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Kerala is one of the states in India that has undergone a rapid demographic transition. Due to its low fertility and mortality rates, Kerala reportedly has the highest proportion of older people in its population in India. In addition, large-scale internal and international migration of the younger age groups (about 10 per cent of the population) has left many households without an adult member. This has potentially serious implications for care and living arrangements for older people in Kerala. Using an extensive longitudinal panel (2004–19) of older adults, this chapter explores how living arrangements have changed among older adults in Kerala; how the changes in family size influences the living arrangements; and examines whether this change in living arrangements or household size is associated with changes in the health and survival status of older adults. The results show that a high proportion of the population aged 60 and over in Kerala still live with their family members. The study also found that older persons who live with one other person had a lower chance of dying, while those who lived with five or more household members had an increased risk of mortality. This finding remained even after adjusting for daily living activities score, health perception, sex and age. These results are interesting and raise some crucial questions about the assumptions around the impact of demographic change on older adults in Kerala and India more widely.
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