Cross-sectional and repeated surveys from household components of Demographic and Health Surveys in sub-Saharan Africa were examined to determine whether household composition indicators for older adults (N = 52,573), involving offspring and grandchildren, correlated with national levels of AIDS mortality. One in 4 was living with a grandchild whose own parents were absent. Absence was a result of residence elsewhere and parents being deceased. Older adults in countries with a high accumulation of AIDS mortality were more likely to live in a skip-generation household and with a double-orphaned grandchild and less likely to live in a 3-generation household. Change in living arrangements toward skip generation and a double orphaned household was experienced in countries with high accumulation of AIDS mortality.