Midlife and later life

This topic is for autistic adults in midlife and later life. Three entries are here: health in midlife and later life, aging and cognitive change, and retirement and care in later life.

The research on this age group is young and rests on a few cohorts. The largest is the AgeWellAutism register, a self-selected UK volunteer group of autistic adults aged 40 to 93 together with matched non-autistic adults, which supplies much of what the two entries can say.¹

Sleep is worse in midlife and later life. In the AgeWellAutism cohort (265 autistic and 167 matched non-autistic adults aged 40 to 93), autistic adults reported worse sleep in every domain, and the gap held after adjusting for age, anxiety, depression and PTSD.¹ The same cohort reported more sensory processing differences, and the link between sensory differences and depression strengthened with age.² Trauma is also more common: autistic adults in midlife and old age reported more of every childhood trauma type measured and more PTSD symptoms, and autism group membership still predicted PTSD symptoms after the trauma people reported was taken into account.³ For self-harm, 388 participants (222 autistic) reported higher suicidal ideation, self-harm thoughts, deliberate self-harm and suicidal self-harm, though the difference in recent self-harm was not significant once depression was adjusted for,⁴ and US Medicare records show about eleven times more recorded suicidality or self-injury in autistic older adults.⁵

On prevention, a 2026 systematic review of 56 studies found lower recorded high blood pressure but higher rates of severe cardiovascular outcomes, which its authors read as a gap in prevention,⁶ while US health-record studies record more high blood pressure (and, in one, more heart disease).⁵ No study found as of October 2026 has measured how much routine preventive care autistic adults in this age group receive. Getting care is harder: 15 UK autistic women aged 51 to 73 described barriers, stigma and being invisible in both age and gender terms,⁷ a systematic review found that autistic adults use emergency and hospital care as much or more than others,⁸ and 17 autistic adults aged 46 to 72 described a need for autism-informed aging support.⁹

Dementia is diagnosed more often in autistic adults than in others in US public insurance records: among Medicaid enrollees aged 30 to 64, 4.04% of autistic adults without a recorded intellectual disability had a dementia diagnosis over five years, against 0.97% of enrollees with neither.¹⁰ On thinking tests, the largest longitudinal study followed 128 autistic and 112 non-autistic adults aged 24 to 85 and found no difference in change over time on any of 15 measures.¹¹ Falls are more common: in Medicare records from 2013 to 2021, 47.4% of 13,732 autistic adults aged 65 and over had a recorded fall, against 31.5% of matched non-autistic adults, about twice the odds once observation time was taken into account.¹² Medicines are part of the picture: about two-thirds of 512 autistic adults with higher support needs took at least one medicine with anticholinergic effects, and those taking more reported more everyday memory problems.¹³ One proposal holds that the aging brain clears waste products less well, which is a proposed mechanism supported mostly by animal work and early cross-sectional imaging.¹²

Autistic adults retire at about the same age as non-autistic adults, but reach it through different working lives. In the "Planning for Older Age" survey of 517 adults aged 40 to 90, 395 of them autistic, the two groups had retired, or expected to retire, at similar ages, while autistic participants were less likely to have made very detailed plans (21.7%, against 41.8%) and much more likely to have made none at all (41.1%, against 12.3%); they reported less full-time work, more unemployment and less financial stability, and were less likely to have a workplace pension (70.4%, against 95.1%).¹⁴ A US community cohort that followed 341 autistic adults for 22 years found competitive employment hours rising into early midlife and then falling into late midlife among those without an intellectual disability.¹⁵ What comes after retirement is barely studied: a 2024 scoping review of 35 studies found 57% looked at only one of five areas of healthy aging and none looked at all five,¹⁶ and a 2026 scoping review found only eight studies on racial and ethnic disparities among autistic adults aged 60 and over.¹⁷ Loneliness and social connection are part of this picture: in a two-year study of 209 autistic adults aged 40 and over, a better quality of life at the start predicted more emotional support later, more than the other way round.¹⁸