<p>In response to population ageing, many countries and regions, including Kerala state in India, have pledged to make their societies as age-friendly to ensure the healthy ageing of their older citizens. The decentralized local governments in Kerala have been given the mandate to undertake interventions for healthy ageing with support from sectoral stakeholders like the health and social justice departments and several initiatives have been attempted. These initiatives reportedly attempt to be participatory and inclusive in line with the spirit of the democratic decentralization initiatives of the state. We tried to study the phenomenon of civic participation of elderly for healthy ageing initiatives in Kerala using a parallel convergent mixed method study design. The document reviews suggested varying successes and gaps in efficiency of spending allocated funds for ageing initiatives. Secondary data based on the Longitudinal Ageing Study in India Wave I (2017–18) suggested poor social participation levels, particularly of older women. We collected primary quantitative data and qualitative data to describe the health and social vulnerabilities of older persons and the approaches undertaken in a recent initiative for neighbourhood groups for the elderly in Kerala. We used photovoice and in-depth interviews to describe the ageing experience of older people in residing in rural Kerala. The policy and programme initiatives are not aligned with the people’s actual needs and the current age-friendly initiatives are falling short in creating truly inclusive democratic spaces for older people to participate and create healthy ageing neighbourhoods and communities.</p>