Childhood adversity, current adversity and cognitive frailty among older adults in rural China: does social support play a role?

Little is known regarding the association between adverse experiences and cognitive frailty, and the role of social support in this relationship. This study aimed to investigate the association between adverse experiences and cognitive frailty, as well as determine how social support affects this relationship among rural older adults in China. Data were obtained from two waves of follow-up surveys (2020 and 2022) conducted by the Shandong Rural Elderly Health Cohort (SREHC), including 2,572 participants aged 60 years or above. The primary outcome was cognitive frailty, defined as the co-existence of physical frailty (≥3 Fried criteria) and cognitive impairment (educationally adjusted Mini-Mental Status Examination). Self-reported adverse experiences were categorised as no adversity, only childhood adversity (≥1 of 12 events before age 17), only current adversity (≥1 of 7 events past year), and dual adversity (experiencing both childhood and current adversity). The Generalized Estimating Equation (GEE) analyses and the margins plot were performed to estimate our hypothetical models. In fully adjusted models, older adults with dual adversity were significantly associated with a higher risk of cognitive frailty (OR = 1.64, 95% CI: 1.02-2.63), not significant in only childhood or only current adversity. Social support alleviated the risk of cognitive frailty among rural older adults with only childhood adversity (OR = 0.41, 95% CI: 0.21-0.79) or dual adversity (OR = 0.26, 95% CI: 0.09-0.72), but not among those with only current adversity. Our results underscore the relationship between dual adversity and cognitive frailty, not significant in only childhood or only current adversity, with social support serving as a pivotal moderating factor. Governmental authorities should elevate their awareness of adverse experiences, and enhancing social support is crucial to preventing cognitive frailty and promoting healthy aging.