The Association Between Adverse Childhood Experiences And Frailty Among Chinese Older Adults

Aims:Adverse Childhood Experiences(ACEs)have a crucial impact on the psychological status,cognitive function,and physical function of old adults.Few studies have explored the relationship between ACEs and frailty with the life course theory.whether ACEs directly or indirectly affect the risk of frailty among old adults,which can provide scientific reference for prevention and intervention.To verify life course epidemiology models,we investigated the extent to which depressive symptoms,social isolation and physical function mediated the association between ACEs and frailty incidence in Chinese older adults.Methods:We used four waves of data from the China Health and Retirement Longitudinal Study(2011,2013,2014,and 2015)to compare ACEs between individuals who acquired frailty(n=329)and those who remained frailty-free(n=3893).Frailty was measured by the validated physical frailty phenotype(PFP)scale.Measure childhood negative experiences from three dimensions:neglect,abuse and family dysfunction.ACEs was assessed by three dimensions:neglect,abuse and household dysfunction.A marginal structural model with stabilized inverse probability weights was applied to examine the effect of ACEs on frailty risk and explore the mediating effect of depressive symptom,social isolation,and physical function,which provided references for other causal inference studies.Results:This study comprehensively describes the frailty incidence of Chinese community older adults among different populations.Overall,we found 7.79%of older adults were frail within the 4-year follow-up under study.The natural direct effect of ACEs on the risk of frailty was 0.45(95%CI:0.18,0.68).The indirect effect through material factors was 0.27(95%CI:0.08,0.43),explaining 37.5%of the total effect.There is dose-response relationship between ACEs and frailty.The association between ACEs and frailty is different in age,sex,and education.ACEs increase the risk of frailty among older,female,and lower educated people.Conclusions:The finding that the effect of ACEs on frailty operates predominantly through depressive symptoms has important implications.Early screening for high-risk population and health education is crucial as well as pay attention to children’s growth education and improve the level of social support.