Effects of Adverse Childhood Experiences on Functional Disability Among Community-Dwelling Older Adults: The Mediating Role of Depressive Symptoms and Cognitive Function

Objectives To examine whether adverse childhood experiences (ACEs) influenced functional disability through depressive symptoms and cognitive function. Methods Data were from five waves (2011-2020) of the China Health and Retirement Longitudinal Study (CHARLS) among 7461 participants aged ≥60 years. Logistic regression and Cox proportional hazard regression model were carried out to test the associations among ACEs, depressive symptoms, cognitive function, and functional disability. A four-way decomposition was applied to explore the mediation and interaction effects. Results Depressive symptoms (coefficient = 0.085-0.120, 95% CI = 0.082-0.124, attributable ratio: 11.4-15.4%) and cognitive impairment (coefficient = 0.014-0.029, 95% CI = 0.009-0.033, attributable ratio: 1.8-3.9%) mediated the association between ACEs and functional disability. There were significant multiplicative interaction of threat-related ACEs with depressive symptoms on functional disability (P for interaction = 0.018-0.029). Conclusion ACEs contributed to functional disability through depressive symptoms and cognitive impairment. Healthcare professionals should proactively target older adults with ACEs to address psychological and cognitive health issues, thereby preventing functional disability.