Health in midlife and later life
What the research finds about the physical and mental health of autistic adults in midlife and later life, covering sleep, trauma, self-harm and suicidal thoughts after 40, what reviews suggest about prevention and heart care, and gaps in getting care.
What scientists have found about the health of autistic adults in middle age and later life, and why most of what we know comes from one group of volunteers in the UK.
Sleep, anxiety and sensory load after 40 Emerging
Sleep is one of the better-studied subjects in this entry, and the evidence for this age group still comes mainly from one cohort built for it. In the AgeWellAutism register, 265 autistic and 167 age- and gender-matched non-autistic adults aged 40 to 93 reported their sleep. The autistic group reported worse sleep than the non-autistic group in every area the questionnaire covers, and the gap held after age and symptoms of anxiety, depression and PTSD were taken into account. Within the autistic group, women reported more difficulty on the overall sleep score than men. Poorer sleep went with older age in both groups, and the link between poor sleep and anxiety was stronger in the autistic group than in the non-autistic group.1 Everyone was measured once, so the study shows that worse sleep and being autistic go together in this age group, not which comes first. How common sleep problems are, and what the treatment trials found, is covered in Eating and sleep.
A second paper from the same cohort asked about sensory processing differences. Autistic adults reported more of them, and more anxiety and depression, than non-autistic adults. Autistic women reported more sensory processing differences than autistic men, though anxiety and depression scores did not differ significantly by gender within the autistic group. The sensory differences went with anxiety and depression in the autistic group, and the link with depression grew stronger with age. Autistic participants more often than non-autistic participants said their ability to cope with sensory experiences had got worse over their adult life, and among autistic participants, those who reported worse coping were older.2
Sleep is one of the best-studied subjects here. Most of what we know about this age group comes from one group, AgeWellAutism. It asked 265 autistic adults and 167 non-autistic adults about their sleep. The adults were aged 40 to 93. The autistic adults said their sleep was worse in every way the questions asked about.1 This was still true after the scientists allowed for age, anxiety, depression and PTSD. Autistic women scored worse than men on the overall sleep measure. Poorer sleep went with older age in both groups. Poor sleep and anxiety were linked more strongly in the autistic group.1 Everyone was asked once, so we cannot tell which comes first. You can read more about sleep problems and their treatment in Eating and sleep.
Another paper from the same group asked about the senses. Autistic adults reported more differences in how they deal with sound, light, touch, taste, smell and movement. They also reported more anxiety and depression than non-autistic adults. Autistic women reported more of these sensory differences than autistic men. In the autistic group, the sensory differences went with anxiety and depression. The link with depression was stronger in older people.2
One cross-sectional cohort, the AgeWellAutism register, a self-selected UK volunteer group measured once at one point in time. The sleep findings and the sensory findings come from the same cohort and count as one study.
Differences in how a person registers and responds to sound, light, touch, taste, smell and movement.
A UK online register of autistic and non-autistic adults aged 40 and over who volunteer to take part and complete questionnaires. A volunteer register is self-selected, so people more engaged with autism research may be over-represented, and the figures describe this group rather than autistic adults in general. Most autistic members were diagnosed in adulthood, and a small number had no formal diagnosis and identified as autistic themselves.
This comes from one group of people, asked once. So we cannot tell what causes what.
Differences in how a person notices and reacts to sound, light, touch, taste, smell and movement.
AgeWellAutism is a UK list of adults aged 40 and over who choose to join and fill in questionnaires. People who choose to join may not be like all autistic adults. Most autistic people in it found out they were autistic as adults. A few had no diagnosis and called themselves autistic.
Trauma and PTSD after 40 Emerging
In the same register, 446 autistic and 183 non-autistic adults aged 40 to 90 reported on childhood and adulthood trauma, with women making up about 55% of the autistic group. The autistic group reported more of every type of childhood trauma measured, including emotional and physical abuse and neglect and sexual abuse. In adulthood, emotional and physical abuse and neglect were higher, while the difference in sexual abuse did not reach significance. Within the autistic group, autistic women and people in midlife (40 to 64) reported the most trauma.3
The autistic group also reported more symptoms of PTSD. The link between trauma and PTSD symptoms was stronger in the autistic group than in the non-autistic group, and autism group membership still predicted PTSD symptom scores after reported trauma was taken into account.3 Everyone was measured once, so the study shows that trauma and PTSD symptoms are more common in this group, not the direction of any link. The general account, and why both are often missed, is in Trauma, PTSD and dissociation.
In the same group, 446 autistic adults and 183 non-autistic adults took part. They were aged 40 to 90. They answered questions about hard and frightening events. Most of the autistic group were women. The autistic group reported more of every kind of childhood trauma, including abuse and neglect. In adulthood, abuse and neglect were higher too, but the difference in sexual abuse was not clear. Autistic women and people in middle age reported the most trauma.3
The autistic group also reported more PTSD symptoms. PTSD is a set of lasting reactions after a frightening event. The link between trauma and PTSD symptoms was stronger in the autistic group than in the non-autistic group. Being autistic still predicted PTSD symptoms after the amount of trauma was taken into account.3 Everyone answered once, so we cannot tell which comes first.
One cross-sectional cohort, self-report, measured once. The general account is in Trauma, PTSD and dissociation; this entry keeps the midlife and older-age detail.
One group of people, asked once. More about trauma and PTSD is in Trauma, PTSD and dissociation.
Self-harm and suicidal thoughts after 40 Emerging
In the register, 388 participants (222 of them autistic) aged 40 to 93, with an average age of 60.9, answered questionnaires about self-harm and suicidal thoughts. The autistic group reported higher rates of suicidal thoughts, thoughts of self-harm, deliberate self-harm and self-harm with suicidal intent than the non-autistic group. For self-harm in the last year, the difference was no longer significant once current depression was taken into account. Within the autistic group, women reported more suicidal thoughts and more suicidal self-harm than men. Autistic people in old age (65 and over) were more likely than those in midlife (40 to 64) to have had thoughts of self-harm, to have deliberately self-harmed and to have self-harmed with suicidal intent.4 The study relies on self-report from a self-selected sample.
In Medicare records, suicidality or self-inflicted injury was recorded about eleven times more often in autistic older adults than in a matched comparison group.5
A separate cross-sectional study of 9,979 adults aged 50 and over, about three-quarters of them women, grouped people by autistic traits rather than a diagnosis. Depression, anxiety, PTSD, loneliness and social isolation each helped explain the link between autistic traits and suicidal thoughts, though each effect was small. For suicidal self-harm, being male, depression, PTSD and social isolation were the mediators.6 On sex, this study and the register point in different directions: the register found autistic women higher on suicidal self-harm, while the larger, mostly female trait-based study put being male among the mediators. Because each study looked at everyone at one time, neither can show which comes first. The suicide and self-harm rates for autistic people overall, and what is known about what helps, are in Suicide and self-harm.
In the same group, 388 people took part. Of these, 222 were autistic. They were aged 40 to 93. They answered questions about self-harm and thoughts of suicide. The autistic group reported more of all of these than the non-autistic group.4 For self-harm in the last year, the autism difference went away once the scientists allowed for current depression. Autistic women reported more thoughts of suicide and more self-harm with the wish to die than autistic men. Autistic people aged 65 and over reported more than those in middle age.4 People wrote their own answers, so the study trusts what they said about themselves.
Medicare records tell a similar story. In autistic older adults, self-harm or suicidal behavior was recorded about eleven times more often than in similar non-autistic adults.5
Another study asked 9,979 adults aged 50 and over, mostly women, about their autistic traits. Depression, anxiety, PTSD, loneliness and being socially isolated each helped explain the link between autistic traits and thoughts of suicide. Each effect was small. For self-harm with the wish to die, being male, depression, PTSD and isolation mattered.6 On sex, the two studies disagree. The UK group found autistic women higher. The larger study, mostly women, found being male mattered. Because everyone was asked at one time, we cannot tell what leads to what. You can read more in Suicide and self-harm.
A cross-sectional cohort, a claims study and a large survey, each measured once. Because people who died by suicide could not take part in the cohort, it may understate how common this is. The overall rates for autistic people are in Suicide and self-harm.
Three studies, each done once. Some people who died by suicide could not take part, so the numbers may be too low.
The everyday signs of autism, measured by a set of questions.
Missed prevention and heart care Emerging
A 2026 systematic review of 56 studies of autistic adults found a mixed cardiovascular picture: lower recorded rates of high blood pressure, but higher rates of severe outcomes such as heart failure and stroke. Its authors read this as a sign of gaps in early detection and preventive care.7 The direction of the high-blood-pressure finding is not settled: large US health-record studies of autistic adults record more high blood pressure than comparison groups, not less, and a Medicare study of autistic older adults also records more heart disease.5,9 The conditions themselves and the figures behind them are covered in Physical health and lifespan; this entry notes where prevention may be missed. What happens to thinking, memory and dementia risk with age is covered in Aging.
A narrative review of autistic older adults found outcomes generally poor across health and functioning, including limited physical activity, alongside more medical conditions and less social and community participation.8
No study found as of October 2026 has measured how much routine preventive care, such as blood-pressure and cholesterol checks, autistic adults in midlife and later life receive.
Preventive care means checks and treatments that stop illness early or before it starts. A 2026 review of 56 studies found a mixed picture for autistic adults. Fewer were recorded as having high blood pressure. But more had serious problems such as heart failure and stroke. The authors think early checks and prevention may be missed.7 Big US health-record studies find more high blood pressure and heart disease in autistic adults, not less.5,9 So the answer depends on where the numbers come from. The conditions and the numbers are in Physical health and lifespan. Thinking and memory with age are in Aging.
A second review found that autistic older adults often have poorer health. That includes less physical activity and less time with other people.8
No study found as of October 2026 has measured this. No one knows how much routine preventive care autistic adults in middle and later life get. This includes checks such as blood-pressure and cholesterol tests.
A single 2026 systematic review, whose cardiovascular findings its authors describe as mixed, and a narrative review. The systematic review's samples are almost entirely autistic adults without an intellectual disability.
One big review of many studies, and one review of the research. The studies in the big review mostly left out autistic adults with an intellectual disability.
Regular checks and treatments, such as blood-pressure tests, that aim to stop illness early or before it starts.
Getting care in midlife and later life Emerging
In interviews, 15 autistic women aged 51 to 73 in the UK described barriers to health care. They described stigma and stereotypes in how professionals understood autism, a build-up of poor experiences that lowered their confidence in services, and the effort needed to navigate the system. They felt that being an older woman contributed to their autism-related needs being overlooked or misunderstood.10
A systematic review of autistic adults found they used emergency departments and hospitals as much as or more than comparison groups, and used primary care and preventive services more. Its authors read the frequent emergency and hospital use as routine care in the community not meeting their needs.11
In a separate interview study, 17 autistic adults aged 46 to 72 described a need for support with aging to be autism-informed. The study's authors recommend involving autistic people in the design of health and social care services, and making services trauma-informed and strength-focused.12 What is known about care in general, including emergency departments, surgery and screening, is in Getting health care.
In interviews, 15 autistic women in the UK, aged 51 to 73, talked about getting health care. They said staff often did not understand autism. Bad experiences built up and made them trust services less. Getting help took a lot of effort. They felt that being an older woman made services overlook their needs.10
A review of studies found that autistic adults go to emergency rooms and hospitals more than other adults. Some studies found they go about as often. They also use primary care and preventive services more. The authors think ordinary care in the community is not meeting their needs.11
In another study, 17 autistic adults aged 46 to 72 talked about growing older. They said support for getting older needed to understand autism. The authors say services should involve autistic people in planning. They also say services should be trauma-informed and build on people's strengths.12 You can read more about care in general in Getting health care.
Small qualitative interview studies and one systematic review. The samples are named where they limit the finding, and none is a national sample.
These are small studies where people talk about their own lives. None used a national sample.
In the community Community
Sarah Hendrickx, writing with Jess Hendrickx about autism in women and girls, reports that tiredness and fatigue arrive earlier than usual for autistic women, around age 40, even when they are in otherwise good physical health.c1 The older women she interviewed describe reaching self-acceptance with age and a greater freedom to assert what they need. In a chapter on health and well-being, Hendrickx writes that she asked doctors over and over why she was so exhausted and got no answers: "They acted like exhaustion was normal."c2
Niamh Garvey, an autistic nurse and writer, describes a good night's sleep as one of the most important things for her in staving off autistic burnout, and writes that difficulties with sleep are very common in autistic people.c3
Sarah Hendrickx writes about autism in women and girls. She found that tiredness comes earlier than usual for autistic women, around age 40. This was even when they were in good physical health.c1 The older women she talked to said they accepted themselves more as they got older.
Hendrickx also writes that she kept asking doctors why she was so tired. She got no answers: "They acted like exhaustion was normal."c2
Niamh Garvey is an autistic nurse and writer. She says a good night's sleep is one of the most important things that helps her avoid autistic burnout. She also writes that sleep is hard for many autistic people.c3
How autistic writers describe health in midlife and later life. These are descriptions and arguments, not research findings.
These are what autistic writers say about their own lives. They are not research findings.
Sources
Research
- 1Roper S, Barbinta A, Quinton AMG, Charlton RA, Happé F, Stewart GR. Sleep Problems and Mental Health in Middle-Aged and Older Autistic and Non-Autistic Adults. International Journal of Geriatric Psychiatry, 2026. https://doi.org/10.1002/gps.70259
- 2Chen Y, Jenkins CA, Charlton RA, Happé F, Mandy W, Stewart GR. 'Utterly Overwhelming': A Mixed-Methods Exploration of Sensory Processing Differences and Mental Health Experiences in Middle-Aged and Older Autistic Adults. Autism in Adulthood, 2026. https://doi.org/10.1089/aut.2024.0031
- 3McAdams E, Quinton AMG, Charlton RA, Happé F, Stewart GR. Trauma and PTSD Symptoms: Exploring the Experiences of Autistic and Non-Autistic Adults in Midlife and Old Age. Autism, 2026. https://doi.org/10.1177/13623613261486059
- 4Roper S, Charlton R, Happé F, Stewart GR. Self-harm and suicidality experiences of autistic and non-autistic adults in midlife and old age. Molecular Autism, 2025. https://doi.org/10.1186/s13229-025-00693-x
- 5Hand BN, Angell AM, Harris L, Carpenter LA. Prevalence of physical and mental health conditions in Medicare-enrolled, autistic older adults. Autism, 2020. https://doi.org/10.1177/1362361319890793
- 6Nuzum E, Medeisyte R, Eshetu A, et al. Autistic traits and suicidality in midlife and old age: investigating mediating effects of mental health and social connectedness. Nature Mental Health, 2026. https://doi.org/10.1038/s44220-025-00579-0
- 7Dickinson A, Ryan D, Carroll JE, Lord C. Aging in autism: A systematic review of cognitive, neural, and physical health findings. Neuroscience & Biobehavioral Reviews, 2026. https://doi.org/10.1016/j.neubiorev.2026.106820
- 8Klein CB, Klinger LG. Aging Well and Autism: A Narrative Review and Recommendations for Future Research. Healthcare, 2024. https://doi.org/10.3390/healthcare12121207
- 9Croen LA, Zerbo O, Qian Y, et al. The health status of adults on the autism spectrum. Autism, 2015. https://doi.org/10.1177/1362361315577517
- 10Gillions A, O'Nions E, Mansour H, et al. The healthcare experiences of middle and older age autistic women in the United Kingdom. Autism, 2026. https://doi.org/10.1177/13623613251362265
- 11Gilmore D, Krantz M, Weaver L, Hand BN. Healthcare service use patterns among autistic adults: A systematic review with narrative synthesis. Autism, 2022. https://doi.org/10.1177/13623613211060906
- 12Aitken R, Berry K, Gowen E, Brown LJ. How do autistic adults experience ageing? A qualitative interview study. Autism, 2026. https://doi.org/10.1177/13623613261422937
Community sources
- c1Hendrickx S, Hendrickx J. Women and Girls on the Autism Spectrum: Understanding Life Experiences from Early Childhood to Old Age. Jessica Kingsley Publishers, 2024. Chapter 5, "Later Years".
- c2Hendrickx S, Hendrickx J. Women and Girls on the Autism Spectrum: Understanding Life Experiences from Early Childhood to Old Age. Jessica Kingsley Publishers, 2024. Chapter 13, "Health and Well-Being".
- c3Garvey N. Looking After Your Autistic Self: A Personalised Self-Care Approach to Managing Your Sensory and Emotional Well-Being. Jessica Kingsley Publishers, 2023. Chapter 16, "Mental Health and Mental Illness in Autism", section "Melatonin: The Sleep Hormone".