Midlife Years Research Articles

A biological age based on common clinical markers predicts health trajectory and mortality risk in dogs.

Predicting aging trajectories through biomarkers of biological aging can guide interventions that optimize healthy lifespan in humans and companion animals. Differences in physiology, genetics, nutrition, and lifestyle limit the generalization of such biomarkers and may therefore require species-specific algorithms. Here, we compared correlations of standard clinical blood parameters with survival probability in humans with those of the two most common mammalian companion animals, cats and dogs, and highlighted universal and species-specific relationships. Based on this comparative analysis, we generated and validated an algorithm that predicts biological age in canines using a longitudinal dataset with health records, blood count, and clinical chemistry from 829 dogs spanning over 12years. Positive deviations of biological from chronological age (AgeDev) measured by this composite score significantly correlated with a decreased survival probability (hazard ratio = 1.75 per 1year of AgeDev, p = 3.7e - 06). Importantly, in nearly half of the dogs whose biological age was accelerated by more than 1year, none or only a single individual marker scored outside its respective reference range, suggesting practical applications for the detection of unfavorable health trajectories. Analyzing samples from a unique 14-year life-long diet restriction study, we show that restricted caloric intake lowers biological age, an effect that can be quantified at midlife years before a difference in survival is observed. Thus, a biological age clock based on clinical blood tests predicts the health trajectories of dogs for use in research and veterinary practice.

Education differences in blood pressure trajectories by sex through midlife: Findings from the National Health and Nutrition Examination Survey, 1999-2018.

Although it has long been established that age and sex play a role in blood pressure levels across the lifespan, the extent to which educational attainment moderates these relationships has been understudied. Thus, the purpose of this study was to assess educational differences in SBP, DBP, and pulse pressure (PP) trajectories among men and women through the midlife years. We conducted an analysis of pooled data from the 1999 to 2018 National Health and Nutrition Examination Survey to assess whether education moderates blood pressure measurements among men and women over the midlife years. Statistical analyses were performed using survey-weighted linear and quadratic regressions to assess these trajectories. During midlife, women with at least a college degree maintained the lowest average level of SBP compared to men at all education levels and women with a high school diploma or less. They also maintained the lowest level of PP, though not different from men with at least a college degree and women with less than a college degree. However, no educational differences were observed in DBP between men and women during the midlife years. Our study shows clear delineation in the trajectories of PP and SBP by education such that a 4-year education is more protective than some college and a high school degree, particularly among women. These results highlight the need to consider upstream policy interventions (education policy initiatives) that could reduce population-wide elevated blood pressure.

Pregnancy complications and new-onset maternal autoimmune disease.

Autoimmune diseases disproportionately impact women and female-specific aspects of reproduction are thought to play a role. We investigated the time-varying association between pregnancy complications and new-onset autoimmune disease in females during the reproductive and midlife years. We conducted a population-based cohort study of 1704553 singleton births to 1072445 females in Ontario, Canada (2002-17) with no pre-existing autoimmune disease. Pregnancy complications were preeclampsia, stillbirth, spontaneous preterm birth and severe small for gestational age (SGA). Royston-Parmar models were used to estimate the time-varying association between pregnancy complications and a composite of 25 autoimmune diseases from date of delivery to date of autoimmune disease diagnosis or censoring at death, loss of health insurance, or 31 March 2021. Models were adjusted for baseline socio-demographics, parity and comorbidities. At 19 years (median = 10.9 years of follow-up), cumulative incidence of autoimmune disease was 3.1% in those with a pregnancy complication and 2.6% in those without complications. Adjusted hazard ratio (AHR) curves as a function of time since birth were generally L-shaped. Universally, risks were most elevated within the first 3 years after birth [at 1 year: preeclampsia AHR 1.22, 95% confidence interval (CI) 1.09-1.36; stillbirth AHR 1.36, 95% CI 0.99-1.85; spontaneous preterm birth AHR 1.30, 95% CI 1.18-1.44; severe SGA AHR 1.14, 95% CI 0.99-1.31] and plateaued but remained elevated thereafter. Prior history of pregnancy complications may be an important female-specific risk factor to consider during clinical assessment of females for possible autoimmune disease to facilitate timely detection and treatment.

Family strain, but not family support, is linked to worse pain interference among midlife adults reporting new chronic pain.

Although family relationship quality has been linked to later chronic pain incidence for aging adults, it is unclear whether the quality of these relationships is linked to the impact of pain. We estimated longitudinal associations between family relationship quality (i.e., family support and family strain) and pain interference for adults who develop novel chronic pain across 10 years of midlife. We conducted a secondary analysis of data from the Midlife in the United States (MIDUS) study. Using path analysis, we tested whether family support and strain reported by participants (54% female, age M = 54.8 years) who denied having chronic pain at the study's second wave (MIDUS 2, 2004-2006) but reported chronic pain 10 years later (MIDUS 3, 2014-2016; N = 406) was associated with the interference of that pain with daily activities after accounting for key covariates, including sociodemographics, depression symptoms, global physical health, and MIDUS 3 reports of family support and strain. The hypothesized model demonstrated good fit to the data based on multiple model fit indices. Greater family strain at baseline, but not family support, was significantly associated with greater pain interference 10 years later. Findings build on prior studies to suggest that not only are stressful family relationships likely associated with the odds of developing chronic pain, but they are also linked to the interference of that chronic pain when it develops. We recommend biopsychosocial screening in primary care that captures family relationship quality and can inform best practices for nonpharmacological, family-based pain management. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Representing Life and Death in Care Institutions: Between Invisible Victims and Suffering Old Women

The article examines the representation and (in)visibility of ageing people in German care institutions during the Covid-19 pandemic. Within the framework of a qualitative content-analytical and discourse-analytical study of 185 articles, including 108 images from German newspapers, the authors trace the patterns behind the representation of ageing people. In so doing, they argue that in the media discourse ageing people are often represented without agency and in a strongly homogenised way as “others.” By emphasising pre-existing conditions and vulnerability, older and disabled people appear naturally at risk. The article also problematises the mere counting of life and death in care institutions, which contributes to a naturalisation and symbolic annihilation of the death of ageing people. Furthermore, the authors identify the notion of the suffering old woman as a key figure in pandemic media discourse, performing a critical function. She embodies an appeal to society to show sympathy and solidarity and to act reasonably with respect to the pandemic measures yet contains no elements of discursive agency or personal characteristics beyond that. Additionally, the suffering old woman reinforces traditional patterns of patriarchal representation. The authors conclude that the pandemic has placed the German care crisis in settings of institutionalised geriatric care into the media spotlight. However, the comprehensive inclusion of ageing people has been absent. Emphasising one’s own ability and thus adapting to the midlife years seems to be the only way to precarious inclusion for ageing people in the discourse.

Impact of novel risk factors of atherosclerosis on severity of coronary artery disease in young Indian patients suffering from Myocardial Infarction

Abstract Funding Acknowledgements Type of funding sources: None. Background Asian Indians are affected at least a decade earlier with cardiovascular diseases (CVD), in their most productive midlife years as compared to people of European ancestry. This is the first study from Indian sub-continent assessing the impact of novel risk factors of atherosclerosis on angiographic severity of coronary artery disease (CAD) in terms of SYNTAX scores in young patients (<40 years) suffering myocardial infarction (MI). Purpose This study was undertaken to evaluate the association of novel risk factors of atherosclerosis with severity of CAD at the index hospitalization in young MI patients. Methods In this single center observational study, 75 consecutive young MI patients were included. Patients having previous CVD, chronic kidney disease, chronic Liver disease and any bleeding diathesis were excluded. Homocysteine, highly sensitive C- reactive protein (hs-CRP) and lipoprotein- a (Lp-a) were measured and correlated with SYNTAX I and SYNTAX II. Results Smoking (85.5%) was the most common traditional risk factor for MI while other traditional risk factors did not have significant effect on severity of CAD in young patients with MI. The mean homocysteine level was 24.43± 10.02 micromole/L, hs-CRP 8.2± 1.44 mg/L and Lp(a) 59± 23.10 mg/dL. The sensitivity and specificity of hs-CRP ³8.5 mg/L for prediction of multivessel disease was 67% and 70% respectively while that of Lp(a) ³ 66.5 mg/dL was 71% and 67% respectively. On further analysis, the sensitivity and specificity of hs-CRP value ³8.5 mg/L for prediction of SYNTAX I score > 22 was 75% and 65% respectively while that of Lp(a) ³ 66.5 mg/dL was 75% and 60% respectively. On multivariate linear regression, hs-CRP was the significant predictor of SYNTAX I score (p=0.03) when adjusted for homocysteine and Lp (a). Conclusions hs-CRP and Lp(a) levels are significantly associated with the severity of CAD in young MI patients. hs-CRP and Lp(a) should be evaluated along with routine risk factors of atherosclerosis in young patients at risk of CAD for early detection, timely management and prevention of major cardiac events.

WOMEN AND CARDIOVASCULAR DISEASES IN INDIA – TIME TO ACT

Cardiovascular diseases (CVDs) are the leading cause of death globally and account for 32% of global deaths. Of these deaths, 85% are due to heart attack and stroke. In India, CVDs accounted for 27% of total deaths in 2017. CVDs affect Indians in their most productive mid-life years compared to later ages of the western population. Early age of onset, rapid progression, and the high mortality rate are particular causes of concern for CVD in India. Globally, ischaemic heart disease accounts for a third of all female deaths and is a cause for concern. Even the Lancet Women and Cardiovascular Disease Commission, 2021 has highlighted cardiovascular diseases as the leading cause of death in women. In India, the proportion of DALYs for CVDs amongst women has changed from 2.9% (in 1990) to 6.6% in 2016. Women are cared only during pregnancy and the immediate post-partum period, in other times their problems are overlooked. The modiable risk factors such as tobacco , alcohol consumption and obesity have increased in women since 2013. The diagnosis of heart disease is often missed out in the Indian women because of their inability to express their ailments openly, compounded by factors like low socio-economic status, lower educational attainment and constrained access to medical care. Estimates suggest that almost 52% of all NCDs can be managed in primary care. The Indian government (GOI) is addressing the preventive aspect of NCDs through Primary Health Care at the Health & Wellness Centers and promote healthy lifestyles by targeted communication and screening at community level especially for the vulnerable, such as the women and elderly. Ayushman Bharat under GOI is being implemented to reduce out of pocket expenditure incurred towards management of non-communicable diseases amongst poor.

POSC142 Cost-Effectiveness of Sacubitril/Valsartan in Heart Failure with Reduced Ejection Fraction Patients in Indian Healthcare Setting

The rising prevalence of heart failure (HF) in midlife years in Indians is posing an economic challenge. Sacubitril/valsartan demonstrated a significant risk reduction of cardiovascular deaths by 20% and HF related hospitalizations by 21% versus enalapril but at a higher cost. We evaluated the cost-effectiveness of sacubitril/valsartan compared with enalapril for the treatment of patients with heart failure with reduced ejection fraction (HFrEF) from the Indian healthcare perspective.

Coping with menopause – Measures that women can take

During menopause, there is a hormonal imbalance that would lead to variety of menopausal symptoms such as hot flashes, weight gain, changes in the body shape, hair loss, hair becomes grayer and coarse, decreased elasticity of the skin, thinning of lining and dryness in the vagina, breast discomfort and urinary incontinence. These menopausal symptoms cause concern and discomfort for these women. It also affects their quality of life. The study aimed to explore the women's sense of body during their midlife years. A phenomenological-heuristic research design used in the study. Eight informants willingly participated in the study under an informal, semi-structured interview with the main question, What are your experiences during midlife? and How did those experiences happened? The transcribed verbatim were analyzed through the use of Moustakas method. The study revealed 7 main themes: (1) I've changed… (2) What is bothering me? (3) Looking back into the windows of the past (4) my weapons for my battle (5) Metamorphosis: A new conquest (6) Dreams: The paramount of my life. The study reflected the entirety of the participant's experiences. This study has shown that living the experience of wellness at menopause can accommodate the experience of change or symptoms. In this way the experience of menopausal change is not disruptive to the woman's continuity of experience, she continues to feel well and to do all the things she wants to do. Further recommendations are needed to enhance the understanding of the lived experience of women regarding their sense of body at midlife.

For Better or for Worse: Health and Marital Quality during Midlife.

Objective: To examine how changes in health are associated with marital quality over a 20-year period of midlife. Background: The health benefit associated with marriage (compared to non-marriage) is well established. Less work has explored how health and changes in a couple's health are associated with the marital relationship. Method: We used a sample of continuously married individuals who participated in three waves of the Midlife in the United States study (n = 1768). Multilevel modeling separated within-person changes and between-person differences in the effect of health on marital quality during midlife and older ages. Results: Marital support was lower and marital strain was higher for those with worse health relative to peers. Marital quality decreased when health decreased. Effects were particularly strong when spouses' health statuses became more discrepant. Conclusion: Health-of both self and partner-plays an important role in determining the marital quality of married persons during the midlife years.

Social Role-Related Stress and Social Role-Related Reward as Related to Subsequent Subclinical Cardiovascular Disease in a Longitudinal Study of Midlife Women: The Study of Women's Health Across the Nation.

The purpose of this study was to determine if midlife social role quality, defined by the stress and rewards associated with four social roles, is related to later-life subclinical cardiovascular disease (SCVD) in a cohort of women transitioning through menopause. The Study of Women's Health Across the Nation (SWAN) is a longitudinal cohort study of midlife women. Stress and reward from four social roles (spouse, parent, employee, caregiver) were assessed at seven early visits. Later-life SCVD was assessed via carotid ultrasound and brachial-ankle pulse wave velocity at two later visits. We tested whether ever reporting an "extremely" or "quite a bit" stressful role was related to SCVD. We also tested whether cumulative stress and reward, as well as baseline and change in stress and reward were related to SCVD, adjusting for demographics and cardiovascular risk factors. Among 1602 women, reporting a stressful role during midlife (between ages 47 and 52 years) was associated with later-life (age 61 years) carotid intima-media thickness, which was 21 μm thicker than never reporting a stressful role. No significant relationships between stressful roles and other SCVD measures were identified. Cumulative and baseline change models of stress and reward were not related to SCVD. A stressful social role in midlife was associated with greater atherosclerotic burden in later-life in a cohort of women transitioning through menopause. Social role rewards were unrelated to better later-life SCVD. These findings extend the knowledge of stress and cardiovascular disease in women by using measures of stress and reward for multiple social roles over the years of midlife.

Work Values in the United States: Age, Period, and Generational Differences.

This article examines how processes of aging, generational shifts, and changes over historical time periods shape differences in work values in the United States. Our analyses of data from the General Social Surveys and the International Social Survey Program show that changes over historical time periods are most consistently responsible for temporal differences in work values. In particular, during recent periods Americans tend to place greater importance on jobs that provide security, high income and opportunities for advancement; this is consistent with a narrative that these job rewards have become more difficult to attain recently and are thus more problematic for workers. Some differences in work values are also attributable to aging or life course processes, especially the greater importance placed on high income during the mid-life years when family responsibilities are generally greatest. By contrast, we find few differences in work values among members of different generations or cohorts. We also find that people from less advantaged social origins and those with greater labor market resources are more likely to value economic rewards.

Effect of apolipoprotein E4 on clinical, neuroimaging, and biomarker measures in noncarrier participants in the Dominantly Inherited Alzheimer Network.

The apolipoprotein E ε4 allele (APOE4) is the major genetic risk factor for sporadic Alzheimer's disease (AD). APOE4 may have effects on cognition and brain atrophy years before the onset of symptomatic AD. We analyzed the effects of APOE4 in a unique cohort of young adults who had undergone comprehensive assessments as part of the Dominantly Inherited Alzheimer Network (DIAN), an international longitudinal study of individuals from families with autosomal dominant AD. We analyzed the effect of an APOE4 allele on cognitive measures, volumetric MRI, amyloid deposition, glucose metabolism, and on cerebrospinal fluid levels of AD biomarkers in 162 participants that did not carry the mutant gene (noncarriers). APOE4+ and APOE4- mutation noncarriers had similar performance on cognitive measures. Amyloid deposition began at an earlier age in APOE4+ participants, whereas hippocampal volume was similar between the groups. These preliminary findings are consistent with growing evidence that the APOE4 allele may exert effects in midlife years before symptom onset, promoting amyloid deposition before altering cognitive performance or brain structure.

Abstract WP169: Midlife to Late-Life Changes in Blood Pressure and Cerebral Blood Flow in Old Age: the AGES-Reykjavik Study

Introduction: Adverse changes in blood pressure (BP) over the life course can lead to adverse cerebrovascular outcomes, including reduced blood flow. In this life-course, longitudinal, population-based study, we investigated the link between midlife to late life changes in BP and cerebral blood flow (CBF) in old age. Methods: From the Age, Gene/Environment Susceptibility (AGES)–Reykjavik Study (2002-2011), 2491 individuals (mean age (SD): midlife 49.7 (6.1) and late-life 79.8 (4.7) years old) were included. BP was measured at three different time points: 1 in mid-life, and 2 in late-life measured 5 years apart (mean follow-up time 30.1 years). With linear mixed models, annual changes in BP were estimated for each participant (mmHg/year). Participants were categorized in tertiles of changes in systolic, pulse pressure and diastolic BP. Total CBF was measured in the last late-life visit with the Phase-Contrast MRI and standardized for brain parenchymal volume (mL/min/100mL). Results: Overall, each mmHg/year increase in systolic BP was associated with 3.2 mL/min/100 mL (95% CI: 0.7-5.7)) higher CBF. Mean (SE) CBF in low, middle and high tertiles of change in systolic BP were 56.0 (0.4), 56.6 (0.4) and 57.5 (0.4) mL/min/100mL respectively (P for trend: 0.01). A similar increase in total CBF was observed for an increase in pulse pressure: each mmHg/year increase in pulse pressure was associated with 6.3 mL/min/100mL (95% CI: 3.8-8.7) higher total CBF. In contrast, an increase in diastolic BP was linked with lower CBF: each mmHg/year increase in diastolic BP was associated with 6.3 mL/min/100mL (95% CI: 3.3-9.4) lower CBF. Mean (SE) CBF in low, middle and high tertiles of changes in diastolic BP were 57.3 (0.4), 57.3 (0.4) and 55.5 (0.4) mL/min/100mL respectively (P for trend: <0.001). All these associations were independent of sociodemographic and cardiovascular factors and antihypertensive medications. Conclusion: In an over 30 years of midlife to late-life follow up, we observed that individuals with increasing systolic BP and pulse pressure have higher CBF in old age. Conversely, increase in diastolic BP is associated with lower CBF. The mechanisms behind the link between long-term BP alterations and CBF need to be elucidated.

Decline in Search Speed and Verbal Memory Over 26 Years of Midlife in a British Birth Cohort

Background: Cognitive capabilities change in later life, although their onset and rate of decline, and how they are shaped by lifetime socioeconomic position, childhood cognition and adult health status are all unclear. Methods: From the Medical Research Council National Survey of Health and Development, we analysed 3,192 participants undergoing one or more cognitive assessments at ages 43, 53, 60–64 and 69. Linear mixed models described cognitive trajectories, adjusting for factors across the life course. Results: For both search speed and verbal memory, better performance at age 43 (the intercept) was associated with higher paternal and own education, childhood cognition, and adult occupational class. For search speed, the trajectory was best described as a quadratic function (decline of 45.6 letters/5-years + 4.6 letters). Verbal memory showed a linear decline of 0.20 words/5-years between ages 43 and 60 and a steeper linear decline of 0.95 words/5-years between ages 60 and 69. Decline in verbal memory in the latter period was steeper in those with higher educational achievements at age 26 (additional 0.28 words/5-years for highest attainment). Conclusions: Decline in verbal memory and search speed across midlife is evident, though with different non-linear trajectories. By implication, pathways to cognitive impairment and dementia in older age may have their origins in this period.

Osteoporosis Knowledge and Health Beliefs Among Men in Midlife Years

ObjectiveTo examine the role of socioeconomic variables on middle-aged adult men's knowledge and health beliefs about osteoporosis. MethodsAn anonymous survey used validated scales to assess osteoporosis knowledge and health beliefs in a sample of 262 men aged 36–55 years. Descriptive and group-differences statistics (MANOVA and ANOVA) were used. ResultsTotal osteoporosis knowledge was low (mean, 11.1 of 22) and mean scores on perceived susceptibility and seriousness health belief domains were also low: 13.2 and 17.2, respectively out of 30. Multivariate ANOVA revealed that perceived seriousness, barriers to calcium intake, and health motivation varied significantly with level of formal education attained (P < .05). There was no significant difference with income. Conclusions and ImplicationsResults of this convenience sample of predominantly white men found that level of osteoporosis knowledge and perceived susceptibility were low. Given the increased prevalence of osteoporosis-related fracture in men, methods to increase knowledge and awareness are needed.

Tailoring strategies for the management of depression in midlife years.

Depression affects one in every five adults in North America. Women are more affected than men, possibly because of genetics, coping strategies, and hormone variations. The concept of a menopause-associated depression, however, remains a complex and controversial topic. Although hormone therapy is not recommended as first-line therapy for depression in midlife women, estrogen-based hormone therapy may minimize the need for or enhance the response to antidepressant or behavior-based therapies in select perimenopausal women.

Overweight and Obesity in Midlife and Brain Structure and Dementia 26 Years Later: The AGES-Reykjavik Study.

High adiposity in midlife might increase risk for late-life brain pathology, including dementia. Using data from the prospective Age, Gene/Environment Susceptibility-Reykjavik Study of men and women (born 1907-1935), we studied the associations of overweight and obesity at midlife (mean age, 50 (standard deviation, 4.7) years) with 1.5-T brain magnetic resonance imaging measures of infarct-like brain lesions, cerebral microbleeds, total brain volume, and white matter lesions volume, as well as dementia, in late life (mean age, 76 (standard deviation, 5.2) years). We used linear and Poisson models to estimate associations in 3,864 persons after adjustment for sociodemographic, health, and lifestyle characteristics. In midlife, the prevalence of overweight was 39% and that of obesity was 8%. After a mean follow-up of 26.2 (standard deviation, 4.9) years, midlife overweight and obesity were not associated with infarct-like brain lesions (relative risk (RR) = 0.82, 95% confidence interval (CI): 0.61, 1.10), cerebral microbleeds (RR = 0.69, 95% CI: 0.37, 1.32), total brain volume (β = 0.05, 95% CI: -0.34, 0.45), white matter lesions volume (β = -0.10, 95% CI: -0.20, 0.01), or dementia (RR = 0.91, 95% CI: 0.49, 1.72) compared with normal weight. These findings do not support the hypothesis that high body mass index in midlife modulates the risk for dementia.

A Phase 1/2a Follistatin Gene Therapy Trial for Becker Muscular Dystrophy

Becker muscular dystrophy (BMD) is a variant of dystrophin deficiency resulting from DMD gene mutations. Phenotype is variable with loss of ambulation in late teenage or late mid-life years. There is currently no treatment for this condition. In this BMD proof-of-principle clinical trial, a potent myostatin antagonist, follistatin (FS), was used to inhibit the myostatin pathway. Extensive preclinical studies, using adeno-associated virus (AAV) to deliver follistatin, demonstrated an increase in strength. For this trial, we used the alternatively spliced FS344 to avoid potential binding to off target sites. AAV1.CMV.FS344 was delivered to six BMD patients by direct bilateral intramuscular quadriceps injections. Cohort 1 included three subjects receiving 3 × 10(11) vg/kg/leg. The distance walked on the 6MWT was the primary outcome measure. Patients 01 and 02 improved 58 meters (m) and 125 m, respectively. Patient 03 showed no change. In Cohort 2, Patients 05 and 06 received 6 × 10(11) vg/kg/leg with improved 6MWT by 108 m and 29 m, whereas, Patient 04 showed no improvement. No adverse effects were encountered. Histological changes corroborated benefit showing reduced endomysial fibrosis, reduced central nucleation, more normal fiber size distribution with muscle hypertrophy, especially at high dose. The results are encouraging for treatment of dystrophin-deficient muscle diseases.

Attitude toward own aging in midlife and early old age over a 12-year period: examination of measurement equivalence and developmental trajectories.

The Attitude Toward Own Aging Subscale (ATOA) is a frequently used measure of subjective aging. Although ATOA in midlife might assume a preparatory role for psychosocial adjustment in old age, research has been dominated by a focus on older adults. To enable a comparison of developmental trajectories of ATOA between middle-aged and young-old adults, we tested measurement invariance between age groups and over a 12-year study period. In addition, personality variables, health dimensions, and sociodemographic variables were investigated as predictors of developmental trajectories of ATOA. Data came from the Interdisciplinary Longitudinal Study of Adult Development (ILSE) with 2 birth cohorts (1930-1932: n = 500; 1950-1952: n = 501) followed over 12 years. Data analyses were conducted with confirmatory factor analysis for ordered-categorical variables and latent growth models. Support for the assumption of partial measurement invariance of ATOA was found in each age group, but not between age groups. Latent growth models revealed a steady decline in ATOA for young-old individuals, whereas ATOA trajectories in midlife were characterized by interindividual variation. Health variables predicted level of ATOA in the young-old. In midlife ATOA were shaped by a variety of factors. Future studies should be conducted with an awareness of differential item functioning of the ATOA scale across age groups. Furthermore, our results point to a greater modifiability of aging attitudes in middle-aged compared with young-old individuals, thus highlighting the importance of the midlife years in shaping developmental trajectories into old age.