Adverse Childhood Experiences and Multidimensional Frailty Transitions in Later Life: Evidence From Three National Aging Cohorts

Objectives To examine whether adverse childhood experiences (ACEs) are associated with distinct multidimensional frailty patterns and transitions across frailty states in later life. Methods We used harmonized longitudinal data from the English Longitudinal Study of Ageing, the Health and Retirement Study, and the China Health and Retirement Longitudinal Study. The analytic sample included 10,643 adults aged ≥50 years who were free of multidimensional frailty at baseline. ACEs were assessed across eight childhood adversity domains and modeled as binary, categorical, and continuous exposures. Multidimensional frailty was defined as frailty in ≥2 physical, psychological, or social domains. Cox and multi-state models assessed incident frailty patterns and transitions, respectively, with adjustment for age, sex, and educational attainment. Results Overall, 61.9% of participants reported at least one ACE, and 61.8% developed multidimensional frailty during follow-up. ACE exposure was associated with increased risks of all four incident frailty patterns, with hazard ratios ranging from 1.15 to 1.32. Cumulative ACE exposure was associated with higher risks across all four frailty patterns (3%-12% per additional ACE). In multi-state models, ACEs were associated with most transitions to multidimensional frailty (per-ACE HRs, 1.00-1.15). Sensitivity analyses were generally consistent, although associations were attenuated after excluding participants with frailty in any domain at baseline. Conclusions ACEs were associated with a higher risk of multidimensional frailty in later life, including distinct frailty patterns and transitions across frailty states. These findings support a life-course approach to frailty prevention, with attention to early-life adversity and multidimensional vulnerability.