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Old sounding...I was 45 when my first grand-child was born, in fact, the day after my 45th birthday.
I called my parental grandmother Nana, and my maternal grandparents Grandma Becky and Grandpa Jim. This had been well established by other grandchildren, I was one of the younger ones.
I don't mention my paternal grandfather, I never knew him, he died quite young. So I think of him rather formally, as Grandfather Lastname.