In India’s southern state of Kerala, 70-year-old TO Dominic starts most of his days with a phone call to one of his sons.
One of them lives in the neighbouring Karnataka, the other in the Middle East. Both left home some years ago in search of better employment opportunities, leaving him and his wife MJ Martha to manage on their own.
The calls are comforting, revolving around familiar topics such as health and the weather. But when the couple need help at home, it is not their sons who can provide it.
Their predicament is becoming increasingly common in Kerala, India’s fastest-ageing state, where migration has left growing numbers of elderly people living alone.
Last month, the state government announced a dedicated department for elderly welfare, which officials say is the first of its kind in India, to address the challenges of an ageing population.
“We depend entirely on our neighbours,” Dominic says, sitting in the house that was once filled with the chatter of children but where he now often sits in silence.
“Our children visit very rarely and we don’t have relatives nearby to assist us. Things are becoming increasingly difficult.”
Seated next to him, Martha says loneliness has become an increasingly common part of growing old.
Their story is not an isolated one.
For generations, elderly Indians lived with their children and depended on them for care. But migration for work and education has steadily weakened that tradition, particularly in Kerala, India’s fastest-ageing state, where the government is now trying to respond.
The new department’s strategy is centred on “ageing in place” – helping older people remain in their homes and communities rather than moving into institutions, says its head, Dr Rathan Kelkar.
The plans include expanding community and home-based care, and introducing “social prescribing”- connecting older people with meaningful social activities.