build a house on the parents' land, they will find land elsewhere in the village. Typically, the youngest daughter inherits parental house and it is her responsibility to take care of their parents for the rest of their life (Podhisita, 1984; Yoddumnern-Attig, Richter, Soonthorndhada, Sethaput, & Pramualratana, 1992). The matrilocal preference allows daughters who traditionally live geographically close to look after their parents. Limanonda (1979) found 72 percent matrilical residence in the rural northeast as evidence of matrilocal norm (Limanonda, 1979), but there is also evidence that the norm is flexible, especially if

financial considerations point towards alternative arrangements (Chamratrithirong, Morgan, & Rindfuss, 1988).

Children are considered as the elderly parents' security (Knodel, Chayovan, & Prachuabmoh, 2011; Mason, 1992). After retirement age, former civil servants and some workers in the formal sector have the provident fund as their financial security. But most elderly Thais have worked in informal sectors in which social welfare benefits and their own savings are relatively minimal. Although an attempt has been made to provide necessary facilities and services equally for all Thais, only the universal healthcare coverage scheme is widely available for older persons who are vulnerable (Tangcharoensathien, Tantivess, Teerawattananon, Auamkul, &Jongudoumsuk, 2002). Social welfare for older persons has not been fully developed (Jitramontree & Thayansin, 2013) and this is a situation common in other developing countries. In rural Thailand only a small minority of elderly individuals are financially secure. Typically among Thai people, it is recognized that children should take care of their parents in order to repay the parents for nurturing them during their childhood. When their parents can no longer work to earn enough, it is the children's responsibility to give support (Curran et al., 2005; Foster, 1975). Children are considered as the main source of income. Fifty-two percent of people age 60 and over and 68 percent among those age 70 and over identify children as the main source of income (Knodel etal., 2011).

In the future, children in Thailand may no longer be able to be considered as the main support and caregivers for parents due to demographic changes. Low fertility and childlessness are now common. In Thailand family planning policies were launched in 1970 and its success affected the total fertility rate (TFR) which dropped from 6.3 in 1970 to 1.47 in 20052006 (Knodel, Chamratrithirong, & Debavalya, 1987; National Statistical Office, 2007). The fertility decline consequently affects family size which dropped from 5.7 in 1970 to 3.8 in 2000 (Prasartkul, Vapattanawong, & Thongthai, 2011). Not only does low fertility impact family size, but the dispersion of adult children who migrate for employment (Knodel et al., 2011) also results in fewer co-resident with older parents. The rapid decline of fertility and longer life expectancy contribute to a larger proportion of older people. The elderly share of total population doubled from 6 to 12 percent during 1980-2011 (United Nations, 2010) and will rapidly increase to 20 percent in 2031 (Prasartkul, 2013). With fewer and more dispersed children, older persons have lower availability of caregivers.

Dimensions of care giving and receiving

According to the task-specific model of care provision (Iecovich et al., 2004), different types of support might be provided by different groups of people, such as family, friends, and neighbors. And within the kin group, those occupying different positions, such as daughter or grandson, may give different types of assistance and support (Campbell & MartinMatthews, 2003). The older persons, as support receivers, may prefer different types of support from different persons based on their experience and skills. This study concentrates on five different support types: meal preparation, personal care, transportation, financial support, and mental support. These five types of support essentially maintain the older persons' well-being and are related to the instrumental activities of daily

living (IADL) which has been widely used to measure older persons' condition (Kobayashi, 2006; Lawton & Brody, 1969). IADL was developed for economically advanced countries, and includes ability to use the telephone, shopping, food preparation, housekeeping, laundry, transportation, responsibility for own medications, and ability to handle finances (Branch, 2000). We reduced this list to make it more suitable for rural Thailand.

Fig. 1 illustrates, in three dimensions (gender, geographic distance, and closeness of kin), the factors influencing from whom the older persons might prefer to receive which type of support. The five support types are perceived differently depending on the gender of both receivers and givers, and closeness of kin. The options available to an elderly person may be limited by geographical distance. In addition, the preferences vary by type of support. In other words, one may prefer different persons depending on their ability to help for a particular need and how comfortable the older persons are with support from that person. Meal preparation, personal care, and transportation require regular and frequent services, and thus closer proximity makes the services easier. In addition, it is expected that older people would prefer meal preparation and personal care from females rather than males. Emotional and financial support can be provided remotely through modern communication technology. In Thailand, cell phones are affordable and considered an essential living item. Money transfer is a reliable service with modest fees. Self-delivery, on the other hand, requires not only travel expenses, but it is also time-consuming.


To examine the preferences of older individuals, focus group discussions were conducted in Nang Rong district during spring 2012. Focus groups can be used for a variety of purposes. We were interested not only in the preferences ofthe older persons, but also in the extent to which they agreed with one another. The give-and-take of focus group discussion allows focus group members to listen and react to one another. In our case there was remarkable consensus and so we did not go on to individual qualitative interviews. People aged 60 and over are the target of national development plan as stated in the 2010 Thai Constitution. Additionally, this age covers the definition of elderly people

and retirement age (60 and 65 years old respectively) in many countries. Thus we recruited male and female participants aged 60 and over to take part in focus group discussions from 7 geographically dispersed villages in Nang Rong. The focus groups were held separately for men and women for a total of 14 focus groups. As part of the discussion, the older persons were asked to rank their preferences by type of support and their feelings toward those care givers.

The recruitment of focus group participants was assisted by Nang Rong district public health officers and village health care volunteers. The recruitment was announced through their social network a few weeks before the focus groups took place. Most older persons in Nang Rong receive some services from the village health care volunteers and they typically share information, so it is likely that most of older persons in the village were informed. The elderly participants volunteered to join the discussion. Since the opinions of participants across groups and villages are similar, it is plausible to assume that the focus group participants fairly represent Nang Rong elderly. The older persons were asked to gather at a public place within the village, such as a community pavilion or local healthcare center. The first author, as moderator, led the group discussion, which lasted about 60-90 minutes. Central Thai language was spoken during the discussions. When the focus group participants spoke some local dialect words or phrases, they were translated into central Thai by local health care volunteers.

Table 1 summarizes the characteristic of the focus group participants. To protect the privacy of focus group members, the village name and location are not disclosed; instead a village number was assigned to each village. Each focus group had 6-9 participants. The age range of participants was 60-85 years old. Only two males were never-married; the rest were or had been married. Most male participants were currently married and lived with their spouse. The proportion of married female participants living with their spouse was lower than their male counterparts and the proportion of widowers was higher, as would be expected given differences in ages between spouses and higher mortality among men.

The characteristics of villages are shown in Table 2. Most of the villages have paddy rice cultivation with sugar cane and cassava in some. Among these seven villages, five villages most often spoke Thai Korat, one village spoke Khmer, and another one spoke both Thai Korat and Khmer.

Fig. 1. Factors influencing support preferences of Thai older persons.

Table 1

Characteristics of 14 focus group participants.

Village no. Number of participants Min age Max age Marital status

Male Female Male Female Male Female Male Female

1 8 8 60 61 78 72 1 single, 6 married, 5 married,

1 windowed 3 widowed

2 6 7 64 60 73 70 5 married, 3 married,

1 widowed 4 widowed

3 9 8 61 63 79 78 9 married 4 married,

4 widowed

4 7 8 64 60 83 85 6 married, 1 single, 2 married,

1 widowed 2 separated, 1 divorced, 2 widowed

5 6 6 60 62 80 71 1 single, 4 married, 4 married,

1 widowed 2 widowed

6 7 8 64 62 84 82 5 married, 6 married,

2 divorced 2 widowed

7 7 7 63 63 77 70 7 married 4 married, 3 widowed

To assure that the focus group discussion provided the required analysis data, the discussion guide was developed with the suggestions of three experts in qualitative methodology and family study. The questions were revised to be simple and

understandable for local participants by one of the experts who were originally from northeastern Thailand. Three main

questions were asked. First: 'Typically, for _ (type of

assistance) who do you think who should be the person to

Table 2

Characteristics of villages studied by focus group discussion.

Village Agricultural cultivation

Language Diversity


Village settlement

85 percent of households in the village do Thai

agricultural cultivation. Among these Korat

households, 99 percent grew rice. The and

remaining households grew corns, sugar Khmer cane, eucalyptus, and other crops.

84 percent of households in the village do Khmer agricultural cultivation. All of these households grew rice. Few households also grew cassava and eucalyptus. 71 percent of households in the village do Thai agricultural cultivation. All of these Korat

households grew rice. Some households also grew coconuts, bananas, eucalyptus, and mixed cultivation.

69 percent of households in the village do Thai agricultural cultivation. Among these Korat

households, 99 percent grew rice and 28 percent grew cassava.

73 percent of households in the village do Thai agricultural cultivation. Among these Korat

households, 95 percent grew rice and 47 percent grew cassava. Few households grew corns and vegetable.

78 percent of households in the village do Thai agricultural cultivation. All of these Korat

households grew rice. Few households grew vegetable.

39 percent of households in the village do Thai agricultural cultivation. All of these Korat

households grew rice. Few households also grew vegetable. This village became urbanized due the expanded city.

Many languages were spoken including Central Thai, Thai Korat, Khmer, Lao/ Northeastern Thai/Isan, Suay, Northern Thai, and Southern Thai. In addition, Chinese and English were used.

This village is relatively less diverse when compared to the first village. People speak Central Thai, Thai Korat, Khmer, Lao/ Northeastern Thai/Isan, and Suay This village is relatively less diverse when compared to the first village. People speak Central Thai, Thai Korat, Khmer, Lao/ Northeastern Thai/Isan, and Suay

This village is relatively less diverse when compared to the first, second, and third village. People speak Central Thai, Thai Korat, Khmer, and Lao/Northeastern Thai/ Isan

This village is relatively less diverse when compared to the first village. People speak Central Thai, Thai Korat, Khmer, Lao/ Northeastern Thai/Isan, and Suay

This village is relatively less diverse when compared to the first, second, and third village. People speak Central Thai, Thai Korat, Khmer, and Lao/Northeastern Thai/ Isan

This village is relative least diverse. People speak only Central Thai and Thai Korat.

There are three areas of settlement in different time of which they are less than a hundred years old. The second old village was settled about 30 years after the first one. About five years later, the third one was settle.

Less than a hundred years old

The old village which is more than a hundred years old

The old village which is more than a hundred years old with the new area of settlement

There are three areas of settlement in different time. They are less than a hundred years old. The newest area was settled about 20 year after the oldest one.

The old village which is more than a hundred years old

Less than a hundred years old

Source: Nang Rong Project Community Survey, collected in 2000.

best take care the older persons? why?' Second: 'Who is the

next person for taking care of the older persons for_(type

of assistance)?' Third: 'How would you feel if you received assistance from that person compared to the first person mentioned?' These questions were used for five types ofsupport: meal preparation, personal care, transportation, financial and emotional support. In addition, other questions were raised to encourage the older persons to keep thinking about the issues until no additional new information was produced.

The conversations were recorded with the focus group participants' permission and transcribed. The transcribed documents were coded and analyzed using QRS NVivo software. During the focus group, themes were developed to permit ranking the preferred support providers by types of support. Types of support were described to the participants. We began with meal preparation and then personal care, transportation, financial support and emotional support respectively. For each type of support, the questioning about preferred providers was raised in such a manner that focus group participants could name anyone. Once one type of provider was mentioned, other focus group participants were asked their opinions. Some participants mentioned different types of providers. When it appeared that there were no additional types of providers, the moderator asked the group to rank order their choices.

The transcribed documents from each group were coded within QRS NVivo by the moderator. To determine the preference rank, mentions of preferences were retrieved on a type-of-support by type-of-support basis. A summary table of answers about preferred kin, reasons, and emotional expression was used to compare across groups. To rank the older persons' kin preference for the various types of assistance, the frequency that the older persons mentioned certain types of persons, the rational provided and the emotional expression toward those caregivers were taken into account. Since focus group members were asked to rank their preferences, the transcripts were checked for preference order within and across groups. There was substantial rank-order consistency within and across focus groups, making it easier to develop the results presented below.


Provider preferences of older persons are discussed below by type of support.

Meal preparation

Meal preparation refers to meals that may be cooked at the house where the older person resides, or cooked elsewhere and brought to the house of the older person. Elderly men prefer their wife for meal preparation because she has more experience and knows their favorite foods. If their wife is not able to cook or is no longer alive, children are the next option. Elderly women prefer their children, even if their husband is still alive. This reflects the lack of cooking experience among men in this generation. When asked to compare between son and daughter, both elderly men and women expressed a preference for their daughters to prepare their meals. Post-nuptial residence oftheir children is an important determinant to provide meal preparation. The older persons are more likely to ask their daughter than their son because she more likely lives nearby. But

daughters also might be better cooks than sons, reflecting the specific Nang Rong setting in the early 21st century.

Mostly, the son does not pay much attention to cooking. The daughter is preferred because she lives with her parents after marriage. In addition, daughters are keen to cook and have more cooking experience. (Male, Village 3)

It should be our daughter to take care of us because she is better than the son. Sons are different from daughters. Sons live faraway and have to work outside. Even though our son truly loves us, he is different from our daughter. He is not as gentle as her. She gives more attention in taking care of us, thoroughly. She knows what we like to eat and brings those things to us. Our son says he worries about us. However, he is just different from her. She is better. (Female, Village 4)

Older persons feel comfortable receiving meal preparation support from their children. Although the older persons consider this support as a filial obligation, they appreciate their children's help and do not want to their children to be worried or concerned if the food the children prepare is not as good as they would have liked. Further, older persons have concerns about being a burden.

[However,] I am afraid that I may bother them. Sometimes they are upset about something. I do not feel this with my daughter-in-law as much as I feel with my own children. I feel sad with my children. I am afraid to bother my daughter-in-law too. I had never heard if she complains, but I am afraid she may have. I think my children do not complain because I am their mother. I think I am not bothering my daughters because they think they are doing for their mother. They do it as filial duties. They cook for me because they are willing to do so. I do not feel if I am bothering them. (Female, Village 2)

If they cook well, I encourage them to do it. If the food is not delicious, I will say something funny (laugh ) and say that your food is good. I do not want to make them sad. And so I ask them to cook for me again (Female, Village 7)

Personal care

Personal care includes any care or assistance regularly or occasionally given by a person to an older person who is not able to care for themselves due to physical limitations. Personal care, for example, includes feeding food, medicating, washing the body, getting dressed, and caring for them when they are sick. Elderly men prefer their wife and then their daughter, while elderly women prefer their daughter and then granddaughter. Personal care is viewed as a female task by both elderly males and females. Elderly men gave reasons that their wife has experience and is (socially) closer. In addition, it was felt that it is the wife's duty is to take care of her husband and children. Elderly women think that the personal care giver for them should be their daughters. Not only is it an obligation and opportunity to repay for nurturing their daughters since childhood, but it is because they prefer someone of the

same gender. Since this support involves intimate care, elderly women feel more comfortable with their daughter. Older persons also prefer their daughters because they are perceived to be more gentle than sons. Moreover, the older persons tend to ask for help from their children who live geographically closer. Due to matrilocal residence, the proximity of daughters and granddaughters makes personal care easier for them (Rittirong, Prasartkul, & Rindfuss, 2013), indicative of the life course principle of linked lives, parents and daughters in this case.

I am happy that they return to take care of us. I am happy and do not feel uncomfortable. They are my children. They do it because they love us. I may be afraid to bother other people. Because my children are my family, I am not afraid to bother them. I do not feel uncomfortable. I am proud and grateful to have someone taking care of us. I may get well much sooner because I am very happy when seeing them. (Male, Village 4)

The daughter is female like us. We do not feel close to the son. He touches us strongly. The daughter can do anything including cleaning our mess when we are seriously sick and unconscious. Other people do not take care of us. They are not akin to our children. We do not feel comfortable to others.(Female, Village 4)

Transportation assistance

Transportation refers to assistance and transportation given to older persons by taking them to receive medical treatment or do business in town. Most of the time, older persons in rural areas are at home in their villages. The main reasons they need to leave their village are for medical appointments or treatments. Older persons feel comfortable having their children drive them to the hospital because it is expected of children. Typically for children or grandchildren who own a vehicle, the older persons pays nothing for transport. Sometimes older persons may be concerned about their children's financial condition, so they may give money for gasoline. Frequently children or grandchildren go to town after their farm work is completed in the morning, so older persons plan their appointments in the afternoon. If the household does not own a vehicle or no one in family is available to provide transportation, older persons ask their neighbors. If neighbors drive them, older persons would generally not only pay for gasoline but also give them extra money for wear and tear on the neighbor's car/truck and to compensate them for their time. This is described in the quotes below as 'renting' a car. Older persons usually need a child to go with them even they rent neighbors' car because their child can help communicate their symptoms to the health care provider and help with hospital paperwork. Older persons feel uncomfortable doing the paperwork and some mistakes may happen due to miscommunication. And they like having a child with them when they are not feeling well.

I am glad and not afraid to bother my children. I am glad that

my children take me to the hospital. I do not feel

uncomfortable. I know they have to do it, in return for being raised by their parents. I am thankful, but I do not necessarily say thank you to them (laugh). I say thank you to relatives instead. I feel awkward to say thank you to my children. I may say to other people, "Thank you very much for the ride". I thank them. (Male, Village 7)

I do not have any children or grandchildren taking me to a hospital. There is only my wife. We rent a car and she goes with me. I feel lonely going alone. It is difficult to talk to the doctor. (Male, Village 5)

I am glad and proud of them (children). Even though they are tired (from work), they take their mother (the older persons themselves) to see the doctor. Sometimes my daughter or my daughter-in-law takes me (to a hospital). If they are busy, my son will do. I am afraid I may waste their time. (Female, Village 2)

Financial support

Financial support refers to any financial assistance given directly to an older person or to the household where the older person resides. This includes money the older person receives for expenses such as household consumption and medical treatment. Almost all older persons in Nang Rong villages worked in agriculture before they retired. All Thais 60 and over receive monthly pension payments from the government; however, the amount is insufficient to cover living expenses. The monthly amount of social security varies by age: 6069 years old is 600 baht, 70-79 years old is 700 baht, 8089 years old is 800 baht, and 90 years and over is 1000 baht. (The currency exchange at the time of the focus groups was about 30 baht per 1 US dollar.) And so, clearly social security amounts are not sufficient to cover the financial needs of older individuals. Those over 60 can access standard health services at public hospitals free of charge, and that does help their financial situation, but they still need additional support from other sources.

Elderly Thai married couples do not distinguish between his or her money, rather it is considered as the same purse. If they turn to others for financial support, they will first ask their nearest child, typically a daughter, as it is easier and faster to receive help from a child who is geographically nearby. Later, if necessary, they will ask more distant children for additional support. Distant children can use the postal mail service to send money back to their parents. Unmarried children are more likely to provide financial support because they do not have their own household's expense as much as married children, again showing the importance of linked lives—across three generations in this case (Rindfuss, Piotrowski, Entwisle, Edmeades, & Faust, 2012).

Older persons do not have to return money received from their children because this help is considered to be repaying their parents for raising them. Since older persons can no longer work to earn enough money, it is the time for their children to pay their respect by taking care of their elderly parents. If children are not able to help, older persons will ask their siblings or relatives or lenders. Lenders usually require interest, about 5-10 percent

per month, which makes it very difficult for older persons because they are no longer generating income. A loan from the agricultural bank is a reasonable alternative, but it requires land with a title deed and many older persons do not own land or do not own land that is securely titled.

I love all my children equally. If anything happens, the nearest child Imows first. It is easier and faster to get help from children living nearby. A son and a daughter are fine for me. (Male, Village 5)

I think of my children. If we do not have any children, we will be starved to death. I thinI of my children who move out to worIk They send money back immediately when I ask. (Female, Village 5)

After taking a glance at our children, I think they may not have money. Then I ask a neighbor to lend me some money. What I say means if we ask our siblings and they may not have money, we have to go asking a neighbor to lend us money. It is difficult to find someone lending you some money. If we need an amount of money, we have to look for a lender. (Male, Village 7)

Older individuals also use credit based on their expected monthly social security/pension payments. They may borrow food or household items from a grocery store in the village and pay the debt once they receive their monthly pension payment.

I do not owe anyone any money. I only buy food from a grocery store on credit. I borrow food for my family. I can barely survive by the older persons'pension fund along each month. (Female, Village 5)

Emotional support

Emotional support refers to any action such as talking, consulting, or discussion which expresses a giver's feeling of affection, sympathy and/or understanding toward older persons. Those over 60 sometimes will need to talk to or consult with someone when they are worried or depressed. Problems about which they worry are often related their health conditions. Further, many older persons do not have enough savings for their retirement, so they need to rely on their children. If their children are capable of providing financial support, then they do not have to worry about financial issues in their later life. However, frequently their children have financial constraints, thus causing worries for the older persons. An additional source of worry involves children who have moved to Bangkok. They worry about how well their children are doing in the distant city.

The majority of both elderly men and women prefer turning to their spouse for emotional support. Since they spent their life living with their spouse, they said that their spouse shares their fate and helps them emotionally. Children, especially daughters with whom the older persons may live, are their next preference. Farming decisions (if they rent their land to others) and/or are contemplating taking a loan on their farm are the main topic to discuss with their children. Older persons prefer

consulting their mature children because they can get useful suggestions.

In addition to health and economic conditions, some older persons worry about their children who live in distant cities. Most would like it if their migrant children would return to live in their natal village, but they realize that this is unlikely.

It depends on the issue. These days I consult my children about rice farming. I have to consult my children about the investment. My wife does not understand. (Male, Village 3)

I worry about my children who move out to earn money far away. I want them back and live with me. I keep thinking about this. When my children are working in Bangkok or elsewhere, I am always worried about them. I miss them. I want them to live nearby, but it is not possible because they have to earn money. I keep thinking of them until the feeling has gone. I talk to my neighbors about anything to provide relief and forget that feeling. (Female, Village 1)

We can talk about anything, but some of them (children) are far away. (Female, Village 1)

Note that the parents who miss their migrant children do not talk about the possibility of moving to Bangkok to be with or near their children. Rather they hope their children will return, and, if they do not, they will just continue to miss them. This is consistent with the broader international literature which suggests that older individuals prefer to stay where they had been and age in place (Granbom et al., 2014).

Support from community organizations

In addition to familial and neighborly social support, local organizations play important roles as assistance providers for those over 60. There are Buddhist temples, Subdistrict Administrative Organizations (SAO) and local health care centers. Religion plays an important role in their life, relieving grief and depression. The Buddhist temple is the place that villagers gather, especially on holy days (4 days a month) to make merit, pray, and listen to the sermon delivered by a monk. Older people feel comfortable and relieved from stress or depression when they go to the temple. They can talk to a monk about anything, but they usually refrain from talking about their problems because they do not want their worldly concerns to distract the monks' religious practice. Since the temple is for funerals and cremations, older people think that temple will be the last place for them. Thus, they feel attached to the temple. They think that the temple (monks and neighbors) will eventually bring them peace at the end of their life.

Some older persons go to Buddhist temples in the village when they are suffering and desire help to solve their problems. Although making merit cannot solve their problems, it makes them feel relieved. Some of them expressed that the temple is the place of last resort if they need emotional support:

[I consult]Myself. I do not want to think too much. I go to a temple to make merit. I do not Ioiow whether it helps solving the

problem (laugh). Yet I feel grateful. When I donate some food for monks in the morning, I am delighted. (Female, Village 1)

I would go to a temple if there is no one to help and look after me. I just go to a temple. [If I live alone at home], no one knows when I die. I might be brought to a temple when a time passed (laugh). In case if we cannot ask for help from anyone. Children do not come over. No one sees us, I am alone and not capable of taking care of myself, I will go to a temple (other elderly women laugh). Who else would come to help us? We die alone. (Female, Village 6)

Subdistrict Administrative Organizations (SAO) are local authorities subsidized by the national government to provide various services within subdistricts. Its policy follows the national government policies; however, the activities vary across SAOs. A main service for all SAOs is to pay monthly pensions. Some SAOs encourage people in the community to engage in activities to improve the well-being of older individuals, such as clubs for exercise and/or travel. As such, the SAOs provide a mechanism for older village residents to build social capital (Heenan, 2010). In one of the villages examined here, the SAO provided emergency transportation. This service allows older people to access to transportation anytime by dialing the emergency number, 1669.

Local health care centers provide prevention and care by health personnel. Physicians from the district hospital usually work at the centers a few days per week. The centers also recruit villagers to work as health care volunteers. The health care volunteers look after their neighbors, providing advice or bringing patients to the local health care center. Physicians visit the older person's house if the older person cannot travel to the center.

Summary table

The results from focus group discussions, in terms of help from kin and their linked lives, are summarized in Table 3. The preferences are shown separately for elderly men and women. Elderly men prefer their wife for meal preparation and personal care. Daughters and sons are considered as the second and third preferences respectively. A daughter is the elderly women's preference for the same supports, while son and granddaughter are the next preferences for meal preparation. Granddaughters become the second preference for personal care among elderly women. Gender does not matter for transportation and financial support. Both elderly men and women prefer either a son or daughter for providing their transport as well as financial support. Elderly men consider grandson and granddaughter for the next options for transportation, but elderly

women could not describe their next options. Financial support should be from their children as the older persons did not provide any other choices. The older persons prefer to receive emotional support from their spouse. The next person should be their daughter. The elderly women did not distinguish between sons and daughters.

Discussion and conclusion

This study examined the preferences of rural Thai older individuals regarding from whom they would like to provide assistance if and when assistance is needed. Note that this might be quite different from those who actually provide assistance. The distinction is important because the health and well-being of the older persons is likely affected by both the quality of care they receive and whether the caregivers are those whom they prefer to be providing care.

The results clearly illustrate the principles of the life course framework (Bengtson et al., 2005; Elder, 1977, 1983; Elder et al., 2003), especially the notion of linked lives. Rural older Thais have a clear hierarchy of preferred caregivers, but they also recognize that a preferred caregiver might not be available. And so they have contingency plans which involve more distal kin, neighbors and the local Buddhist temple.

We find clear evidence that preferences are influenced by social norms evident in contemporary rural Thailand. First, gender-specific tasks are evident. Second, the value of familial responsibility reinforces the expectation of filial care from children. Third, if support is required to be delivered frequently or within a relatively short time period, residential patterns, especially culturally influenced post-nuptial residence patterns of adult children, are important in their preference.

Our results, that the older persons prefer daughters for meal preparation and personal care, are consistent with other findings that daughters tend to be involved in parent care (Lee, Dwyer, & Coward, 1992) and are more likely to help with indoor chores and personal care, while sons are more likely to help with home maintenance (Brewer, 2001; Rathbone-McCuan, 1985). In addition to gender, kinship closeness is important as the older persons prefer their son rather than granddaughter as the second option.

In Northeast Thailand, post-nuptial residence patterns have followed matrilocal residence norm (Limanonda, 1979; Podhisita, 1984; Yoddumnern-Attig et al., 1992) as described previously. This residential pattern makes parental care easier for daughters who co-reside or live in close proximity. Not surprisingly, elderly parents mentioned their daughters in many cases of need.

Filial responsibility for taking care of their elderly parents is found for adult children across a variety of cultures (Lee, Parish,

Table 3

Kin preferences of Thai older persons for assistance and support.


Meal preparation

Personal care


Financial support





Emotional support




Granddaughter Grandson

& Willis, 1994; Mason, 1992; Ofstedal, Knodel, & Chayovan, 1999; Spitze & Logan, 1990; Sung, 2001). Consistent with the finding, it is common in Thai culture that elderly parents expect to receive support from their children (Knodel, Saengtienchai, & Sittitrai, 1995).

In addition to social norms, demographic and socioeconomic factors are an important issue. Fertility is a significant factor affecting the availability of adult children in Nang Rong (Rittirong et al., 2013). Due to increased contraceptive prevalence in Thailand during the period of fertility decline 1970-1987 and changing fertility preferences (Prasartkul et al., 2011), the total fertility rate dropped to very low level at 1.5 in 2012 (Institute for Population and Social Research, 2012). Reinforced by high urban-rural migration among adult children (Chamratrithirong, 2007), fewer children available in a family creates constraints on the availability of caregivers for elderly parents living in rural areas. The current demographic situation (low fertility and rural-to-urban migration) suggests that it may be more difficult in the future for elderly rural Thais to receive help from their preferred caregivers.

Technology eases the communication between parents and migrant children compared to earlier decades (Knodel, Kespichayawattana, Saengtienchai, & Wiwatwanich, 2010; Knodel & Saengtienchai, 2007). Although some types of support require providers to be living nearby, emotional and financial support can be delivered from afar. Cell phones and service charges are affordable in general. The proportion of households owning telephones and/or mobile phones was 0.03 in 2000. By the time of this study in 2012, cell phones could be found in almost every village household. Due to the reasonable price of cell phones and service, most older individuals or their households own a cell phone. The device may cost less than 30 U.S. dollars and there is no charge when answering calls. A prepaid credit of about 5 U.S. dollars can last one year. For financial support, money transfer is served at the post office and bank with reasonable fee in Thailand. Despite the affordable communication cost, elderly parents prefer to ask for assistance from someone living nearby rather than to contact those far away.

Community services are also important. The availability of resources within the village was recognized. For example, older persons commonly thought of their community free transport for emergency when asked about their transportation preference. In addition, neighbors are the option frequently mentioned. In rural villages in Nang Rong district, people consider their neighbors as their relatives even if the neighbors are neither blood relatives nor relatives by marriage. Their social closeness developed since they moved to this area as frontiers around 1950s.

The results clearly show the importance of incorporating the task-specific model of care provision (Iecovich et al., 2004). The preferred caregiver varied across tasks. Females were preferred for meal preparation because they were perceived to be better cooks and for personal care because they were thought to be gentler. On the other hand there was no gender preference for transportation or financial assistance.


This research received financial support from The Royal Golden Jubilee Ph.D. Program, The Thailand Research Fund

(PHD/0049/2552). We would like to thank elderly participants for informative focus group discussion. We greatly appreciate the valuable guidance provided by colleagues of Institute for Population and Social Research, Mahidol University. Our special thanks to Chai Podhisita, Bencha Yoddumnern-Attig, and Suchada Thaweesit for suggestions on qualitative methods, and to Sara Curran, Kerry Richter, and Aphichat Chamratrithirong for comments on an earlier draft of this paper.


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