Adverse childhood experiences and trajectories of multimorbidity in individuals aged over 50: Evidence from the English Longitudinal Study of Ageing

Background: Adverse childhood experiences (ACE) are important for chronic diseases yet their association with multimorbidity remains understudied. Few studies consider the complexity of multimorbidity or observe multimorbidity development over time. Objective: We investigated whether ACE were associated with multimorbidity at baseline and over a 12-year follow-up period. Participants and setting: 5326 participants aged over 50 were obtained from the English Longitudinal Study of Ageing (ELSA). Methods: An ACE summary score was derived using eight ACE items measuring abuse, social care, and household dysfunction. From repeated measurements of 29 chronic conditions over a 12-year period (2008–2019) we derived two multimorbidity measures: number of chronic diseases and number of chronic disease categories. We used multinomial logistic regression to assess associations between ACE and both measures. Mixed effects models were estimated to examine trajectories of multimorbidity by ACE over time. Results: Graded associations between ACE and multimorbidity were observed. Compared to those without ACE, participants with ≥3 ACE had three times the risk of having ≥3 chronic diseases (RRR 3.06, 95 % CI 1.85–5.05) and falling into ≥3 chronic disease categories (RRR 2·93 95 % CI 1·74–4·95). Graded associations persisted during 12-year follow-up, though differences in multimorbidity between those with ≥3 ACE and those without ACE remained constant (B 0.02, 95 % CI 0·01–0·03, and B −0·01, 95 % CI −0·02–0·00, number of chronic conditions and chronic condition categories respectively). Conclusion: ACE are associated with multimorbidity risk and complexity, associations arising before the age of 50. Early intervention amongst those with ACE could attenuate this association

Adverse childhood experiences and diurnal cortisol patterns in older people in England

Adverse childhood experiences (ACE) are associated with HPA axis dysregulation at younger ages, but there is scarcity of evidence for this association at older ages. To add to our knowledge of the lifetime impact of ACE on HPA axis function, we examined whether ACE were associated with diurnal cortisol patterns in a national sample of 587 participants (356 women) aged 55-79 years from the English Longitudinal Study of Ageing (ELSA). We conducted descriptive analyses and estimated sex-specific robust regression models of the associations between the 8-item summary ACE score and four measurements of salivary cortisol over a 24-h cycle (upon waking, 30 min later, at 7 pm, and at bedtime) as well as the cortisol awakening response (CAR) and the diurnal cortisol slope. Our models were adjusted for age, then for childhood socioeconomic position and finally for adult socioeconomic position. In men, we found significant differences that were independent of covariates, with more ACE being associated with lower salivary cortisol levels on waking, a greater CAR, and a flatter diurnal cortisol slope. In women, we observed a graded association between ACE and increased 7 pm salivary cortisol levels. Our findings indicate that childhood adversity is related to HPA axis in older people, especially men. The chronological distance (on average >50 years) between ACE and salivary cortisol levels suggests the existence of a lifelong association between childhood adversity and HPA axis and neuroendocrine function. Notwithstanding sex differences, based on our findings we suggest that HPA axis dysregulation could be a pathway that mediates the association between ACE and chronic disease later in life

Adverse childhood experiences and age-trajectories of depressive symptoms in older adults from China

Background Adverse childhood experiences (ACEs) have profound lifelong consequences. Less is known about their impact on outcomes in late life, such as psychological distress in older adults. Moreover, there is a paucity of evidence on associations of ACEs with age-trajectories in depressive symptoms, especially with distinct patterns of trajectories. We investigated associations between ACEs and trajectories of depressive symptoms at mid-to-older ages in a Chinese population sample. Methods We used the longitudinal data from the China Health and Retirement Longitudinal Survey (13846 participants ≥45y). Depressive symptoms were measured by CES-D10 (Centre for Epidemiologic Studies Depression Scale) at four waves (2011-18). A range of ACEs (<17y) were retrospectively reported by participants. Growth Mixture Models were used to identify distinct age-trajectories of depressive symptoms and their associations with ACEs. Results We identified two trajectory groups: (1) persistent high (men 14%; women 19.2%) and (2) low/normal levels of depressive symptoms. Several ACE measures were associated with increased risk of having persistent high levels of depressive symptoms (mid-to-older ages) after adjusting for other ACEs, sex, childhood SES (financial status, parental education, occupation), adult SES (education, financial status, urban/rural residence), health behaviors and limitations in daily activities. For example, adjusted OR was 1.35 (95% CI:1.17,1.55) for physical abuse (28.2%), 1.38(1.19,1.59) for domestic violence (24.3%), 1.48(1.23,1.78) for parental drinking, drug or mental health problems (9.4%), 1.59(1.38,1.84) for those had a bedridden parent (18.7%). Conclusions ACEs have a long lasting effect on trajectories of depressive symptoms in older adults, independent of childhood SES and adult factors, highlighting the need to act early to reduce the long lasting impact on mental health in later life. Key messages • Adverse childhood experiences are associated with persistent high levels of depressive symptoms from mid-to-older ages. • Associations are independent of childhood SES and adult factors

Physical activity and trajectories in cognitive function:English Longitudinal Study of Ageing

BACKGROUND: There are limited data on physical activity in relation to trajectories in cognitive function. The aim was to examine the association of physical activity with trajectories in cognitive function, measured from repeated assessments over 10 years. METHODS: We conducted a 10-year follow-up of 10 652 (aged 65±10.1 years) men and women from the English Longitudinal Study of Ageing, a cohort of community dwelling older adults. Self-reported physical activity was assessed at baseline and neuropsychological tests of memory and executive function were administered at regular 2-year intervals. Data from six repeated measurements of memory over 10 years and five repeated measurements of executive function over 8 years were used. RESULTS: The multivariable models revealed relatively small baseline differences in cognitive function by physical activity status in both men and women. Over the 10-year follow-up, physically inactive women experienced a greater decline in their memory (-0.20 recalled words, 95% CI -0.29 to -0.11, per study wave) and in executive function ability (-0.33 named animals; -0.54 to -0.13, per study wave) in comparison with the vigorously active reference group. In men, there were no differences in memory (-0.08 recalled words, 95% CI -0.18 to 0.01, per study wave), but small differences in executive function (-0.23 named animals; -0.46 to -0.01, per study wave) between inactive and vigorously active. CONCLUSION: Physical activity was associated with preservation of memory and executive function over 10 years follow-up. The results were, however, more pronounced in women

Physical activity and trajectories in cognitive function: English Longitudinal Study of Ageing

Background: There are limited data on physical activity in relation to trajectories in cognitive function. The aim was to examine the association of physical activity with trajectories in cognitive function, measured from repeated assessments over 10 years. Methods: We conducted a ten year follow-up of 10,652 (aged 65 ± 10.1 years) men and women from the English Longitudinal Study of Ageing, a cohort of community dwelling older adults. Self-reported physical activity was assessed at baseline and neuropsychological tests of memory and executive function were administered at regular 2-year intervals. Data from six repeated measurements of memory over ten years and five repeated measurements of executive function over eight years were used. Results: The multivariable models revealed relatively small baseline differences in cognitive function by physical activity status in both men and women. Over the ten year follow-up, physically inactive women experienced a greater decline in their memory (-0.20 recalled words, 95% CI, -0.29 to -0.11, per study wave) and in executive function ability (-0.33 named animals; -0.54 to -0.13, per study wave) in comparison with the vigorously active reference group. In men there were no differences in memory (-0.08 recalled words, 95% CI, -0.18 to 0.01, per study wave), but small differences in executive function (-0.23 named animals; -0.46 to -0.01, per study wave) between inactive and vigorously active. Conclusion: Physical activity was associated with preservation of memory and executive function over ten years follow-up. The results were, however, more pronounced in women

Trajectories of verbal episodic memory in middle-aged and old adults: Evidence from the English Longitudinal Study of Ageing

OBJECTIVES: To identify distinct latent groups of baseline levels and age-related decline in verbal episodic memory in middle-aged and older adults, and to identify factors associated with these trajectories. DESIGN: Longitudinal study of six data collections over a period of 10 years. SETTING: Population-based cohort in England. PARTICIPANTS: 9,515 community-dwelling adults aged 50-79 years. MEASUREMENTS: Six repeated measurements of immediate and delayed recall of 10 words over 10-year follow-up. Group-based trajectory modeling was used to identify patterns of baseline levels and subsequent decline in memory in two age categories (50-64 and 65-79 years), and to investigate associations between trajectories and baseline predictors of group membership (gender, education, household wealth, marital status, smoking and physical activity) and time-varying covariates (depressive symptoms and number of chronic conditions). RESULTS: Four trajectories were identified and labelled according to baseline status and decline in memory: very low/decline (9.8%), low/stable (40.2%), average/stable (39.5%) and good/stable (10.5%) in the younger group, and very low/rapid decline (15.7%), low/decline (32.0%), average/stable (38.8%), and good/stable (13.5%) in older participants. In people with stable or declining trajectories, a higher number of depressive symptoms and the presence of cardiovascular diseases were associated with worse memory. Female sex, younger age, and higher education, wealth and physical activity were consistently associated with more favourable trajectories. CONCLUSIONS: We identified four memory trajectories. Factors known to be associated with cognitive reserve (such as education, wealth and physical activity) were associated with better memory function while depressive symptoms and cardiovascular disease were associated with poorer memory. This suggests that interventions to reduce depressive symptoms and better manage cardiovascular risk factors and disease in midlife may help prevent or delay future memory decline

Could COVID-19's Aftermath on Children's Health Be Felt into the 22nd Century?

The COVID-19 pandemic has massively affected people’s health, societies, and the global economy. Our lives are no longer as they were before COVID-19, and, most likely, will never be the same again. We hypothesize that the effect of the COVID-19 pandemic on population health and the economy will last for a very long time and will still be felt in the 22nd century. Our hypothesis is based on evidence from the 1918–1919 influenza pandemic, the Dutch famine during the Second World War, and the 2007–2008 economic crisis, as well as from the rationally predicted impact of COVID-19 on human development. We expect that the COVID-19 pandemic, including the mitigation measures taken against it, will affect children’s development in multiple ways, including obesity, both while in utero and during critical and sensitive windows of development, including the early childhood years and those of puberty and adolescence. The psychosocial and biological impact of this effect will be considerable and unequally distributed. The implications will last at least a lifetime, and, through inter-generational transmission, will likely take us to future generations, into the 22nd century. We argue for the urgent need of designing and initiating comprehensive longitudinal cohort studies to closely monitor the long-term effects of COVID-19 on children conceived, born, and raised during the pandemic. Such an approach requires a close and effective collaboration between scientists, healthcare providers, policymakers, and the younger generations, and it will hopefully uncover evidence necessary to understand and mitigate the impact of the pandemic on people’s lives in the 21st and 22nd centuries

Cardiovascular risk factors and memory decline in middle-aged and older adults: the English Longitudinal Study of Ageing.

BACKGROUND: We investigated the association between trajectories of verbal episodic memory and burden of cardiovascular risk factors in middle-aged and older community-dwellers. METHODS: We analysed data from 4372 participants aged 50-64 and 3005 persons aged 65-79 years old from the English Longitudinal Study of Ageing who were repeatedly evaluated every 2 years and had six interviews of a 10-year follow-up. We measured the following baseline risk factors: diabetes, hypertension, smoking, physical inactivity and obesity to derive a cardiovascular risk factor score (CVRFs). Adjusted linear mixed effect regression models were estimated to determine the association between number of CVFRs and six repeated measurements of verbal memory scores, separately for middle-aged and older adults. RESULTS: CVRFs was not significantly associated with memory at baseline. CVFRs was significantly associated with memory decline in middle-aged (50-64y), but not in older (65-79y) participants. This association followed a dose-response pattern with increasing number of CVFRs being associated with greater cognitive decline. Comparisons between none versus some CVRFs yielded significant differences (p < 0.05). CONCLUSIONS: Our findings confirm that the effect of cumulative CVRFs on subsequent cognitive deterioration is age-dependent. CVRFs are associated with cognitive decline in people aged 50-64 years, but not in those aged ≥65 years. Although modest, the memory decline associated with accumulation of cardiovascular risk factors in midlife may increase the risk of late-life dementia