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Adverse Childhood Experiences and Aging-Associated Functional Impairment in a National Sample of Older Community-Dwelling Adults

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Abstract

Background

Prior research on the health implications of adverse childhood experiences (ACEs) has focused on early or midlife adults, not older adults who bear the greatest burden of health-related functional impairment.

Objective

To examine associations between ACEs, objectively measured physical mobility and cognitive impairment, and functional disability in older community-dwelling adults.

Design

Cross-sectional analysis.

Participants

Community-dwelling older U.S. adults ages 50 years and older.

Main Measures

Participants completed structured questionnaires assessing history of ACEs (childhood experience of violence/abuse, witnessing of violence, financial insecurity, parental separation, or serious illness), underwent standardized physical performance testing (tandem balance, 3-m walk, chair stand test) and cognitive testing (survey adaptation of the Montreal Cognitive Assessment), and reported functional disability (difficulty with activities of daily living).

Key Results

Among the 3387 participants (aged 50 to 97 years; 54% female), 44% reported a history of one or more types of ACEs. Thirty-five percent met criteria for physical mobility impairment, 24% for cognitive impairment, and 24% for functional disability. After adjusting for age, gender, race, and ethnicity, participants reporting any ACE history were more likely to demonstrate physical mobility impairment (OR 1.30, 95% CI 1.11–1.52) and cognitive impairment (OR 1.26, 95% CI 1.03–1.54) and report functional disability (OR 1.69, 95% CI 1.38–2.07), compared to those with no ACE history. Childhood experience of violence was associated with greater physical mobility impairment (OR 1.38, 95% CI 1.11–1.71) and functional disability (OR 1.86, 95% CI 1.49–2.33).

Conclusions

Older adults with a history of ACEs are more likely to experience physical and cognitive functional impairment, suggesting that efforts to mitigate ACEs may have implications for aging-associated functional decline. Findings support the need for trauma-informed approaches to geriatric care that consider the potential role of early life traumatic experiences in shaping or complicating late-life functional challenges.

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Data Availability

Data from the National Social Life Health and Aging Project cohort that underlie this manuscript are already available for public request and download through the National Archive of Computerized Data on Aging - https://www.icpsr.umich.edu/web/NACDA/studies/36873.

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Funding

The National Social Life, Health and Aging Project was funded by the National Institute of Aging (NIA) and National Institute of Health grants R01AG043538, R01AG048511 and R37AG030481. Drs. Alison Huang and Nadra Lisha were supported by NIA grant K24AG068601.

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Authors and Affiliations

  1. Department of Medicine, School of Medicine, University of California, San Francisco, CA, USA

    Victoria M. Lee BS, Anita S. Hargrave MD, MAS, Nadra E. Lisha PhD & Alison J. Huang MD, MAS

  2. Veterans Affairs Medical Center, San Francisco, CA, USA

    Anita S. Hargrave MD, MAS

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Contributions

VML and AJH developed the research question and hypothesis. VML conducted the literature review. VML, AJH, NEL and ASH designed the study and analyzed and interpreted the data. NEL conducted the statistical analyses. VML wrote the initial draft and ASH, NEL, and AJH contributed to the revision of the manuscript. All authors have read and approved the final version of the manuscript before submission. There were no additional contributors to this research.

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Annual Scientific Meeting of the American Geriatrics Society, May 4-5th, 2023; Society of General Internal Medicine Annual Meeting, May 13th 2023.

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Lee, V.M., Hargrave, A.S., Lisha, N.E. et al. Adverse Childhood Experiences and Aging-Associated Functional Impairment in a National Sample of Older Community-Dwelling Adults. J GEN INTERN MED 38, 3362–3371 (2023). https://doi.org/10.1007/s11606-023-08252-x

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