Department of Social Medicine, National Research Institute for Child Health and Development, Tokyo, Japan.
Department of Health Education and Health Sociology, School of Public Health, The University of Tokyo, Japan.
J Gerontol A Biol Sci Med Sci. 2018 Jan 16;73(2):261-266. doi: 10.1093/gerona/glx097.
A life-course perspective is essential in understanding the determinants of higher-level functional limitations. We examine the impact of adverse childhood experiences (ACEs) on higher-level functional limitations in older people.
Data were from the Japan Gerontological Evaluation Study 2013, a population-based cohort of independent people aged 65 years or older across Japan (n = 19,220). ACEs before the age of 18 were assessed in terms of seven adversities: parental death, parental divorce, parental mental illness, family violence, physical abuse, psychological neglect, and psychological abuse. Associations between the cumulative number of ACEs and higher-level functional limitations were investigated by multivariate Poisson regression with robust error variances, adjusted for age, gender, childhood disadvantage, adult sociodemographics, adult health behaviors, and health status.
Of the older people, 36.3% reported at least one ACE. Older people who had experienced two or more ACEs showed significantly greater higher-level functional limitations than those with no ACE in a crude model (prevalence ratio, PR = 1.61, 95% confidence interval, CI = 1.51-1.71). After adjusting the covariates, this association remained (PR = 1.19, 95% CI = 1.12-1.27).
ACEs showed robust independent effects on higher-level functional limitations among older Japanese without disabilities, even after adjusting for potential covariates in childhood and adulthood. The current findings may help in understanding the impact of the latent effects of ACEs on functional limitations in older people.
从生命历程的角度理解导致更高层次功能限制的决定因素至关重要。我们研究了不良童年经历（ACEs）对老年人更高层次功能限制的影响。
数据来自日本老年评估研究 2013 年，这是一项基于人群的日本独立 65 岁及以上老年人队列研究（n=19220）。18 岁之前的 ACEs 从以下七个逆境方面进行评估：父母死亡、父母离婚、父母精神疾病、家庭暴力、身体虐待、心理忽视和心理虐待。使用具有稳健误差方差的多变量泊松回归，调整年龄、性别、儿童劣势、成年社会人口统计学、成年健康行为和健康状况，调查累积 ACE 数量与更高层次功能限制之间的关联。
在老年人中，36.3%的人报告至少有一种 ACE。在粗模型中，经历过两种或两种以上 ACE 的老年人比没有 ACE 的老年人表现出更高层次的功能限制（患病率比，PR=1.61，95%置信区间，CI=1.51-1.71）。调整协变量后，这种关联仍然存在（PR=1.19，95%CI=1.12-1.27）。
即使在调整了儿童和成年时期的潜在协变量后，ACEs 对日本无残疾老年人的更高层次功能限制仍具有稳健的独立影响。目前的研究结果可能有助于理解 ACEs 对老年人功能限制的潜在影响。
