Associations of Adverse Childhood Experiences With Falls and Fall Risk Factors Among Middle-Aged and Older Adults in China

Introduction

This study examined the associations of adverse childhood experiences (ACEs) with falls and fall risk factors and investigated whether fall risk factors mediate the association between ACEs and falls.

Methods

This population-based cross-sectional study included 9,961 participants aged ≥45 years from the 2014 Life History Survey and the 2015 follow-up survey of the China Health and Retirement Longitudinal Study. Data analysis was performed from April 3 to May 7, 2024. Logistic regression models were used to assess the associations of the cumulative number of ACEs with falls and fall risk factors, as well as each ACE type. The Karlson–Holm–Breen method was used to examine the total (direct and indirect) effect of fall risk factors mediating the association between each ACE type and falls.

Results

Associations of the cumulative number of ACEs with falls and specific fall risk factors were observed. Seven of the 12 ACEs were associated with falls, including physical abuse, household mental illness, witnessed domestic violence, bullying, parental death, sibling death, and parental disability. Corresponding fall risk factor patterns totally or partly mediated the associations between the 6 ACE types (excluding parental death) and falls. Pain and depressive symptoms were the dominant contributors.

Conclusions

ACEs were associated with falls and specific fall risk factors. Pain and depressive symptoms predominantly mediated the association between each type of ACE and falls. Early identification and targeted treatment of pain and depressive symptoms are critical for reducing fall incidence of ACEs-exposed individuals in later life.