Department of Medicine, School of Medicine, University of California, San Francisco, CA, USA.
Veterans Affairs Medical Center, San Francisco, CA, USA.
J Gen Intern Med. 2023 Nov;38(15):3362-3371. doi: 10.1007/s11606-023-08252-x. Epub 2023 Aug 2.
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.
To examine associations between ACEs, objectively measured physical mobility and cognitive impairment, and functional disability in older community-dwelling adults.
Cross-sectional analysis.
Community-dwelling older U.S. adults ages 50 years and older.
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).
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).
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.
先前关于不良童年经历（ACEs）对健康影响的研究主要集中在早期或中年成年人，而不是那些承受最大健康相关功能障碍负担的老年人。
研究 ACEs、客观测量的身体活动能力和认知障碍与社区居住的老年成年人功能障碍之间的关联。
横断面分析。
年龄在 50 岁及以上的社区居住的美国老年人。
参与者完成了评估 ACEs 历史的结构化问卷（儿童期经历的暴力/虐待、目睹暴力、经济不安全、父母分离或严重疾病），接受了标准化的身体表现测试（平衡双杠、3 米步行、椅子站立测试）和认知测试（蒙特利尔认知评估的调查适应），并报告了功能障碍（日常生活活动困难）。
在 3387 名参与者（年龄 50 至 97 岁；54%为女性）中，44%报告了一种或多种类型的 ACEs 历史。35%符合身体活动能力受损标准，24%符合认知障碍标准，24%符合功能障碍标准。在调整年龄、性别、种族和民族后，报告有 ACE 史的参与者更有可能表现出身体活动能力受损（OR 1.30，95%CI 1.11-1.52）和认知障碍（OR 1.26，95%CI 1.03-1.54），并报告功能障碍（OR 1.69，95%CI 1.38-2.07），与没有 ACE 史的参与者相比。儿童期经历的暴力与更大的身体活动能力受损（OR 1.38，95%CI 1.11-1.71）和功能障碍（OR 1.86，95%CI 1.49-2.33）相关。
有 ACE 史的老年人更有可能经历身体和认知功能障碍，这表明减轻 ACEs 的努力可能对与衰老相关的功能下降产生影响。研究结果支持采用创伤知情方法进行老年护理，考虑早期生活创伤经历在塑造或使晚年功能挑战复杂化方面的潜在作用。
