How adverse childhood experiences affect the association between chronic condition progression and subjective or...

Objectives: Little is known regarding the association between chronic condition progression and subjective or objective cognitive function, and whether adverse childhood experiences (ACEs) moderate this association. This study aimed to explore the association between chronic condition progression and subjective or objective cognition, and to determine whether ACEs moderate this relationship.Methods: This study used two waves of follow-up surveys (2020 and 2022) conducted by the Shandong Rural Elderly Health Cohort (SREHC), including 2,607 older adults aged 60 years or above. Chronic condition progression was defined as the change in the number of 12 chronic conditions across waves. Subjective and objective cognitive function were measured by the Subjective Cognitive Decline Questionnaire 9 and Mini Mental State Examination, respectively. ACEs were measured by seven items of childhood adversity before age 17. Generalized linear mixed models with random intercepts were used to estimate our hypothetical models.Results: Chronic condition progression was significantly associated with subjective cognitive decline (β ranging from 0.428 to 0.869, all p < .05) but not with objective cognitive function. The moderating effect of ACEs was only on subjective, but not objective, cognitive function. ACEs exacerbated this association among rural older adults with multimorbidity, whether unchanged (unchanged multimorbidity × ACEs: β = 0.406, p = .026) or progressive (no chronic condition to emerging multimorbidity × ACEs: β = 0.990, p = .023; one chronic condition to emerging multimorbidity × ACEs: β = 0.456, p = .043; progressive multimorbidity × ACEs: β = 0.696, p = .001). This moderating effect was significant among males but not females.Conclusions: Chronic condition progression was associated with subjective cognitive decline but not objective cognitive function. ACEs amplified this association among older adults with multimorbidity, particularly among males. Incorporating subjective cognitive screening into chronic disease management, with attention to childhood adversity, may help identify older adults earlier in rural settings.