The Association between Adverse Childhood Experiences and Frailty: A Systematic Review

Objective: Based on life-course theory, adverse childhood experiences (ACEs) have emerged as risk factors for health in later life. This study aimed to explore the association between ACEs and frailty. Design: Systematic review. Setting and Participants: Frail older adults who have experienced ACEs. Methods: We searched 7 databases: PubMed, Cochrane Library, Embase, Web of Science, Scopus, PsycINFO, and China National Knowledge Infrastructure (CNKI). The last searched date was October 27, 2023. Included studies should have investigated the association between exposure to at least 1 ACE and frailty. Two researchers independently assessed the risk of bias in the included studies using the NewcastleOttawa Scale (NOS) and an adapted version of the NOS scale and also extracted relevant characteristics and outcomes of the included studies. Results: A total of 14 studies were finally included. Consistent associations with increased risk of frailty were only shown in studies that assessed family members with mental illness, low neighborhood quality, emotional abuse, sexual abuse, and combinations of ACEs. In addition, women exposed to ACEs were more likely to be at risk for frailty than men, and greater numbers or types of exposure to ACEs were associated with higher odds of frailty. The results of the quality assessment showed a moderate risk of bias in half of the studies. Conclusions and Implications: This study summarizes for the first time the evidence for an association between ACEs and frailty. Considered collectively, increased attention to ACEs may be one way to prevent frailty, and unhealthy lifestyles resulting from ACEs may serve as a breakthrough in developing interventions. (c) 2024 AMDA - The Society for Post-Acute and Long -Term Care Medicine.