For me the question really comes down to this: what are you really passionate about? Does what you do each day still light your fire? Do you find fulfilment and challenge in your work?
I'm 45 and got laid off six months ago (third time in 20 years in IT). It was a marvellous opportunity to sit back, take stock and think - do I really want to do this for another 20 years? It surprised me how simple the answer to this was. Although it has been a good career and the money has been pretty good, I know that forward options for me are becoming limited. I don't want to go into management; as an architect I'm not too far from the upper limit of the technical stream; I have zero interest in switching to allied fields (e.g. technical sales), and I'm pretty over having to relearn stuff every five years or so to stay employable. Most of all, I'm sick of doing work that makes no discernable difference to anyone's life... in a global sense it's pretty meaningless.
So - I've tossed in the towel and am studying medicine instead. It didn't take too much thinking to realise that this is where my passions really lie... life's too short for regret, so I'm grasping the opportunity while I'm still young enough to get the study done and have time left to practise medicine.
If your answers to my first questions point you to the areas you already work in, then great - figure out ways to make your career sustainable for another 20 years or so, and be prepared for compromises. If not, now is the time to grasp the nettle and make real changes, while you still have time for them to make a difference. But know what you are passionate about! This is what will power you.