The theme of the United Nations International Day of Older Persons on October 1, 2026, is The Age of Longevity: Rethinking Systems for Longer Lives. For Kerala, the theme has particular relevance. The state is further along the ageing curve than most of India and will have to redesign public policy around a population that is living longer, while facing higher healthcare and care needs.
The share of Kerala’s population aged 60 and above was projected at 16.5% in 2021, compared with 10.1% for India, and is expected to reach 22.8% by 2036. By then, older people will account for a larger share of Kerala’s population than its young population.
The demographic transition reflects longer life expectancy, sustained low fertility and the migration of younger adults in search of employment. It is also changing household structures. More older people, particularly women, are likely to spend part of their later lives without the support of an adult child living nearby. The policy implications extend well beyond pensions and hospitals.
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Kerala also faces a substantial burden of chronic disease among older people. Analysis of LASI data found that 59.2% of older adults in Kerala had multimorbidity, compared with 32.1% nationally. The burden rises with age and is particularly relevant to a state where the demand for continuing care is already high.
Kerala has important institutional assets with which to respond. Community-based palliative care, Vayomithram, strong local governments and the state’s emerging institutional architecture for senior citizens provide a foundation. The problem is that these initiatives do not yet amount to a single, adequately financed and accountable ageing strategy.
The state’s response should therefore be organised around a simple proposition: longevity has to be treated as a cross-government policy issue rather than as a programme confined to the health or social justice departments.
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Longevity is changing the policy problem
People are living longer across the world. The number of people aged 60 and above is projected to rise from about 1.2 billion in 2025 to 2.1 billion by 2050, according to the United Nations. The fastest growth is occurring among the oldest age groups.
Longer lives are an achievement, but additional years of life do not automatically translate into additional years of good health. The gap between lifespan and healthspan has major consequences for families, healthcare systems and public finances. It also changes the nature of care. A health system designed largely around episodes of acute illness is poorly suited to people living for decades with several chronic conditions.
The same demographic change affects employment, housing, transport, social protection and local government. An older person who cannot safely reach a health centre, use public transport, manage a digital service or remain in a home that has become physically unsuitable faces a policy failure that cannot be attributed to the health system alone.
The UN Decade of Healthy Ageing, which runs from 2021 to 2030, places age-friendly environments, combating ageism, integrated care and long-term care at the centre of the international response. WHO’s age-friendly framework similarly recognises that the places where people live can either support or undermine their ability to remain healthy and independent.
For Kerala, this means that the ageing agenda should be built into routine government planning, including the People’s Plan process and local infrastructure decisions.
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Towards an ageing strategy for Kerala
The first requirement is institutional. Kerala should consider a comprehensive law on the rights and welfare of older persons, supported by an Elderly Budget that identifies expenditure on older people across departments and local governments.
The proposed institutional architecture should give the Department of Senior Citizens Welfare a coordinating role, while bringing together health, social justice, local self-government, housing, labour and finance. Every local self-government institution should have a designated mechanism for ageing-related planning and monitoring.
The state also needs a better ageing information system. Data should be routinely disaggregated by age groups such as 60–69, 70–79 and 80+, as well as by sex, disability, living arrangement and district. Where appropriate, it should also capture social and economic disadvantage. Kerala cannot design services for a rapidly changing older population if it does not know where older people live, how they live and what support they require.
The WHO age-friendly framework offers a practical structure for local governments. Its eight domains cover outdoor spaces and buildings, transport, housing, social participation, respect and social inclusion, civic participation and employment, communication and information, and community support and health services.
These principles can be incorporated into the People’s Plan rather than treated as a separate international programme. Kerala’s local governments already have the institutional reach to adapt public spaces, improve mobility, strengthen community services and identify vulnerable older residents.
Making everyday life safer
Age-friendly policy is often reduced to ramps and handrails. Those are necessary, but the objective is broader: enabling older people to continue living independently for as long as possible.
Public buildings, hospitals, panchayat offices and other public facilities should meet accessibility standards. Footpaths need to be usable by people with reduced mobility. Public spaces require adequate seating, lighting and toilets. A statewide falls-prevention programme could combine strength and balance exercises, home-safety assessments and medication reviews.
Public transport also needs to be designed around the realities of older passengers. Low-floor buses, priority seating and staff training can make routine travel safer. In rural and hilly areas where conventional bus services are inadequate, local governments could support community transport to health centres, markets and other essential services.
Housing is equally important. Grants through existing state and local programmes could help older households adapt bathrooms, entrances and other parts of their homes. Regulation of retirement and assisted-living facilities will become increasingly important as family-based care becomes less reliable.
The state should pay particular attention to older people living alone. A local system that identifies those who need regular contact or emergency assistance could link them to health workers, community organisations and local government services without turning surveillance into the default form of social care.
Health care must move closer to the home
Kerala’s high prevalence of multimorbidity makes fragmented disease-specific care increasingly inadequate. The primary healthcare system should therefore adopt an integrated approach to older people’s needs.
WHO’s Integrated Care for Older People framework provides a basis for assessing mobility, nutrition, vision, hearing, cognition and psychological well-being, along with other aspects of intrinsic capacity. It is designed to connect assessment with person-centred care and referral rather than treating each condition in isolation.
Family Health Centres could incorporate such assessments into routine care for older patients, with referral pathways to district-level geriatric services. Medication review and management of multiple chronic conditions should form part of this system.
Long-term care needs similar attention. Kerala’s community palliative-care networks and Vayomithram provide a starting point for a continuum that includes home-based care, respite services, day care and regulated residential care.
The workforce is central to this transition. Paid care workers need training, decent working conditions and predictable remuneration. Family caregivers, many of them women, also need training, respite and financial support. A system that assumes families will absorb every increase in care needs will eventually shift the cost to women within households.
Dementia should be treated as part of this emerging care system rather than as a specialist issue. District-level memory clinics, early detection through primary care and support for caregivers can reduce the burden on families and improve the quality of care.
Older people need income, rights and a voice
Longevity also exposes weaknesses in India’s labour and social protection systems. Older workers who have spent much of their lives in informal employment often reach old age without adequate contributory pensions. Women are particularly vulnerable because lower lifetime earnings, unpaid caregiving and longer life expectancy can compound financial insecurity.
Kerala’s welfare pensions therefore need predictable and timely payments, with better identification of eligible people who remain outside existing schemes. Health coverage for older people should also address the recurring outpatient and medicine costs associated with chronic illness.
Protection from abuse is another essential component. Maintenance Tribunals under the Maintenance and Welfare of Parents and Senior Citizens Act, 2007 need to function effectively. Police, banks and health workers should be trained to recognise financial exploitation and other forms of elder abuse. The state machinery responsible for senior citizens should have the capacity to monitor these protections rather than leaving older people to navigate them individually.
Participation is equally important. Older people should have a formal voice in local planning through Gram Sabhas and other community institutions. Libraries, day-care centres, cultural groups and senior citizens’ forums can provide opportunities for social participation. Lifelong learning and flexible employment can allow people who wish to remain economically or socially active to do so.
Digital inclusion deserves similar attention. Government services increasingly require online interaction, but digital access cannot be treated as equivalent to digital capability. Information about pensions, healthcare and welfare services should remain available in accessible Malayalam and through assisted channels. The Elder Line 14567 should be better connected to local support services.
A rights-based approach to longevity
The international debate on ageing is also moving towards a stronger rights framework. The Madrid International Plan of Action on Ageing, adopted in 2002, remains a central international instrument. In April 2025, the UN Human Rights Council adopted Resolution 58/13 establishing an open-ended intergovernmental working group to elaborate a legally binding instrument on the human rights of older persons.
The significance for Kerala is practical. Ageing policy should not be confined to welfare provision. Older people are citizens with rights to health, income security, participation, mobility, protection and dignity.
Kerala has many of the institutions needed to make such an approach work. Its local governments, primary healthcare network, community organisations and experience with decentralised planning give it advantages that many ageing societies lack.
The challenge is to connect these strengths. Kerala does not need a new programme for every dimension of ageing. It needs a system in which existing programmes work towards a common objective, are funded over time, generate usable data and can be held accountable at the local level.
The test of an ageing policy should ultimately be whether an older person can remain healthy, financially secure, mobile, socially connected and protected from abuse without having to navigate a maze of disconnected institutions. As Kerala’s population grows older, that is becoming a test of the state’s public systems as a whole.