Adverse Childhood Experiences, Cognitive Outcomes, and Frailty in Older Adults: A Systematic Review and Meta-analysis

Adverse childhood experiences (ACEs) are important life-course determinants of health and may contribute to vulnerability in later life. Frailty and cognitive outcomes are important concerns in older adults, yet evidence linking ACEs to these outcomes has not been systematically synthesized. This review evaluated the associations between ACEs and frailty or cognitive outcomes in middle-aged and older adults.

Following PRISMA guidelines, we searched seven databases from inception to December 2025. Two reviewers independently screened studies, extracted data, and assessed risk of bias using Joanna Briggs Institute critical appraisal tools. Random-effects meta-analyses were performed where possible, and remaining findings were synthesized narratively.

Twenty-six observational studies met the inclusion criteria. Five studies contributed to the meta-analysis of frailty outcomes and six to cognitive outcomes. ACEs were associated with higher odds of frailty (OR = 2.05, 95% CI 1.61-2.63), objective cognitive impairment (OR = 1.46, 95% CI 1.18-1.82), and subjective cognitive decline (OR = 2.04, 95% CI 1.40-2.98). Narrative synthesis revealed substantial heterogeneity in the measurement of ACEs, frailty, and cognitive outcomes across studies.

ACEs are associated with increased risks of frailty and adverse cognitive outcomes in later life. These findings underscore the importance of a life-course perspective in aging research and suggest that childhood adversity may be relevant to later-life risk identification and prevention.