Associations between adverse childhood experiences and later-life multiple functional limitation in older adults across four cohorts

The aim of this study is to evaluate the association between Adverse Childhood Experiences (ACEs) and multiple functional limitation in older adults across various international settings. We used longitudinal data from 78,417 adults aged 50 years or older in four ageing cohorts: the China Health and Retirement Longitudinal Study (CHARLS), the English Longitudinal Study of Ageing (ELSA), the Survey of Health, Ageing and Retirement in Europe (SHARE), and the Health and Retirement Study (HRS). Six ACE indicators were assessed retrospectively (physical abuse, emotional neglect, parental death, foster care placement, financial hardship, and parental unemployment) and analyzed in two ways: as the cumulative number of ACEs (categorized as 0, 1, 2, or ≥ 3), and as four ACE types (physical abuse, emotional neglect, adverse family environment, and economic adversity). At each survey wave, multiple functional limitation was measured as the number of impairments across six domains (hearing, vision, physical functioning, mobility, mental health, and cognition), giving a score from 0 to 6. Within each cohort, we used survey-weighted generalized estimating equations with a Poisson distribution to estimate associations with functional limitation, adjusting for age, sex, and survey wave. Cohort-specific risk ratios (RRs) were then combined using random-effects meta-analysis. Across all cohorts, the proportion reporting at least one ACE ranged from 32.6% in ELSA to 66.9% in CHARLS. Compared with those reporting no ACE, the RRs (95% CI) for functional limitations were 1.17 (1.09–1.26) for one ACE, 1.29 (1.17–1.43) for two ACEs, and 1.39 (1.20–1.61) for three or more ACEs. Among the four ACE types, physical abuse (RR, 1.18; 95% CI, 1.08–1.29), economic adversity (RR, 1.16; 95% CI, 1.10–1.23), and emotional neglect (RR, 1.11; 95% CI, 1.02–1.20) were each associated with higher functional limitation. Increased risks were observed across all six domains, with the strongest associations for mental disorders among individuals with three or more ACEs (RR, 1.82). The findings were consistent across cohorts and robust in sensitivity analyses. ACEs were consistently associated with a greater risk of experiencing multiple functional limitations in later life, emphasizing the importance of mitigating childhood adversity to promote healthier ageing.