Cambodia Elderly Survey
The Survey of Elderly in Cambodia (SEC), conducted in 2004, involved data collection from a representative sample of 1,273 adults aged 60 and older living in Cambodia. It was supported by grants from the National Institute on Aging and from UNFPA Cambodia. The data collection and subsequent analyses was led by Dr. John Knodel at University of Michigan and Dr. Zachary Zimmer currently at Mount Saint Vincent University in Canada. The lead researchers were assisted by Kiry Souvan Kim and Sina Puch of the Department of Sociology at the Royal University of Phnom Penh. Until the time of the survey, relatively little if any systematic data had been collected on Cambodia’s older population. Consequently, one chief purpose of the survey was to provide a basic but comprehensive cross-sectional demographic, social, economic, and health profile of Cambodia’s older population. This profile was published in a report commissioned by UNFPA Cambodia (Knodel et al. 2005).
While the SEC questionnaire included a number of standard survey components that tend to be the focus of general studies of older-aged populations, such as those that garner information on household composition, socioeconomic standing, and physical well-being, older Cambodians at the time were dealing with some unique circumstances, and efforts were taken to include survey questions to cover topics that were distinctive to this population. First, older-aged Cambodians lived through an exceptionally traumatic period of history during their earlier adult years. They were all survivors of the Khmer Rouge takeover in 1975 and the Khmer Rouge rule that lasted until 1979. During that period of upheaval, political violence, severe food shortages, and lack of medical care resulted in an estimated 1.5–2 million deaths constituting as much as a fourth of the total population (Heuveline 1998; Kiernan 2003). Many of those who died were the sons, daughters, and spouses of the older-aged population. Some questions on the SEC were included to capture the impact of the dramatic political history that may have influenced the lives of older Cambodians. Second, although declining, Cambodia was experiencing the highest AIDS prevalence rates in Asia. Adult AIDS prevalence peaked at 3% in 1997 (UNAIDS 2006). Many who were infected and died were adult sons and daughters of the older population, and older persons were frequently primary caregivers for their HIV-infected children. Some questions on the SEC were meant to assess the influence of illness and death of adult children and awareness and knowledge of older persons regarding AIDS, especially as related to caregiving to HIV-infected persons.
The SEC sample came from the six most populous provinces of Cambodia, which combined included more than 50% of the national population. These were, in the order of population size: Kampong Cham, Kandal, Phnom Penh, Prey Veng, Battambang, and Takeo. Sampling was conducted by a multistage cluster proportionate to size design that involved stratified selection in the following manner: selection of districts within provinces, selection of communes within districts, selection of villages (PSUs) within communes, selection of two adjacent enumeration areas (EAs) within villages, random selection of 25 households within the 2 EAs, and selection of one older person within households. (Due to its smaller geographic size, in Phnom Penh, the sampling began at the stage of selecting villages). The sample was drawn with the assistance of staff at the National Institute of Statistics (NIS). NIS also provided staff who enumerated households that contained an older person within EAs, working from maps that were hand-drawn during the 1998 Cambodian Census.
Fieldwork took place in three stages; the first was in April 2004 with data collection in Phnom Penh. The second was in July and August 2004 with data collection in five provinces. The third was supplemental fieldwork undertaken in August and September 2004, again in Phnom Penh. The final sample included 800 respondents from rural areas in the 5 provinces and 473 from the city of Phnom Penh. This meant that Phnom Penh was oversampled, which was done to increase the number of urban residents in the survey. The overall response rate was 91.5%; 84.6% in Phnom Penh, and 97.9% in the other 5 provinces.
The final dataset includes weights that can be used to make the sample representative of the population 60 and older in Cambodia at the time of the survey. Weighted statistics indicated that the basic characteristics of the sample, such as age, sex, and marital status distributions, resembled closely characteristics of those aged 60+ from previous nationally based enumerations such as those collected by the 1998 Cambodian Census and the 1999 Socioeconomic Survey.
Results from the SEC are available in the main report (Knodel et al. 2005) as well as in several academic papers published by the lead researchers and colleagues. Some of the more interesting findings follow. The Cambodian older-aged population in 2004 had an unusual sex ratio favoring females, a function of high mortality rates of males during the Khmer Rouge period. As a result, a large proportion of older Cambodian households were female headed. The Cambodian population of older adults in 2004 was found on average to be living with very low socioeconomic conditions. For instance, they were characterized as having minimal wealth, with a substantial proportion living in poverty, and very few having any schooling or literacy. Schooling levels and literacy rates were however much higher for males versus females; about 28% of males were totally illiterate compared to about 80% of females (Knodel et al. 2005). The health status of older Cambodians was found to be, on average, much worse than other populations of older persons in the region. For instance, the prevalence of disability as measured by Activities of Daily Living was found to be as much as twice as high as that found in surveys in Myanmar, Indonesia, Philippines, and Thailand (Zimmer 2006). Older-aged parents in Cambodia were found to commonly play a key role in the care of their grown sons and daughters living with AIDS; however, knowledge of HIV/AIDS was found to be relatively low while willingness to care for their ailing children was found to be strongly related to knowledge (Knodel and Zimmer 2007). A large percentage, about 43%, of older Cambodians were found to have experienced the death of a child during the 4-year Khmer Rouge period (Zimmer et al. 2006). Moreover, a large majority of these deaths were reported to have been caused by violence. While these events are no doubt traumatic, the analyses could not find much association between deaths of children during the Khmer Rouge period and living arrangements, levels of support or economic well-being at the time of the survey.
SEC notwithstanding, Cambodia’s older population remains understudied with no national representative surveys focused on them having taken place since SEC. SEC data remain available for academic analysis. Interested parties should contact Dr. Zachary Zimmer at Mount Saint Vincent University in Canada for information on accessing the data.
- Knodel J, Zimmer Z (2007) Older persons’ AIDS knowledge and willingness to provide care in an impoverished nation: evidence from Cambodia. Asia Pac Popul J 22(1):11–28Google Scholar
- Knodel J, Kim KS, Zimmer Z, Puch S (2005) Older persons in Cambodia: A profile from the 2004 Survey of Elderly. UNFPA Cambodia and Royal University of Phnom Penh. UNFPA and RUPP, Phnom PenhGoogle Scholar
- UNAIDS (2006) 2006 report on the global AIDS epidemic. UNAIDS, GenevaGoogle Scholar