The newly elected Congress government in Kerala has announced the formation of a department for the elderly people, the first such initiative in India. At present, the welfare of the aged comes under the state’s Social Welfare department.Here’s what to know about the initiative and how Kerala’s changing demographic profile prompted the move.Kerala is going through a critical phase of demographic transition. With its demographic profile similar to East Asian and European countries, Kerala is India’s most rapidly ageing state. As per the Elderly in India Report of 2021, around 16.5% of the state’s population is aged above 60 and is expected to touch 20.9% of the total population by 2031 compared with the all-India figure of 13.1%.The old age dependency ratio — the number of the aged per 100 persons of working age group — has risen from 19.6% in 2011 to 26.1% in 2021. This figure is expected to go up to 34.3% by 2031. According to state government data, the number of residents in old age homes in Kerala has increased from 19,149 in 2016-17 to 37,895 in 2024-25.Three reasons are contributing to Kerala’s rapid ageing. Over the years, Kerala’s total fertility rate (TFR) — the average number of children that are born to a woman over her lifetime — has declined and is now 1.35 children per woman in 2023 as per the state’s Vital Statistics data. This is below the national replacement level of 2.1, which indicates the rate required for a population to replace itself across generations.The life expectancy has increased in Kerala owing to better healthcare facilities.Also read | Shashi Tharoor writes: Kerala must show how an ageing population can thriveBesides, many in the working age population migrating abroad en masse has turned Kerala into a land of the grey. A major chunk of those who migrate to non-West Asian countries settle there, leaving their aged parents back home. So, there is a large proportion of senior citizens in Kerala, with many households having only aged parents.Story continues below this adAt the same time, a large-scale return of migrants from West Asia after they no longer are of working age adds to the state’s elderly.Geography and demographyThe India Ageing Report of 2023 said that around 17.5% of Kerala’s rural population comprised individuals aged 60 and above, compared with 15.4% in urban areas. The density of aged people in rural areas is mainly attributed to outmigration of the working age population in search of employment. There are more elderly women than men, especially in advanced ages: sex ratio among those 80-plus is 1651 women per 1000 men.Also read | India’s demography at crossroads: Elderly may outnumber the youthThe difference in life span is another factor, with female life expectancy is estimated at around 78.4 years, while that of men is 71.9 years. This has created a large number of women — many of them widows — who live alone without much social and financial support. The data on MGNREGS shows that 88-90% of Kerala’s workforce are women, while the corresponding national average is around 55-59%. Among MGNREGS workers in Kerala, around 38% are aged between 61 and 80 and there is another 1% above 81, which indicates the financial distress of the state’s aged.Health of the elderlyAs per the Longitudinal Ageing Study in India Wave 1 (2017-18), over 70% of Kerala’s elderly suffer from at least one chronic ailment, with hypertension, diabetes, arthritis, and cardiovascular diseases most prevalent. The India Ageing Report 2023 said that nearly 1 in 4 older adults in Kerala exhibit symptoms of psychological distress. The Kerala State Initiative on Dementia (Smruthipadham) estimates that approximately 4.86% of persons aged 65 and above are affected. This calls for expansion of dementia care services, caregiver training, and public awareness to counter stigma and ensure early diagnosis.Story continues below this adIn 2025, Kerala formed a first-of-its-kind State Elderly Commission, a quasi-judicial forum for protecting the rights and welfare of senior citizens. Around 75% of the aged population is covered under welfare pension schemes.NewsletterFollow our daily newsletter so you never miss anything important. On Wednesday, we answer readers' questions.SubscribeKerala has already launched certain community initiatives such as Vayomithram (mobile medical care) and Samayaprabha (daycare). The Kerala Care Palliative Grid has been formed in collaboration with the Digital University Kerala to coordinate palliative care. All voluntary organisations and associations in the field of palliative care are part of the grid. Around 1.5 lakh bedridden people and another ailing 4 lakh are getting care from a palliative care grid, which includes 1,387 government institutions and 1,227 NGOs. The resource challenge aheadThe growing graph of senior citizens has thrown up challenges for Kerala in the health and service sectors, mainly on shifting its focus to geriatric care. This requires nurturing a care economy in the state.In 2023, the Directorate of Health Services had found that the state has around 120 geriatricians, 600 nurses trained in elderly care, 400 physiotherapists, and 50 occupational therapists. To meet projected service needs and align with the World Health Organization’s recommended multidisciplinary care model, Kerala should have a workforce of nearly 300 geriatricians, 1,500 nurses, 900 physiotherapists, and 250 occupational therapists by 2030.