Stressful experiences during childhood could have more far-reaching effects than previously thought, contributing to issues with daily tasks like getting dressed or preparing meals in older age, according to a new national analysis.
The authors of the study, published Wednesday in the Journal of General Internal Medicine, say it is the first to link adverse childhood experiences (ACEs) with objective measures of functional impairment in older U.S. adults. Potential adverse childhood experiences include financial insecurity, parental separation, severe illness, and experiencing or witnessing violence or abuse.
Other studies have linked ACEs with accelerated aging and with poor health outcomes like cognitive decline and dementia.
“It was striking that the older women and men who had a history of of any adverse childhood experience, and also select types of adverse childhood experiences, were more likely to have objective signs of physical mobility impairment, cognitive impairment including problems with memory and concentration, and also to report difficulty carrying out core activities of daily living,” said lead author Alison J. Huang, an internal medicine specialist and primary care doctor at University of California San Francisco Health.
Adults between the ages of 50 and 97 who had experienced violence as children, for example, were 80% more likely to have difficulty with daily living activities and 40% more likely to have mobility problems compared to those who had not. Older adults who reported having an unhappy family life as children were 40% more likely to have some degree of cognitive impairment.
The findings were based on data from 2010 and 2015 cohorts of the National Social Life, Health, and Aging Project, drawing on analysis of 3,387 people who had completed questionnaires about their ACEs history. Participants had also been tested on their standing balance, 3-meter walk, and chair stand, on their cognitive abilities, and on their self-reported issues with daily living activities.
The UCSF researchers controlled for factors besides ACEs that could be associated with impairments in physical mobility, cognitive function, and ability to perform basic self-care tasks. They also controlled for behaviors associated with certain health outcomes such as tobacco use, as well as for socio-demographic factors like financial assets.
Among participants, 54% identified as female. For Huang, it was particularly important that this study offer insights into tackling women’s health issues at older ages.
“We tend to think that women’s health is primarily important to the extent that women conceive and bear children,” Huang said. “In the post-reproductive years, we don’t value women’s health and functioning as much as we should.”
Janet M. Coffman, a professor of health policy at UCSF who was not involved in the study, lauded its “sophisticated” design that includes an oversampling of Black participants. This kind of design makes it more likely that the sample is representative of all U.S. adults aged 57 to 85, she said via email, and makes it easier to detect statistically and clinically significant differences between Black and white people.
Why are younger people more likely to report adverse childhood experiences?
One of the most striking parts of the study, Huang said, is that people in their 50s reported higher prevalence of ACEs compared to people who were in their 60s and older.
Huang said it’s possible that adults over 60 simply had less exposure to adverse childhood events, though “it seems a little counterintuitive.” There could also be age-related differences in how people over 60 perceive or recall these experiences compared to people in their 50s, or how willing each group is to report these experiences in a research study.
“Maybe they have different degrees of concern about witnessing of violence or experience of violence,” said Huang. “Maybe what some older adults might take for granted, to someone else it’s like a violent exposure.”
A recent analysis in the Centers for Disease Control and Prevention’s online journal Morbidity and Mortality Weekly Report also found that adults aged 65 and over reported a “strikingly lower” prevalence of ACEs compared to younger people.
“Although this might be due to recall bias or differing trends over time, it might also reflect the risk of premature mortality accompanying exposure to a high number of ACEs,” the CDC authors wrote.
Similarly, Huang said, it’s possible that in the UCSF study, “folks who may have already had the greatest health consequences of ACEs may not have been even eligible to participate anymore,” whether because they’ve died or because they now live in long-term care facilities rather than in private homes.
Preventing childhood stress and trauma
The study raises big questions for future research, particularly about the reasons why ACEs seem to impact physical and cognitive function later in life, Huang said. Huang wonders, for example, whether there could be a physiological stress response that causes people to develop more chronic conditions that accelerate as they age, or if the cumulative effect of ACEs leads to more financial insecurity in older age. That, in turn, could leave people more likely to develop health problems and with fewer resources to address health issues.
Coffman supports the latter theory, noting that findings from the study that controlled for socio-demographic factors suggest that having a partner in older age, along with higher educational attainment and financial assets, reduced some of the impacts of most ACEs on functional impairment.
“I am sure that at least part of any effect of ACEs on long-term health outcomes is that it can affect people’s social and economic stability later in life, which, of course, is bad for long-term health outcomes,” Huang acknowledged. “But that may not be all of the effects of ACEs.”
Either way, the study’s findings support incorporating trauma-informed principles into geriatric care, according to the authors of the study.
“Screening for ACEs needs to be coupled with services to help people cope with past traumas and the effect of past traumas on their health,” said Coffman.
Another big takeaway from the study may be the importance of reducing childhood stress and trauma in the first place.
“I would encourage the field to focus more research on positive childhood experiences and how we support families in building better childhoods before they are in crisis,” said Melissa T. Merrick, president and CEO of the national nonprofit Prevent Child Abuse America, who was not involved in the study.
Merrick cited her previous work with the CDC, which found that preventing ACEs could reduce depression in the U.S. by 44%. Research shows, she said, that “providing families with concrete and economic supports like paid family leave, childcare subsidies, and tax credits … help prevent child abuse and neglect.”