The decision taken at the first Cabinet meeting of the new UDF government in Kerala to set up a separate Department for Senior Citizens’ Welfare has been hailed as timely – if not overdue – for a State where 18.7% of the population is already above 60 years, compared to the national average of around 11-12%.

Kerala is ageing faster than any other State and by 2036, the figure is projected to cross 22%.

The outgoing LDF government had already acknowledged this – the 2026-27 State Budget placed strong emphasis on the care economy and the silver economy. Kerala again was the first State in the country to present a dedicated Elderly Budget, setting aside ₹46,236.52 crore for senior citizens’ welfare initiatives, accounting for 19.07% of the total 2026-27 Budget outlay.

The Economic Review 2025 said that the old-age dependency ratio (defined as the number of old people per 100 working population in the 15-59 year group) is currently at 26.1%, against a national average of 15.7%. In another decade, this is estimated to increase to 34.3% against a national average of 20.1%.

Female dependency ratios are consistently higher than male figures, reflecting the feminisation of ageing.

“Among those above 60 years, widowers account for just 9.7 %, while widows constitute 58.6 %. Women living alone in this situation face a host of challenges including property rights disputes and social and cultural discrimination. A dedicated division and mechanism must be established within the Senior Citizens’ Department to address their specific social and health concerns,” says B. Ekbal, public health expert.

In Kerala, ageing and social transformation challenges, such as issues of isolation and poor mental health of the elderly, are also overshadowed by the staggering burden of chronic multimorbidities among the aged.

NCD burden

Kerala enters the ageing transition already carrying one of the heaviest non-communicable disease (NCD) burdens in India. An ICMR-INDIAB study suggested the prevalence of diabetes in adults at about 24% and that of hypertension at a staggering 43%. In those above 55 plus years, the prevalence of HT was 68.9%.

A 2022 cross-sectional study in Malappuram, published in PLOS ONE, found that the prevalence of multimorbidity was 39.8% across primary care settings in Kerala. All domains of quality of life were impaired in individuals with multimorbidity, while treatment burden increased sharply.

A more recent 2024 study in Ernakulam district, published in Frontiers in Public Health, reported that multimorbidities due to lifestyle diseases was prevalent in 42.6% of individuals aged 40 years and above. Uncontrolled hypertension and diabetes can progress into chronic kidney disease, heart failure and stroke complications, requiring specialist intensive care and pushing up healthcare costs steeply.

A paradox

The paradox is that Kerala already spends more on healthcare than any other State, at 5.2% of the GSDP. Yet, 59% of this is out-of-pocket expenditure. In a State where the private sector dominates when it comes to inpatient care, the prospects of a chunk of the population requiring continuous medication and frequent hospitalisations can push families into the realm of catastrophic health expenses

Elderly care and welfare initiatives in Kerala have long been fragmented across Health, Social Justice, Local Self-Government and Finance departments, with no cohesion or accountability. A dedicated department should consolidate geriatric health policy, long-term care frameworks for the elderly, palliative care, caregiver and rehabilitation infrastructure and initiatives for productive ageing under one umbrella

“A range of schemes currently implemented across various departments for the elderly includes old-age homes, day-care centres, Vayomithram, Vayo Amrutham, Sayamprabha, Vayoraksha, ‘Mandahasam’ (which provides free artificial dentures), and ‘Sallapam’ (a telephone friendship initiative to combat isolation). All of these must be rigorously evaluated through social auditing to determine whether their stated objectives are being met,” Dr. Ekbal says.

Urgent steps must be taken to address shortcomings and reorganise all these schemes under the new department with greater efficiency, he adds.