Social Support Networks and Coping With Aging: A Mixed Methods Study Among Older Adults With Adverse Childhood Experiences (ACEs) in Malaysia

Adverse childhood experiences (ACEs) are known to have long-term impacts on mental health and social functioning, potentially hindering the development of supportive social networks later in life. Asia’s rapidly aging populations face complex social and healthcare challenges, highlighting the need to understand how early-life trauma influences older adults’ experiences and utilization of social support systems. Despite widespread recognition of the importance of social support as a significant protective factor, its complex dynamics in later life remain underexplored. This study aims to examine the association between ACEs and perceived social support among older adults in rural Malaysia, and to explore how older adults with a history of ACEs perceive the role of social support in coping with age-related challenges. A mixed-method approach was employed. Quantitative data were analyzed from a cross-sectional study of 1,928 participants (aged 60 years and above), drawn from the Prevent Elder Abuse and NegleCt InitiativE (PEACE) project in the state of Negeri Sembilan. The Duke Social Support Index (DSSI) measured perceived social support, whereas the Adverse Childhood Experiences – International Questionnaire (ACE-IQ) assessed childhood adversity. In-depth interviews were conducted with 21 older adults with ACEs exposure. A theory-informed reflexive thematic analysis was conducted to identify key themes related to the role of social support and its influence on coping processes. Quantitative analysis revealed that exposure to any ACEs was associated with a higher likelihood of reporting good perceived social support (AOR = 1.72, 95% CI: 1.35-2.19), suggesting possible resilience or adaptive social coping mechanisms among older adults with such experiences. The qualitative findings further contextualized this pattern, revealing three central themes: (a) perceived benefits of social support in enhancing well-being, (b) barriers to seeking social support, and (c) the multifaceted role of social support in later life. Despite past trauma, many participants demonstrated resilience by actively building and maintaining meaningful support networks to cope with aging. However, some continued to face perceived and actual barriers, often shaped by stigma or limited resources. This study highlights that, despite early-life adversity, older adults in rural Malaysia can develop strong social support networks that positively influence their quality of life and emotional well-being. These findings suggest the need for targeted interventions, such as community support groups, social skills training, and intergenerational programs, to strengthen social connections. Policies that promote family involvement, expand access to community-based resources, and incorporate person-centered, trauma-informed care can further enhance support structures and improve overall outcomes for vulnerable older populations.