Unhappy family or trauma in youth leads to poor health in old age

Adverse childhood experiences have impacts deep into old age, especially for those who experienced violence, and include both physical and cognitive impairments.

It's known that a difficult childhood can lead to a host of health issues as a young or midlife adult, but now, for the first time, researchers at UC San Franciso have linked adverse experiences early in life to lifelong health consequences.

They found that older U.S. adults with a history of stressful or traumatic experiences as children were more likely to experience both physical and cognitive impairments in their senior years. Stressful childhood experiences could include exposure to physical violence or abuse, severe illness, family financial stress or being separated from parents.

The study, which appears Aug. 2, 2023, in the Journal of General Internal Medicine, found that those who experienced violence in childhood were 40% more likely to have mobility impairment and 80% more likely to have difficulty with daily activities. Those who came from unhappy families were 40% more likely to have at last mild cognitive impairment.

"We looked at self-reported disability, as well as objectively measured physical and cognitive impairment, and learned that early life stressful experiences can have ramifications all the way into older age," said senior author Alison J. Huang, MD, a UCSF professor of medicine and director of research in General Internal Medicine at UCSF Health.

"This can mean a higher likelihood of difficulty walking, or carrying out activities of daily living, or problems with memory when people are in their 60s, 70s, 80s, or older," she said.

Root cause for a lifetime of ailments

Almost 60 percent of adults in the U.S. have experienced one or more types of adverse childhood experiences (ACEs) that can undermine a child's sense of safety or stability, according to the Centers for Disease Control and Prevention (CDC). This is associated with chronic physical and mental health issues, including cardiovascular disease, diabetes, autoimmune disease and depression. But there's little research documenting health implications of ACEs across the full lifespan, even though older adults bear the greatest burden of most health conditions.

In 2021, California became the first state to mandate commercial insurance coverage for screening for early stressful or traumatic experiences in both children and adults. Eight other states are considering or implementing similar legislation. This type of screening, however, remains controversial due to an unclear impact on long-term health and a possible burden on the health care system.

Drawing upon data from the National Social Life, Health and Aging Project, a national cohort of older U.S. adults, the new study examined nearly 3,400 participants, slightly more than half female, who were 50 to 97 years old and lived in community settings. Participants were asked about ACEs and underwent tests of balance and walking, as well as cognition and memory. Their difficulty with performing the activities of daily living was also assessed.

Close to half—44%—reported a history of at least one ACE between age 6 and 16. These included, experiencing violence (14%), witnessing violence (16%), financial stress (13%), separation from a parent (16%), and poor health (6%) in childhood. One in five reported more than one adverse childhood experience.

"Given how common ACEs were among our participants, it shows that stressful early life experiences may be markers of risk of functional impairment and disability later in life," said first author and UCSF medical student Victoria M. Lee. "This raises implications for geriatric care: early recognition of childhood trauma may be useful in identifying adults who might benefit from screening or prevention strategies for aging-associated functional decline."