The overarching goal of the SWAN-Aging U19 is to determine the impact of midlife factors on successful aging, with a specific focus on the effects of changes during the menopause transition (MT) and midlife changes in health indicators on functioning and health in early old age. This period in the life course, ages 66-75 years, is a pivotal time of changing social roles and transitioning into old age, when adverse changes in health as well as physical and cognitive functioning begin to accumulate. A major goal of SWAN-Aging is to assess whether racial/ethnic differences in midlife health and the MT explain racial/ethnic disparities in health and functioning in early old age. The third goal is to translate SWAN-Aging findings to women and health care providers. Project 3 focuses on the role of MT characteristics and MT-related and usual midlife-aging-related changes in health indicators on preservation of musculoskeletal health and physical functioning. Project 3 will also examine the interface between physical and cognitive function, because successful aging and maintenance of independence require relative preservation of both of these functional domains into old age. The specific aims of Project 3 are to: 1) determine and quantify the impact of MT characteristics and trajectories of midlife health indicators on maintaining lean mass and muscle strength, minimizing loss of bone mass and increases in fat mass, and preserving physical functioning in early old age; 2) determine and quantify the impact of MT characteristics and trajectories of midlife health indicators on avoidance of falls and fractures in early old age; 3) determine and quantify the extent to which racial/ethnic disparities in musculoskeletal health and physical functioning in early old age are attributable to racial/ethnic differences in MT characteristics and midlife health indicators; and 4) translate SWAN-Aging musculoskeletal findings to women and health care providers. To achieve these aims, the proposed SWAN-Aging visit (when cohort median age will be 71 years) will include measurement of bone mineral density, body composition, muscle strength, and physical functioning, and ascertainment (with adjudication) of interim falls and fractures. Integrating across Projects, we will describe cardiovascular antecedents (Project 2) of trajectories of musculoskeletal health and functioning; the relationship between cognitive function trajectories (Project 1) and falls; and the relation between physical functioning trajectories and the development of disability and the onset of mild cognitive impairment (Project 1). Estimation of the size of the effects of MT-related and midlife factors on musculoskeletal health and functioning in early old age will inform key targets for prevention and intervention in future studies. Identifying modifiable midlife factors and quantifying their impact on preservation of musculoskeletal health and functioning in early old age as well as understanding the intersection of physical and cognitive function are critical first steps needed for developing and testing targeted screening strategies and early interventions to optimize independence and quality of life in older adults.

PROJECT NARRATIVE SWAN-Aging will fill important gaps in understanding the role of the menopausal transition, menopause related health changes and midlife aging on women’s health and functioning in early old age. Accordingly, it will provide useful information to guide clinical decisions in midlife and later life in women who have diverse life experiences and socioeconomic and racial/ethnic characteristics.