How do limited familial ties and community relationships shape health-seeking in older adulthood? Evidence from Indonesia.

OBJECTIVES

In many low- and middle-income countries, older adults rely on family and community networks for health care, yet little is known about how limited familial ties shape their health-seeking behaviors. Given that Indonesia has the world's 4th-largest population that is rapidly aging, this study examines how different dimensions of limited familial ties (spousal absence, solo-living arrangements, geographical separation from adult children, parent-child disconnection) are associated with health-seeking practices among older Indonesians, and whether community engagement and trust moderate these relationships.

METHODS

Using data from Wave 5 of the Indonesia Family Life Survey (N = 2,809 adults aged 60+), we apply latent class analysis to identify distinct health-seeking profiles. Multinomial logistic regression models assess associations between family ties and health-seeking profiles and test interaction effects with community engagement and trust.

RESULTS

We identify 4 distinct health-seeking profiles: Limited, Basic Routine, Traditional, and Comprehensive. Spousal absence is associated with lower engagement in basic routine health-seeking. Living alone with children nearby is associated with more limited health-seeking, whereas parent-child disconnection is linked to greater likelihood of comprehensive health-seeking. While community trust partially compensates for weak familial ties, community engagement may exacerbate gaps in health-seeking among older adults with varying levels of kin availability.

DISCUSSION: Health-seeking behaviors in later life reflect complex interactions between kin availability, relational dynamics, and community context. Reliance on community relationships to mitigate gaps created by absent kin should be approached with caution. Policies should support inclusive, culturally grounded health interventions that account for diverse family structures and care practices.