'Care Beyond Co-Residence': A Qualitative Exploration of Emotional and Instrumental Care Gaps Among Older Adults in Migrant Households of Kerala.

The convergence of youth migration and the nuclearization of families has altered conventional living arrangements in India, indicating a sharp rise in the number of families in which older adults live alone due to the outmigration of their adult children. This study aims to explore the perceptions of left-behind older adults regarding long-distance care practices by their adult children and to describe the practical and functional care deficits that lead to vulnerability and unmet mental health care in migrant households. Twenty older adults above 65 years of age living alone or with a spouse for at least one year due to the out-migration of their adult children were selected purposively. The analysis revealed that distance from migrant children makes older adults feel anxious, miss their family togetherness, and experience increased loneliness and care gaps in later years, contributing to a multifaceted causality of vulnerability while aging alone. Narratives of distance care are often shaped by the bidirectional flow of care across generations through virtual and in-person means, where emotional and functional deprivations continue to challenge the quality of informal distant care among left-behind older adults. Mental health promotion among community-dwelling older adults is crucial for sustaining their functional capacity, thereby delaying psychological morbidities during aging.