Exploring the Link Between Adverse Childhood Experiences and Physical Frailty in Older Adults: A Cross-Sectional Analysis of a Rural Malaysian Population

While international research exploring the association between Adverse Childhood Experiences (ACEs) and negative health outcomes among older adults is growing, this area remains relatively under-investigated in low and middle-income countries, including Malaysia. This highlights a significant research gap that warrants further exploration. This study aimed to determine the prevalence of threat-related and deprivation-related ACEs and examine their association with physical frailty among older adults. We utilized secondary data from the Prevent Elder Abuse and NegleCt InitiativE project, a cross-sectional study of 1928 community-dwelling older adults aged ≥ 60 years old in Kuala Pilah District, Negeri Sembilan, Malaysia. The Fatigue, Resistance, Ambulation, Illnesses, and Loss of Weight (FRAIL) scale assessed physical frailty, while the ACE-IQ measured childhood adversity across threat and deprivation dimensions. Univariate and binary logistic regression were performed to measure the association between ACEs and physical frailty. The prevalence of ACEs exposure was 16.5% (n = 319) experienced combined threat and deprivation-related ACEs, 21.2% (n = 408) experienced threat-related ACEs, 30.1% (n = 580) experienced deprivation-related ACEs, and 32.2% (n = 621) did not experience any type of ACEs. Deprivation-related ACEs were significantly associated with physical frailty in older adults (AOR = 1.44, 95% CI [1.11, 1.87], p = .006). Similarly, exposure to combined threat- and deprivation-related ACEs was also linked to increased odds of physical frailty (AOR = 1.42, [1.04, 1.95], p = .029). Cumulative exposure to four or more ACEs showed the strongest association with frailty (AOR = 2.07, [1.27, 3.39], p = .004). This study highlights that both deprivation-related ACEs and cumulative exposure to ACEs significantly contribute to the development of physical frailty among older adults. The findings underscore the importance of understanding specific ACEs dimensions and cumulative ACEs exposure, as recognizing these associations can guide the formulation of targeted prevention strategies and trauma-informed interventions aimed at reducing frailty risk and improving health outcomes in older populations.