Adverse Childhood Experiences and frailty in later life: a prospective population-based cohort study

Adverse Childhood Experiences and Social Participation on Frailty State Transitions among middle-aged and older adults: evidence from a 10-year prospective study in China

OBJECTIVES

Adverse childhood experiences (ACEs) are associated with frailty, while the association with frailty state transitions and the role of social participation remain unclear. This study aimed to investigate the association between ACEs and frailty state transitions, alongside the moderating effect of social participation METHODS: Data from 9,621 adults aged 45 and older from the China Health and Retirement Longitudinal Study (2011-2020) were analyzed. Frailty was measured with the frailty index, while ACEs and social participation were measured with a validated questionnaire. The association between ACEs and frailty state transitions was estimated using multi-state models. An interaction analysis were used to examine the moderating effects of social participation.

RESULTS

Participants with higher ACEs scores (≥4) were associated with an increased probability of forward transition (robust to pre-frail, HR = 1.37, 95%CI: 1.21-1.54; prefrail to frail, HR = 1.39, 95%CI: 1.18-1.63) and decreased probability of backward transition (pre-frail to robust, HR = 0.64, 95%CI: 0.55-0.76). Additionally, participants with moderate and high level social participation were associated with an increased probability of backward transition (pre-frail to robust, HR = 1.11, 95%CI: 1.01-1.23; frail to pre-frail, HR = 1.17, 95%CI: 1.02-1.33, respectively). Social participation moderated the association between ACEs exposure and frailty (P for interaction <0.05), while participants with lower ACEs scores (1 and 2) and high social participation were associated with an increased probability of transition from frail to pre-frail (HR = 1.26, 95%CI: 1.04-1.89 and HR = 1.15, 95%CI: 1.08-1.69).

CONCLUSIONS

High ACEs scores were associated with an increased likelihood of adverse frailty development. Older adults with ACEs exposure might benefit from intervention strategies to improve social participation.

The Association between Adverse Childhood Experiences and Frailty: A Systematic Review

OBJECTIVE

Based on life-course theory, adverse childhood experiences (ACEs) have emerged as risk factors for health in later life. This study aimed to explore the association between ACEs and frailty.

DESIGN

Systematic review.

SETTING AND PARTICIPANTS

Frail older adults who have experienced ACEs.

METHODS

We searched 7 databases: PubMed, Cochrane Library, Embase, Web of Science, Scopus, PsycINFO, and China National Knowledge Infrastructure (CNKI). The last searched date was October 27, 2023. Included studies should have investigated the association between exposure to at least 1 ACE and frailty. Two researchers independently assessed the risk of bias in the included studies using the Newcastle-Ottawa Scale (NOS) and an adapted version of the NOS scale and also extracted relevant characteristics and outcomes of the included studies.

RESULTS

A total of 14 studies were finally included. Consistent associations with increased risk of frailty were only shown in studies that assessed family members with mental illness, low neighborhood quality, emotional abuse, sexual abuse, and combinations of ACEs. In addition, women exposed to ACEs were more likely to be at risk for frailty than men, and greater numbers or types of exposure to ACEs were associated with higher odds of frailty. The results of the quality assessment showed a moderate risk of bias in half of the studies.

CONCLUSIONS AND IMPLICATIONS

This study summarizes for the first time the evidence for an association between ACEs and frailty. Considered collectively, increased attention to ACEs may be one way to prevent frailty, and unhealthy lifestyles resulting from ACEs may serve as a breakthrough in developing interventions.

Prevalence, perceptions, and experiences of frailty among older migrants from Low- and Middle-Income Countries to High Income Countries: A mixed method systematic review

BACKGROUND

Frailty is increasingly becoming a public health concern, especially among vulnerable populations. Older migrants from Low- and Middle-Income Countries to High Income Countries present with poorer health and are at increased risk of becoming frail. This review aims to explore the prevalence, perceptions, and experiences of frailty among older migrants from Low- and Middle-Income Countries to High Income Countries.

METHODS

This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. Five electronic databases were comprehensively searched for relevant literature published from January 1, 2000, to April 30, 2023. Quality appraisal for the quantitative studies was done with the Joanna Brigg's critical appraisal tool for analytic cross-sectional studies, and the qualitative studies were assessed with the Critical Appraisal Skill Program tool for qualitative studies.

RESULT

Seven studies met the inclusion criteria. Frailty was assessed using modified versions of the Frailty Phenotype and Frailty Index. The prevalence of frailty using the Frailty Phenotype was 16.6 %, and 17 % to 61.9 % according to the Frailty Index. The perceptions and experiences of frailty were characterised by chronic ill-health and a review of healthy pre-migration and early migration lives.

CONCLUSION

Despite the variation in frailty assessment methods, the high prevalence of frailty among older migrants was highlighted across the included studies. The perceptions and experiences of frailty reflect a state of resignation which can complicate the state of frailty. There is the need for ongoing research among migrant groups to identify their predisposition to frailty for early intervention.

Depression Earlier on in Life Predicts Frailty at 50 Years: Evidence from the 1958 British Birth Cohort Study

Frailty and depression in older ages have a bidirectional relationship, sharing some symptoms and characteristics. Most evidence for this has come from cross-sectional studies, or longitudinal studies with limited follow-up periods. We used data from the National Child Development Study (1958 Birth Cohort) to investigate the relationship between depression and early-onset frailty using a life course perspective. The primary outcome was frailty based on a 30-item inventory of physical health conditions, activities of daily living and cognitive function at 50 years. The main exposure was depression (based on a nine-item Malaise score ≥ 4) measured at 23, 33 and 42 years. We investigated this relationship using multiple logistic regression models adjusted for socio-demographic factors, early life circumstances and health behaviours. In fully adjusted models, when modelled separately, depression at each timepoint was associated with around twice the odds of frailty. An accumulated depression score showed increases in the odds of frailty with each unit increase (once: OR 1.92, 95%CI 1.65, 2.23; twice OR 2.33, 95%CI 1.85, 2.94; thrice: OR 2.95, 95%CI 2.11, 4.11). The public health significance of this finding is that it shows the potential to reduce the physical burden of disease later in life by paying attention to mental health at younger ages.