Childhood Disadvantage and Adult Functional Status: Do Early-Life Exposures Jeopardize Healthy Aging?

OBJECTIVES: To examine whether childhood disadvantage is associated with later-life functional status and identify mediating factors. METHODS: Unique and additive effects of five childhood domains on functional status were assessed at baseline (2006) and over time (2006-2016) in a sample of 13,894 adults from the Health and Retirement Study (>50 years). Adult health behaviors and socioeconomic status (SES) were tested as mediators. RESULTS: Respondents exposed to multiple childhood disadvantages (OR = .694) as well as low childhood SES (OR = .615), chronic diseases (OR = .694), impairments (OR = .599), and risky adolescent behaviors (OR = .608) were less likely to be free of functional disability by baseline. Over time, these unique and additive effects of childhood disadvantage increased the hazard odds of eventually developing functional disability (e.g., additive effect: hOR = 1.261). Adult health behaviors and SES mediated some of these effects. DISCUSSION: Given the enduring effects of childhood disadvantage, policies to promote healthy aging should reduce exposure to childhood disadvantage.

Early Origins of Body Mass in Later Life: Examining Childhood Risks and Adult Pathways.

Prior research reveals that negative early-life experiences play a major role in the development of obesity in later life, but few studies identify mechanisms that alter the lifetime risk of obesity. This study examines the influence of negative childhood experiences on body mass index (BMI) and obesity (BMI ≥30) during older adulthood and the psychosocial and behavioral pathways involved. Using a nationally representative sample, we examine the influence of cumulative misfortune as well as five separate domains of misfortune on BMI and obesity. Results show that four of the five domains are associated with BMI and obesity either directly, indirectly, or both. The influence of cumulative misfortune on the outcomes is mediated by three adult factors: socioeconomic status, depressive symptoms, and physical activity. The mediators identified here provide targets for intervention among older adults to help offset the health risks of excess BMI attributable of early-life exposure to misfortune.

Early Origins of Adult Cancer Risk Among Men and Women: Influence of Childhood Misfortune?

OBJECTIVE: To examine the effect of five childhood misfortune domains-parental behavior, socioeconomic status, infectious diseases, chronic diseases, and impairments-on all-site and selected site-specific cancer prevalence and all-site cancer incidence. METHOD: Panel data from the Health and Retirement Study (2004-2012) were used to investigate cancer risk among adults above the age of 50. RESULTS: Risky parental behavior and impairment in childhood were associated with higher odds of all-site cancer prevalence, and childhood chronic disease was associated with prostate cancer, even after adjusting for adult health and socioeconomic factors. Moreover, having one infectious disease in childhood lowered the odds of colon cancer. Cancer trends varied by race and ethnicity, most notably, higher prostate cancer prevalence among Black men and lower all-site cancer among Hispanic adults. DISCUSSION: These findings underscore the importance of examining multiple domains of misfortune because the type and amount of misfortune influence cancer risk in different ways.

Does Early-Life Misfortune Increase the Likelihood of Psychotropic Medication Use in Later Life?

Life-course research has linked childhood experiences to adult mental illness, but most studies focus on anxiety or depressive symptoms, which may be transient. Therefore, this study investigates whether childhood misfortune is associated with taking psychotropic medication, a measure reflecting an underlying chronic mental disorder. Data are from three waves of a national survey of 2,999 U.S. men and women aged 25-74 years. Four domains of childhood misfortune (childhood socioeconomic status, family structure, child maltreatment, and poor health) are considered-specified as separate domains and a single additive measure-as key predictors of psychotropic medication use. Findings reveal an association between additive childhood misfortune and adult psychotropic medication use, net of adult risk factors. Psychotropic medication use is also more likely during the 20-year study for adults who experienced maltreatment and poor health during childhood. These results reveal the importance of early intervention to reduce consumption of psychotropic medications and associated costs.

Alcopops, taxation and harm: a segmented time series analysis of emergency department presentations.

BACKGROUND: In Australia, a Goods and Services Tax (GST) introduced in 2000 led to a decline in the price of ready-to-drink (RTD) beverages relative to other alcohol products. The 2008 RTD ("alcopops") tax increased RTD prices. The objective of this study was to estimate the change in incidence of Emergency Department (ED) presentations for acute alcohol problems associated with each tax. METHODS: Segmented regression analyses were performed on age and sex-specific time series of monthly presentation rates for acute alcohol problems to 39 hospital emergency departments across New South Wales, Australia over 15 years, 1997 to 2011. Indicator variables represented the introduction of each tax. Retail liquor turnover controlled for large-scale economic factors such as the global financial crisis that may have influenced demand. Under-age (15-17 years) and legal age (18 years and over) drinkers were included. RESULTS: The GST was associated with a statistically significant increase in ED presentations for acute alcohol problems among 18-24 year old females (0 · 14/100,000/month, 95% CI 0 · 05-0 · 22). The subsequent alcopops tax was associated with a statistically significant decrease in males 15-50 years, and females 15-65 years, particularly in 18-24 year old females (-0 · 37/100,000/month, 95% CI -0 · 45 to -0 · 29). An increase in retail turnover of liquor was positively and statistically significantly associated with ED presentations for acute alcohol problems across all age and sex strata. CONCLUSIONS: Reduced tax on RTDs was associated with increasing ED presentations for acute alcohol problems among young women. The alcopops tax was associated with declining presentations in young to middle-aged persons of both sexes, including under-age drinkers.

Why do older people change their ratings of childhood health?

A growing number of studies in life course epidemiology and biodemography make use of a retrospective question tapping self-rated childhood health to assess overall physical health status. Analyzing repeated measures of self-rated childhood health from the Health and Retirement Study (HRS), this study examines several possible explanations for why respondents might change their ratings of childhood health. Results reveal that nearly one-half of the sample revised their rating of childhood health during the 10-year observation period. Whites and relatively advantaged older adults-those with more socioeconomic resources and better memory-were less likely to revise their rating of childhood health, while those who experienced multiple childhood health problems were more likely to revise their childhood health rating, either positively or negatively. Changes in current self-rated health and several incident physical health problems were also related to the revision of one's rating of childhood health, while the development of psychological disorders was associated with more negative revised ratings. We then illustrate the impact that these changes may have on an adult outcomes: namely, depressive symptoms. Whereas adult ratings of childhood health are likely to change over time, we recommend their use only if adjusting for factors associated with these changes, such as memory, psychological disorder, adult self-rated health, and socioeconomic resources.

Anemia and its impact on function in nursing home residents: what do we know?

PURPOSE: To provide the advanced practice nurse (APN) information on the prevalence and causes of anemia in elderly nursing home (NH) residents, in order to affect diagnostic and management strategies that may help improve physical function and mobility outcomes. DATA SOURCES: Literature review of current peer-reviewed research articles. CONCLUSIONS: In the United States, the prevalence of anemia increases with advancing age, and are reported to be much higher among older NH residents than among community-dwelling older adults. Causes of anemia among the elderly are often multifactorial. Older individuals with anemia, including mild anemia and even low normal level, have demonstrated lower muscle strength, physical function, mobility, and increased morbidity and mortality outcomes. IMPLICATIONS FOR PRACTICE: Given the potentially significant relationship between anemia and physical performance outcomes among NH residents, gaining a better understanding will help guide future evidence-based care by allowing the APN an opportunity to tailor both medical and restorative care interventions. Because anemia is a potentially modifiable condition, intervention may preserve, limit, or reverse functional impairment and/or disablement, and allow for maximal functional independence.