<p>Longevity is increasing in Spain but not always accompanied by healthy life years. This study aims to evaluate the perceptions of ageing and the differences by sex in patients &gt; 64 years from the Valencian Community, a region on the Spanish Mediterranean coast. We performed a cross-sectional study evaluating self-perceptions of ageing with the Attitude Towards Own Ageing scale, through face-to-face interviews with 186 randomly selected patients in a Primary Healthcare Centre. We assessed sociodemographic variables, physical self-sufficiency, self-rated health, quality of life-related to health, social and family support, and health literacy. It was found that a greater percentage of women showed negative attitudes towards own ageing as compared to men. Variables associated with negative perceptions of ageing for women were bad quality of life and limited health literacy, whereas for men, were social and family support, self-rated health, and quality of life. Sex and gender influence self-perceptions of ageing, reflecting social roles, cultural expectations, and access to resources. Enhancing self-perceptions of ageing through interventions targeting health perception, social support, and quality of life—including health literacy, physical activity, and community engagement—may help close the gap between longevity and healthy life years.</p>