• Victoria M Lee, Anita S Hargrave, Nadra E Lisha, and Alison J Huang.
• Department of Medicine, School of Medicine, University of California, San Francisco, CA, USA. Victoria.Lee@ucsf.edu.
• J Gen Intern Med. 2023 Nov 1; 38 (15): 336233713362-3371.

BackgroundPrior 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.ObjectiveTo examine associations between ACEs, objectively measured physical mobility and cognitive impairment, and functional disability in older community-dwelling adults.DesignCross-sectional analysis.ParticipantsCommunity-dwelling older U.S. adults ages 50 years and older.Main MeasuresParticipants 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).Key ResultsAmong 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).ConclusionsOlder 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.© 2023. The Author(s), under exclusive licence to Society of General Internal Medicine.

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