Childhood and Adulthood Conditions in Relation to Mild Cognitive Impairment among U.S. and Chinese Older Adults: A Life Course Perspective

Abstract

Using two nationally representative datasets, Chinese Health and Retirement Study (CHARLS) and Health and Retirement Study (HRS), this dissertation mainly examined the associations between adverse childhood experiences (ACEs), adulthood educational attainment and various domains of late-life cognitive functioning among older adults in China and United States under the life course framework. Results from cox proportional hazard models revealed that for both samples, various ACEs, for instance family SES and interpersonal relations were significantly associated with higher risk of mild cognitive impairment in later life, reconfirming the life course perspective and accumulative disadvantage theory. For the Chinese sample, childhood hunger was a strong risk factor for the mental status domain of cognitive functioning in later life, while the U.S. sample was especially susceptible to early paternal death. Following that, using adulthood educational attainment as a moderator, the detrimental effects of ACEs were buffered effectively: for both samples, having an education of middle school/high school or above could greatly reduce the risk of episodic memory impairment in later life. Moreover, dividing both samples into male and female groups, gender differences have been detected. Among the Chinese older adults, results revealed that males were more susceptible to mother-related ACEs, while females were influenced by ACEs of all aspects: childhood SES, early paternal death, hunger, and interpersonal relations. The protective effects of education were more significant for females. While for the U.S. sample, both groups suffered from the detrimental effects of various ACEs on late-life cognitive functioning, but the moderation of education only worked for females, greatly reducing the risk of mild cognitive impairment in later life. Findings of this study suggest that for older adults in both China and U.S., adverse childhood experiences could have long-lasting impacts on cognitive functioning throughout the life course, and adulthood educational attainment as an important resource is especially necessary and effective for females to buffer the effects of childhood trauma. This paper could provide reference for future research in an array of fields that can have implications for optimizing cognitive aging.