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Aging and Cumulative Inequality: How Does Inequality Get Under the Skin?
Abstract
This article draws from cumulative disadvantage and life course theories to develop a new theory for the social scientific study of aging.
Five axioms of cumulative inequality (CI) theory are articulated to identify how life course trajectories are influenced by early and accumulated inequalities but can be modified by available resources, perceived trajectories, and human agency.
Although the concept of CI has attracted considerable attention among social scientists, it holds promise for integrating additional disciplinary approaches to the study of aging including, but not limited to, biology, epidemiology, and immunology. The applicability of CI theory to gerontology is illustrated in research on the early origins of adult health.
Primary contributions of the theory to gerontology include greater attention to family lineage as a source of inequality; genes, gestation, and childhood as critical to early and enduring inequalities; the onset, duration, and magnitude of exposures to risk and opportunity; and constraints on generalizations arising from cohort-centric studies.
... This perspective emphasizes the importance of considering the accumulation of social resources and experiences throughout an individual's life in shaping health outcomes. It suggests that early life social advantages can have lasting effects on health in later life, creating a cascade of favorable outcomes over time (Dannefer, 2003(Dannefer, , 2020Ferraro & Shippee, 2009). ...
... Data for this study were drawn from the MIDUS-II (2004-2005) and MIDUS Refresher (2008-2009 cohorts of the Midlife Development in the United States (MIDUS) study. These two cohorts provide a unique opportunity to assess the consistency of findings across different samples within a single study while also evaluating the potential impact of an economic recession on cumulative social support. ...
... Our cross-sectional data, though informative, cannot capture these temporal dynamics. The concept of cumulative social advantage suggests that resources in one life domain can foster advantages in others-for example, strong early family relationships might develop skills that later enhance community engagement, initiating self-reinforcing cycles of positive social experiences that potentially confer long-term health benefits (Dannefer, 2003(Dannefer, , 2020Ferraro & Shippee, 2009). To fully understand these complex, interconnected pathways, longitudinal research is essential. ...
This study introduces the concept of cumulative social advantage as a hierarchical construct encompassing multiple aspects of social connection, including religious, psychosocial, familial, and emotional dimensions. Using data from the Midlife Development in the United States–II (n = 4,028) and Refresher (n = 2,586) cohorts, we assessed the dimensionality, replicability, measurement invariance, and validity of a hierarchical model. Results support measurement invariance across demographic groups and demonstrate the model’s convergent and predictive validity. Cumulative social advantage was associated with lower multimorbidity (β = −.17 [−.22, −.13], p < .001), reduced adiposity (β = −.12 [−.16, −.08], p < .001), fewer difficulties with moderate (β = −.18 [−.22, −.14], p < .001) and basic activities of daily living (β = −.20 [−.24, −.16], p < .001), and a decreased hazard rate for all-cause mortality (adjusted hazard ratio = 0.67 [0.47, 0.95], p < .001), with a standard deviation increase in cumulative social advantage predicting a 33% reduction in the hazard rate. The ameliorative influence of cumulative social advantage was consistent across sex, race, and education. These findings highlight the complex relationship between social connections and critical health outcomes, emphasizing the importance of considering cumulative social advantage as a potential explanation for understanding individual differences in health across the lifespan.
... First, gender analysis frameworks can be applied to document gender disparities in non-communicable diseases (NCDs) and wellbeing outcomes by examining the influence of economic, social and cultural factors on health behaviours 14 . Second, the construct of Cumulative Disadvantage/Advantage (CAD) theory provides a robust basis how early life-health, and social adversities intensify mid-life health disparities leading to a widening of health and wellbeing disparities at old ages 8,15 . Together, these factors contribute to higher cumulative burden of disability, health losses and poorer quality of life for older women. ...
... Additionally, lower early-life investments in human capital-such as nutrition and education for women compared to men-are known to contribute to female disadvantages in late-life health and well-being 20 . This also aligns with the cumulative disadvantage theory highlighting how early-life disadvantages impact health outcomes later in lifeas life course trajectories are influenced by the accumulation of risks and available resources 8,15 . ...
... Fourth, the subnational pattern of gender disparities in ageing and health including gender specific diseases, symptoms and risk factors further highlight the need for both state and older women specific health and social care policy interventions 13,15 . The country's subnational pattern of gender disparities in health and well-being mirror existing regional pattern of socioeconomic and health inequalities. ...
... While wealth could be inherited or bequeathed, this theory highlights that the wealth accumulated by individuals over their life course determines how much they will have when they grow older, with those able to accumulate more having better outcomes, including health outcomes, than their counterparts (Barrett 2003). The cumulative inequality theory (Ferraro and Shippee 2009) presents an alternative that blends many other theories and is considered a middle-range theory incorporating macro-and micro-sociological contents (Ferraro and Shippee 2009). According to the cumulative inequality theory, inequality accumulates over an individual's life course and "social systems generate inequality, which is manifested over the life course via demographic and developmental processes," with an individual's trajectory shaped mainly by risk accumulation, available resources, perceived trajectories, and human agency (Ferraro and Shippee 2009, p.334). ...
... While wealth could be inherited or bequeathed, this theory highlights that the wealth accumulated by individuals over their life course determines how much they will have when they grow older, with those able to accumulate more having better outcomes, including health outcomes, than their counterparts (Barrett 2003). The cumulative inequality theory (Ferraro and Shippee 2009) presents an alternative that blends many other theories and is considered a middle-range theory incorporating macro-and micro-sociological contents (Ferraro and Shippee 2009). According to the cumulative inequality theory, inequality accumulates over an individual's life course and "social systems generate inequality, which is manifested over the life course via demographic and developmental processes," with an individual's trajectory shaped mainly by risk accumulation, available resources, perceived trajectories, and human agency (Ferraro and Shippee 2009, p.334). ...
... However, even though more women than men live beyond age 65, women are worse off beyond this period in different aspects. Perhaps, explained by the cumulative advantage/disadvantage theory (Dannefer 2003), women accumulate more social disadvantages than their male counterparts, leading to the widening inequalities supported by the cumulative inequality theory (Ferraro and Shippee 2009). Older women are more likely poorer than older men (Hunter and May 2013) and suffer from age-related discrimination that increases their vulnerability (Gresh and Maharaj 2013). ...
The population younger than 5 years is now exceeded by those older than 65 globally, with women making up a larger share. Because ageing was traditionally about people older than 60 or 65, Africa, with a predominantly younger population under 50 years, was previously not a focus of ageing research. However, shifting the focus away from people older than 65, a concept without concrete meaning in many African settings, this paper considers ageing a continuous process. It assesses socioeconomic inequalities in ageing and gaps in gender-related socioeconomic disparities in ageing in Africa using South Africa as a case study. Data come from four rounds of nationally representative general household surveys spanning 2003–2018. Using the concentration index to assess socioeconomic inequalities in ageing, a significantly large proportion of younger populations comes from poorer households, while the reverse is the case for older adults. There is a gendered pattern in socioeconomic inequality in ageing. While there are no significant differences in socioeconomic inequalities in ageing between boys and girls aged 0–9 years, socioeconomic disparities become apparent and significantly “favour” males in much older groups, say 60 years and above. The paper highlights the importance of multisectoral action and a gendered approach in addressing the significant socioeconomic inequalities in ageing. While further research is needed to understand key drivers of inequalities, mainstreaming ageing into multisectoral policies, especially prioritising younger women, is necessary to build up resources to reduce socioeconomic disparities in ageing at older ages in South Africa.
... Following life course theory, this perceived individual control is not only influenced by someone's current social circumstances, but also by their experiences earlier in life and their anticipation of the future, and it tends to vary by the age at which individuals pass through career transitions (Elder Jr and Shanahan 2007; see also Thurow 1996) as resource differences accumulate over the "working and educational" life course (Ferraro and Shippee 2009). For this reason, we assume and examine the differences in perceived career resilience across different ages; however, given that age influences career resilience through two opposing pathways we do not formulate a direct hypothesis for the overall age-career resilience relationship but rather focus on these distinct explanatory mechanisms. ...
... Life course theory emphasizes cumulative advantage and disadvantage across the lifespan (Dannefer 2003). Initial advantages or disadvantages tend to compound over time, shaping individuals' trajectories (Ferraro and Shippee 2009) and late-life careers (Turek, Henkens, and Kalmijn 2024). For example, access to education and social expectations of meaningful work earlier in life have long-term consequences for individuals' career opportunities and success later in life (Walsemann, Geronimus, and Gee 2008). ...
Career resilience is critical to the world's aging workforce, aiding older workers in adapting to the ever‐evolving nature of work. While ageist stereotypes often depict older workers as less resilient when faced with workplace changes, existing research studies offer conflicting evidence on whether older age hinders or improves career resilience. In response to this conflicting evidence, the present study employs multi‐level data from 6772 employees in 28 countries to examine the age‐career resilience relationships and underlying mechanisms, hence advancing our understanding of career resilience across the life course. By integrating macro‐contextual factors such as the unemployment rate and the culture of education with individual‐level mechanisms such as positive career meaning and career optimism, we provide a comprehensive model explaining how career resilience varies across age groups. Grounded in life course theory, our findings resolve prior inconsistencies in resilience research, contribute to bridging the micro‐macro gap in HRM literature, and challenge existing age‐based stereotypes.
... Social scientists have only recently begun investigating the role of biological age as a proxy for cumulative inequality, the result of the lifetime accumulation of exposure to structural inequalities that can differentially impact people of color, and a potential predictor of health and social outcomes in epidemiological studies of aging [11]. One experience or range of experiences that may contribute to cumulative inequality and health disparities for non-Whites in the United States is discrimination. ...
... However, due to genetic variation and the accumulation of lifetime exposures, experiences, and health factors, adults of similar chronological age may be experiencing different rates of biological aging [40][41][42]. Enhancing our comprehension of the efficient utilization of biological age as a potential indicator for health and social consequences that contribute cumulative inequality over the life course [11] is necessary. ...
This cross-sectional study aimed to evaluate the relationship between accelerated aging (PhenoAge) and limitations in Activities of Daily Living (ADLs) in White, Black, and Hispanic older adults (≥ 50 years). We further aimed to explore how perceived discrimination may differentially impact this association. We ran multivariable logistic regression models to evaluate the strength of the association between accelerated aging, ADLs, and perceived discrimination using 2014/2016 Health and Retirement Study (HRS) data for White (n=2107), Black (n=435), and Hispanic (n=351) adults aged 50 and older who contributed epigenetic clock data during the 2016 HRS Venous Blood Study. We hypothesized that accelerated aging would be associated with greater levels of functional limitations, and that perceived discrimination would impact this relationship with evident disadvantage among Blacks and Hispanics relative to Whites. We found that more Blacks and Hispanics reported ADLs (23.68% and 23.08% respectively) than Whites (12.48%, p<0.01). Blacks reported more discrimination (M 3.71, SD 4.26, p<0.01) than Hispanics (M 2.69, SD 3.84) or Whites (M 2.86, SD 3.52). ADLs were associated with accelerated aging (OR=1.42, 95% confidence interval = 1.13,1.78) and discrimination (OR=1.07, 95% confidence interval = 1.04,1.10). Our research examining how exposure to discrimination differentially affects the biological aging-ADL association across racial and ethnic groups contributes to efforts addressing health disparities associated with functional decline. This work is part of a broader body of research aiming to understand the impact of discrimination on biological outcomes and their consequences for health and loss of independence.
... As the major causes of death in wealthy nations changed from mostly acute to predominantly chronic conditions, contemporary middle-range theories responded by directing more attention to the social antecedents of chronic disease and disability (Ferraro and Shippee 2009;Pearlin et al. 2005). Unlike acute diseases, chronic diseases develop over longer periods of time, prompting investigators to examine the sociogenesis of poor health: Which life course factors are deleterious to health? ...
... Fourth, given that HRS surveys people 50 years or older, the conclusions are applicable to that population only. As specified in axiom five of cumulative inequality theory, nonrandom mortality before age 50 would likely mean that our results underestimate the relationships studied (Ferraro and Shippee 2009). Finally, we differentiated U.S.born and foreign-born Hispanic adults throughout the analysis, but we have not differentiated Hispanic persons from Mexico, Cuba, Puerto Rico, and other cultures. ...
Although research has identified how stressors are related to either physical or cognitive function in later life, we bridge these literatures by examining dual functionality (neither physical nor cognitive impairment) among Black, White, and Hispanic adults. Using data from the Health and Retirement Study (2006–2016), we investigated whether stressors and resources during childhood and adulthood are related to functional loss at baseline and longitudinally. Analyses revealed that lifetime trauma was associated with dual functionality impairment at baseline, but childhood stressors and everyday discrimination were prospectively associated with loss of dual functionality. Black and foreign-born Hispanic adults experienced earlier loss of dual functionality than White adults, and the effect of childhood stressors on the transition to impairment occurred earlier for U.S.-born Hispanic adults. Findings reveal the influence of exposures in childhood and adulthood on functional health in later life—and how resources may be a counterbalance to functional loss.
... ACEs refer to various profound sources of stress during childhood, such as emotional neglect, physical abuse, and living in problematic family environments, which increase the likelihood of social difficulties, harmful health behaviors (e.g., substance abuse), and adverse physical and mental conditions [2]. According to the life course theory and the cumulative inequality theory [3], the long-term impact of ACEs spans throughout an individual's life, extending into middle and older adulthood, posing risks to their physical and mental well-being [4]. The traumatic experiences and stress during early childhood may also disrupt brain structure and cardiovascular systems, leading to lifelong impairments in social, emotional, and psychological domains, ultimately affecting health and well-being [5], as well as cognitive function [6]. ...
Background
Adverse childhood experiences (ACEs) can have a significant impact on informal social support (ISS) and social participation (SP) among middle-aged and older adults. Existing studies highlight the critical role of SP and ISS in promoting healthy aging. Social participation is associated with reduced cognitive decline, lower mortality risk, and improved mental health in older adults. ISS is linked to better physical and psychological outcomes. However, despite evidence on the protective effects of SP and ISS, the impact of ACEs on these factors in middle and older adulthood remains unclear. To analyze and understand the characteristics of different subgroups of ACEs and to comprehend the influence of ACEs on SP and ISS in middle-aged and older adults.
Methods
Data from the China Health and Retirement Longitudinal Study (CHARLS, 2011–2018) and the 2014 Life History Survey (N = 11070). Diverse aspects of SP frequency, ISS, and ACEs were identified based on the CHARLS questionnaire items and ACEs were categorized using latent profile models. The fixed effects model was used to understand the impact of ACEs on SP and ISS and to explore differences in ACE subgroup.
Results
Three distinct subgroups of ACEs were determined. It was found that the central role of parental mental health in the intergenerational transmission of ACEs, that better parental mental health and childhood SES in ACEs had a positive impact on SP and ISS (p < 0.01), and that those who experienced physical abuse were less likely to contact their children (β = -0.009, p < 0.001). But no significant differences were found in poor parental mental group.
Conclusions
This study reveals that better parental mental health and childhood SES in ACEs have a positive impact on SP and ISS. It is recommended that screening and intervention for ACEs be integrated into the Chinese community health service system to increase the prevalence of SP and reduce the intergenerational transmission of trauma for healthy aging.
... Age at baseline was calculated based on respondents' birth by subtracting the birth year from the year Wave 1 was conducted (1995). To align with age groupings from prior studies examining age variation in psychological well-being 12,17,52 , age was then grouped into early adulthood (40 or younger), middle adulthood (41)(42)(43)(44)(45)(46)(47)(48)(49)(50)(51)(52)(53)(54)(55)(56)(57)(58)(59)(60), and late adulthood (61 or older [Reference]). ...
Long-term trajectories of psychological well-being were investigated using data from a national longitudinal study known as MIDUS (Midlife in the U.S.) The central question was whether educational status and age were associated with gains, losses, or persistent disadvantage on widely studied dimensions of eudaimonic well-being such as personal growth, purpose in life, and self-acceptance. Findings from a sample of adults (N = 6908), aged 25–74 at baseline, showed primarily loss across the 20-year period (1995–2015). Those with a high school education or less showed persistently lower levels of six distinct aspects of well-being compared to those with more education across time. In addition, purpose in life declined for all age groups. Losses over time for autonomy, environmental mastery, and personal growth were steeper for the oldest age group (i.e., 61 years and older) compared to younger (i.e., 40 years and younger) and midlife (i.e., 41–60 years) adults, while losses for self-acceptance were steepest for young adults compared to the two older age groups. The role of structural inequalities in understanding variation in these well-being trajectories and their implications for future health are considered.
... A central issue then consists in the definition of which risks need to be identified and addressed. Accordingly, a number of competing explanatory models have been formulated since the 1980s, striving to clarify how social inequalities "get under people's skin" (Ferraro & Shippee, 2009). As presented below, the formulation of these different models reflects continuing debates across disciplines regarding the roles of biological and social determinants, respectively. ...
The idea of risk, which asserts that nothing happens by chance, has profoundly impacted society over the past decades. However, predictions tend to be challenged by unexpected situations and by the complexity of social processes surrounding actual experiences of vulnerability and danger. I propose to focus on experiences of health risks to better understand how people domesticate their personal vulnerability, including material, affective, symbolic, and interpersonal elements. I consider both how citizens and experts actually think, act, and interact around these experiences, across a range of health risks.
... 16,17 Still, it is currently unclear if increased ADRD risk in multimorbidity reflects accumulated inequality, severity of chronic conditions, or reverse causation at a given point in time. 18 To gain a better understanding of dementia risk in late life, estimating the absolute contributions of chronic conditions, that is, the contribution irrespective of potentially comorbid risk factors over the observational period, requires longitudinal assessments of changing morbidity patterns over significant portions of the lifespan (i.e., mid-to later life). ...
INTRODUCTION
Multimorbidity is associated with increased risk of dementia, but previous estimation of the joint contribution of constituent conditions to dementia incidence did not model additive contributions or temporal proximity in the sequential onset of conditions.
METHODS
Data were analyzed from 9944 Health and Retirement Study participants and Medicare fee‐for‐service beneficiaries, ages 68–99, without Alzheimer's disease and related dementias (ADRD) at baseline, from 1998–2016. ADRD and chronic condition were encoded using validated claims algorithms. We estimated the absolute contribution of eight conditions to ADRD with the longitudinal extension of the average attributable fraction (LE‐AAF).
RESULTS
Hypertension, acute myocardial infarction, atrial fibrillation, diabetes, heart failure, ischemic heart disease, stroke, and arthritis additively accounted for 71.8% (95% confidence interval [CI]: 62.9%–79.1%) of ADRD incident cases based on LE‐AAF.
DISCUSSION
Our findings suggest that multimorbidity plays a pivotal role in ADRD incidence. Targeting constituents of a cardiovascular path to dementia may contribute most to lowering dementia risk.
Highlights
Most dementia cases (71.8%) were attributable to eight chronic conditions.
Hypertension was the largest contributor to dementia risk.
Confidence intervals were smallest for constituents of a cardiovascular path to dementia.
Longitudinal extension of the average attributable fractions (LE‐AAFs) explicitly consider longitudinal patterns of comorbidities.
Acute myocardial infarction did not contribute significantly to dementia incidence.
... Furthermore, current systematic reviews have not included any studies from Latin America. However, loneliness, cognitive function, and other health challenges may be shaped by interrelated contextual challenges and resources (41)(42)(43), culture ( 44 , 45 ), and perspectives on aging ( 20 , 21 ). ...
... Life course, cumulative disadvantage, and cumulative inequality theories partially account for the toll that racism takes on individual and cohort-level aging over time [53,54]. However, gerontology, like psychology, stops short and underestimates the role of capitalism in perpetuating adverse physical and mental health outcomes across the life course. ...
This study introduces racial capitalism, the theory that racism and capitalistic exploitation are inextricably linked, into psychology and gerontology by exploring its mental impact across different age groups of Black Americans. Using Constructivist Grounded Theory (CGT), 27 participants from diverse age groups and socioeconomic statuses were interviewed via theoretical and purposive sampling. In-depth interviews were conducted to examine their lived experiences of racial capitalism and its evolving mental health impact. Data collection continued until thematic saturation was reached, and analysis followed an iterative coding process to identify emergent themes. The analysis revealed three themes: Individual-level racism impacts older adults’ mental well-being; middle-aged adults are learning from older adults’ poor mental health awareness; and younger adults are mentally struggling under the weight of capitalistic exploitation. Older adults primarily focused on individual-level racism earlier in life, maintaining a generally positive outlook. Middle-aged adults reflected on limited mental health awareness passed down from older cohorts and the strain of limited generational wealth transfer. Younger participants expressed heightened mental distress due to contemporary systemic racism and exploitation. These findings informed the development of Cumulative Racial Capitalism Theory (CRCT), a framework theorizing how racism and capitalism continually evolve, cumulatively impacting Black Americans’ mental health.
... A clear example is presented in the professional content on ageing, in which biological ageing is presented as primarily responsible for levels of functionality and related illness, injury and impairments. This contradicts the wide quantitative evidence that social-demographic variables are associated with early mortality and functional outcomes in late life (Ferraro & Shippee, 2009). A more in-depth exploration of this idea, using a different example, will be presented in the subsequent section, illustrating how the profession's engagement with political projects to mitigate both forms of inequality has not been consistently committed to the ethics of life. ...
The chapter defines the central issue related to the exclusion and exploitation of human life—namely, moral and political inequalities. The prominence of moral and political inequalities becomes evident in understanding that not all lives are treated equitably. These inequalities are intricately tied to the ethics of life and the attributed meaning of life. Historical and current examples of moral and political inequalities and their connection with the profession are presented to support occupational therapists in generating social and cognitive critiques of society. Occupational therapists are encouraged to reconsider their own perspectives on politics, and consequently, life and generate critiques of society Addressing and reducing moral and political inequalities is at the forefront of the occupational therapy political project.
... Cumulative inequality (CI) theory is informative for studying the later-life health implications of intergenerational mobility because it 1) acknowledges the important role that accumulation processes play in shaping health across the life course, 2) encourages greater attention be paid to family lineage, and 3) recognizes that life course trajectories are malleable (Ferraro & Shippee, 2009). For example, in terms of accumulation processes and family lineage, high SES older adults who had a high SES in childhood have accumulated advantage over the life course, while low SES older adults who had a low SES in childhood have accumulated disadvantage. ...
... Future research will benefit from applying a similar conceptual approach to longitudinal data. The current framework will benefit from replication studies with different age cohorts as well as longitudinal studies to assess whether there are particular "sensitive periods" in which SDOH, including neighborhood conditions and household material hardships, may be particularly predictive of later health outcomes or if these associations across the life course are tied to risk accumulation [59][60][61]. In addition, future studies including both subjective and objective indicators of neighborhood will be needed considering their correlated but independent importance on health [62][63][64]. ...
This study aimed to examine the impact of neighborhood conditions and household material hardship experiences on young adult health outcomes, while also considering financial autonomy as a critical determinant of health.
We employed a cross-sectional observational design with a diverse sample of young adults from a large urban university. Structural equation modeling was used to analyze the relationships between neighborhood conditions and material hardship with health outcomes by financial autonomy.
Material hardship and neighborhood conditions were significantly related to various health outcomes among young adults. Food insecurity emerged as a significant mediator linking neighborhood conditions to health including global physical health, cognitive functioning, and depression. Financially independent young adults showed stronger direct and indirect effects of neighborhood conditions on health compared to financially dependent counterparts.
This study underscores the complex interplay of neighborhood conditions, household material hardship, and financial autonomy in shaping young adult health. Our findings also suggest how the impact of SDOH on young adult health may have long-term effects later in life. Future research should consider these factors comprehensively to address disparities in emerging adult health.
... She suggested that FHH could be deepened by situating the lives of students' ancestors within larger contexts of culture, social structure, relations of power and oppression, and historical events. Sleeter's broader contextual factors may be particularly helpful for minoritized and/or immigrant families [21], where historical policies and sociocultural practices in minoritized and immigrants' current and former countries can have a cumulative advantage or disadvantage impacting their life course and family health [22]. ...
Background
Family health history can be used as a health promotion tool to assess health risk, improve data collection and disease prevention, initiate interventions, and motivate behavioral change, but its utility as a public health tool has not been fully explored. Collecting information for a family health history can be a challenging task. However, it is an important skill for undergraduate students to learn, particularly those in pre-health majors. Our aim was to create a family interview protocol for students' successful family health history collection using findings from students' research papers and a scoping review.
Study design
We summarized and listed suggestions from students' papers. Our scoping review followed Arksey and O’Malley’s (2005) review process and the PRISMA Extension for Scoping Review checklist (2018).
Methods
We used Medline, CINAHL (EBSCO), ERIC (ProQuest), Web of Science, and Academic Search Premiere databases and Google. Using Covidence, we included peer-reviewed, English, journal articles and grey literature, narrowing our key term combinations to terms like family health history, interview or protocol, and undergraduate or health professional student.
Results
Protocol suggestions included having appropriate settings and preparation to conduct interviews with questions on socio-demographics, cultural and family relationship dynamics, health behaviors, and acute and chronic condition questions for family members. Students' papers addressed preparation for conducting interviews and obtaining better data from existing family trees and extended relatives to maximize learning about risk assessment. The scoping review revealed two themes associated with family health history, including creating genograms and interview methods used with history taking.
Conclusions
Implementing the protocol for future assignments will provide students with a training opportunity to identify their own disease risks, improve their family health history knowledge, and collect family health history data relevant to prevention and interventions focused on understanding chronic conditions and their management.
... These early life stressors also set the stage for how individuals might interact with secondary stressors which come their way, including in the educational, work, and relationship domains. These chains of risk become inextricably linked and generate differing mental health outcomes (Ferraro and Shippee 2009;Pearlin et al. 2005). In particular, early stressors such as emotional abuse characteristic of a disordered family life might constrain access to healthy social ties and lifestyles needed to build satisfactory support systems that might help seminary students overcome R/S struggles (e.g., Hill et al. 2010). ...
Seminary students have been found to be at a higher risk of experiencing abuse in childhood compared with the general U.S. population, as well as demonstrate mental health struggles. This study aims to understand how R/S struggles might explain the relationship between childhood abuse (emotional, physical, and sexual) among a sample of seminary students, a group that is at a higher risk of experiencing emotional and physical abuse in childhood compared to the general U.S. population. Drawing on a unique sample of seminary students at a Mainline Protestant seminary, ( N = 535), regression results suggest that among seminary students, all forms of childhood abuse studied (emotional, physical, and sexual) were associated with greater depressive and anxiety symptoms. We also found consistent evidence that R/S struggles were a mediator of this pathway, explaining anywhere between 20 percent and 35 percent of the overall association between each form of childhood abuse and depressive and anxiety symptoms. This study adds to the growing body of literature describing the associations between childhood trauma and mental health, as well as the role of R/S struggles. We also discuss how seminaries and divinity schools should implement targeted programs for students with a history of childhood abuse.
... The cumulative model posits that disadvantages experienced throughout the life course accumulate and exacerbate health risks. This perspective is rooted in theories such as cumulative advantage/disadvantage theory (Dannefer, 2003) and cumulative inequality theory (Ferraro & Shippee, 2009). Building upon this model, we propose that negative childhood peer relationships, coupled with subsequent social and health challenges, create a cumulative burden that increases vulnerability to disability. ...
Despite the recognized importance of social connections in Chinese culture, research on how childhood peer relationship deficits impact health later in life has been limited. This study aimed to investigate the association between childhood peer relationship deficits and the odds of disability among older Chinese adults and to explore the potential mediating roles of social isolation, loneliness, and cognitive function. Using the longitudinal sample of respondents aged 60 years and older in the China Health and Retirement Longitudinal Study 2013–2018 (N = 7133), the link between peer relationship deficits in childhood and disability in late life was assessed using marginal structural models, and the potential mediating effects of social isolation, loneliness, and cognitive function were examined by the inverse odds ratio weighting technique. Participants who experienced greater childhood peer relationship deficits were more prone to disability (odds ratio: 1.19, 95% CI: 1.09, 1.29) than those with more positive childhood peer interactions. The inverse odds ratio weighting analysis indicated that social isolation, loneliness, and cognitive function individually played partial mediating roles in the association between childhood peer relationships and disability by 11.36% (95% CI: 4.04%–18.99%), 11.95 % (95% CI: 4.65%–19.23%), and 24.58% (95% CI: 17.01%–32.43%), respectively. The combined mediation effect of the three mediators was 30.57% (95% CI: 23.52%–39.91%). These findings suggest that interventions to enhance social connections and cognitive health in older adults may help mitigate the long-term impacts of childhood peer relationship deficits on disability among older Chinese adults.
... Within this ecological tapestry, this literature review discerns the influence of macro and micro systems, the Stress-Buffering Model by Sheldon Cohen and Thomas Wills (1985) magnifies the pivotal role of support in mitigating adversity and enhancing wellbeing. Meanwhile, the Cumulative Inequality Theory by Ferraro and Shippee (2009) unearths the long-term impact of disparities and socio-economic inequalities experienced earlier in life. Through these lenses, this literature review promises to enrich our understanding of the social support networks that shape the lives of older adults in Bangladesh. ...
Social support networks play a crucial role in promoting older adults' well-being and quality of life. This systematic literature review examines the sources, roles, and interventions related to social support networks among older adults in Bangladesh. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines were followed for this study and a comprehensive search of relevant databases resulted in the inclusion of 15 studies that met the inclusion criteria. The findings highlight the significance of social support in the Bangladeshi context, with family members, friends, neighbours, religious institutions, and community organizations emerging as essential sources of support for older adults. Social support contributes to various aspects of well-being, including life satisfaction, mental health outcomes, and overall quality of life. Community-based programs, support groups, and social interventions were identified as effective strategies for enhancing social support networks among older adults. However, gaps and limitations exist in the existing literature, including the lack of longitudinal studies and reliance on self-report measures. Future research should address these gaps by conducting longitudinal studies, employing qualitative research methods, and exploring the experiences and perspectives of older adults themselves. The findings have implications for research, policy, and practice, emphasizing the need to recognize and support existing sources of social support, tailor interventions to cultural and contextual factors, and promote collaboration among stakeholders. This review provides valuable insights for researchers, policymakers, and practitioners seeking to develop evidence-based strategies and support systems that enhance social support networks and improve the well-being of older adults in Bangladesh.
... Researchers have highlighted the importance of exposures and accumulation of experiences across the life course influencing health and well-being in later life . Cumulative inequality theory emphasizes the importance of childhood exposures for human development, the influence of risks and resources on health and well-being across the life course, and processes associated with inequality (Ferraro & Shippee, 2009). Much of the research examining the impact of childhood exposures on health, including cognitive function, focuses on the impact of adversities and stressors in childhood (Brown, 2010;Felitti et al., 1998;Thomas et al., 2022b). ...
Objective
Although research has demonstrated the long-term health consequences of childhood adversities, less is known about the long-term impact of positive childhood experiences, such as parental affection.
Method
Using longitudinal data (1995–2014) from the Midlife in the United States (MIDUS) study, we analyze structural equation models estimating direct and indirect pathways from early-life parental affection to changes in later-life cognitive function through relationship quality in adulthood among Black and White older adults ( N = 1983).
Results
Analyses revealed significant indirect effects of parental affection on better cognitive function through higher levels of social support (both average social support and family social support) in adulthood in the full sample and among Black respondents. Indirect pathways through relationship strain and through friend support were not significant.
Discussion
This work elevates the importance of promoting positive parental relationships during childhood, with implications for better social relationships in adulthood and cognitive function in later life.
... FMD is defined as 14 or more selfreported mentally unhealthy days in the past 30 days, and becomes a particularly consequence of emerging adulthood 20 . According to the cumulative inequality (CI) theory 21,22 , early experiences play a significant role in predicting life course health and well-being. Under the guidance of this hypothesis, a lot of studies highlights how adversity in childhood specifically shapes an adult's mental health 23,24 . ...
Adverse Childhood Experiences (ACEs) may have an impact on cognitive disability through multiple pathways. Frequent Mental Distress (FMD) could result in cognitive disability through different aspects, but the potential mediating role of FMD in the associations remained unclear. So we aimed to investigate not only the association between self-reported ACEs and cognitive disability, but also the mediating effect of FMD between ACEs and cognitive disability. A cross-sectional analysis of respondents aged 18–25 years old in the 2020 and 2021 Behavioral Risk Factor Surveillance System (BRFSS) was performed. Weighted multivariate logistic regression models were used to assess the association of ACEs with FMD and cognitive disability. Mediation effects were used to investigate FMD as mediation between ACEs and cognitive disability in emerging adults. Among the 10,309 respondents, the prevalence of cognitive disability was 15.8%, and 71.6% of them experienced ACEs. We found experienced ACEs, self-reported FMD were significantly associated with 4.05 and 5.61 times increased risk of cognitive disability, respectively. The more types of ACEs respondents experienced, the higher risks of cognitive disability. And mediating effect analysis found FMD mediated the associations between ACEs and cognitive disability. Our study indicated a strong association between ACEs and cognitive disability in emerging adults. Furthermore, FMD plays a mediating role in the associations.
Supplementary Information
The online version contains supplementary material available at 10.1038/s41598-024-79813-1.
... There has been a revolution in terms of thinking more positively and realistically about the prospect of aging well, however, there still remains the challenge for individuals and societies to adjust their attitudes and mindsets when it comes to aging per se (Diehl, Smeyer & Mehrotra, 2020;Ferraro & Shippee, 2009). Unfortunately, aging is still portrayed in pessimistic and apocalyptic terms while ignoring the potential and possibilities for active and productive aging (Burr, Caro & Moorhead, 2002;Foster & Walker, 2015;Lin, Sindall, Williams, & Capon, 2022;Moulaert & Biggs, 2012). ...
... Although often highly correlated, each of these indicators have been shown to differentially impact child development through unique pathways. In many of these studies, lower family income has a long-standing history of being linked to higher maternal physiological stress (Baum et al., 1999;Ferraro and Shippee, 2009;Ryan et al., 2021). Specifically, families' daily lives are filled with everyday stressors stemming from household routines, finances, and tensions with partners (Helms and Demo, 2005). ...
Children’s socioeconomic status (SES) is related to patterns of intrinsic resting-state brain function that subserve relevant cognitive processes over the course of development. Although infant research has demonstrated the association between children’s environments, cognitive outcomes, and resting-state electroencephalography (rsEEG), it remains unknown how these aspects of their environment, tied to SES, impact neural and cognitive development throughout the school years. To address this gap, we applied a multivariate pattern analysis (MVPA) to rsEEG data to identify which neural frequencies at rest are differentially associated with unique aspects of socioeconomic status (SES; income and maternal education) and cognitive (vocabulary, working memory) outcomes among school-aged children (8–15 years). We find that the alpha frequency is associated with both income and maternal education, while lower gamma and theta fluctuations are tied to dissociable aspects of SES and cognitive outcomes. Specifically, changes in the gamma frequency are predictive of both maternal education and vocabulary outcome, while changes in the theta frequency are related to both income and working memory ability. The current findings extend our understanding of unique pathways by which SES influences cognitive and neural development in school-aged children.
... For example, the 'social buffering' hypothesis posits that negative effects of early-life experience on later-life morbidity and mortality can be moderated by the protective influence of adult social integration or exacerbated by adult social isolation [150]. Cumulative risk models further posit that the effects of social advantage and disadvantage act cumulatively across the life course, their influence varying dynamically with changing later-life experiences [151][152][153]. Finally, some studies do not support a special role for early-life adversity but rather show additive effects of particular adverse conditions on health that remain similar in magnitude over the entire life course [154]. ...
Studying biological ageing in animal models can circumvent some of the confounds exhibited by studies of human ageing. Ageing research in non-human primates has provided invaluable insights into human lifespan and healthspan. Yet data on patterns of ageing from wild primates remain relatively scarce, centred around a few populations of catarrhine species. Here, we introduce the white-faced capuchin, a long-lived platyrrhine primate, as a promising new model system for ageing research. Like humans, capuchins are highly social, omnivorous generalists, whose healthspan and lifespan relative to body size exceed that of other non-human primate model species. We review recent insights from capuchin ageing biology and outline our expanding, integrative research programme that combines metrics of the social and physical environments with physical, physiological and molecular hallmarks of ageing across the natural life courses of multiple longitudinally tracked individuals. By increasing the taxonomic breadth of well-studied primate ageing models, we generate new insights, increase the comparative value of existing datasets to geroscience and work towards the collective goal of developing accurate, non-invasive and reliable biomarkers with high potential for standardization across field sites and species, enhancing the translatability of primate studies.
This article is part of the discussion meeting issue ‘Understanding age and society using natural populations’.
This study explores the relationship between emotional intelligence, work commitment, and quality of life among caregivers in geriatric institutions. It investigates whether emotional intelligence and commitment impact caregivers' well-being and the quality of care they provide. The research highlights the unique emotional challenges these caregivers face and proposes an educational intervention model to enhance emotional intelligence and foster psychological resilience. By addressing caregivers’ emotional and psychological needs, the study aims to improve both their well-being and the quality of care for elderly residents in geriatric settings.
Yaşa dayalı toplumsal tabakalaşma, aileden eğitime, ekonomiden siyasete kadar toplumun her kurumunu şekillendirmektedir;
ancak bu etki, cinsiyet, sınıf, ırk ve etnisite temelli tabakalaşma kadar belirgin bir görünürlük taşımamaktadır. Türkiye’de hızla
artan yaşlı nüfus, diğer demografik gruplarda olduğu gibi, sosyal ve ekonomik eşitsizliklerle karşı karşıya kalmakta; ancak bu
durum, yaşlı bireyler için daha derin ve katmanlı bir boyut taşımaktadır. Yaşlılık dönemini biçimlendiren tüm bu eşitsizlikler, yaşlı
sağlığını derinden etkilemektedir. Bu makale, sağlığın temel belirleyicileri ve kümülatif eşitsizlik kuramları çerçevesinde, yaşlılıkta
ortaya çıkan eşitsizliklerin, sosyal ve ekonomik boyutları üzerine bir inceleme sunmaktadır. Bu bağlamda, sosyal sorunlar arasında
yalnızlık, sosyal izolasyon, sosyal dışlanma ve dijital beceri eşitsizlikleri ele alınırken, ekonomik sorunlar kapsamında yoksulluk
ve sosyoekonomik eşitsizlikler ele alınmıştır. Ayrıca, çoklu krizler döneminin bir parçası olarak COVID-19 pandemisi, afetler ve
iklim krizi gibi olguların da yaşlılık dönemindeki eşitsizlikler üzerine ve buna bağlı olarak yaşlı sağlığı üzerine etkileri tartışılmıştır.
Tüm bu incelemenin ışığında, yaşlılık dönemindeki eşitsizliklerin, bireyin yaşamı boyunca yaşadığı deneyimlerle iç içe olduğu,
sosyal ve ekonomik yoksunlukların birbirileriyle ilintili olduğu ve birbirlerini sürekli besleyen bir döngü yarattığı ve bu sorunların
sadece yaşlı bireylerin öznel deneyimleri olarak değil, aynı zamanda toplumsal bir mesele olarak ele alınması gerektiği ifade
edilmiştir. Bu makalenin önerileri arasında, yaşlı bireylerin yaşam kalitesini ve sağlığını derinden etkileyen bu eşitsizlik ve sorunlara
yönelik önleyici mekanizmaların geliştirilmesinin sosyal hizmetler ve politikaların odağına alınmasının önemi vurgulanmıştır.
This study examines the impact of migration experiences—specifically undocumented status and informal sector participation—on the cognitive aging of Mexican return migrants. Using data from 6,277 participants in the 2018 Mexican Health and Aging Study (MHAS), we assess the likelihood of dementia among return migrants relative to non-migrants. The findings reveal that undocumented return migrants who later work in Mexico’s informal sector have significantly worse cognitive outcomes than both non-migrants—Mexican individuals whom never left Mexico—and undocumented return migrants working in the formal sector. Factors such as rural residency, lack of health insurance, and limited education further exacerbate cognitive decline in this population. Legal precarity, economic insecurity, and limited access to healthcare, accelerates cognitive aging for older return migrants, especially those in the informal sector. These results underscore the importance of formal sector participation, especially in contexts where healthcare access is tied to formal employment. The study adds to the growing body of research underscoring the long-term impact of migration on health and emphasizes the need for inclusive health and social policies to benefit aging vulnerable populations in both the United States and Mexico.
Experiences of health risks are shaped by social structures. Exposure to danger and resources to avoid or cope with adverse events are not evenly distributed across society, as evidenced by health inequality research. This chapter examines the role of social stratification factors in health risk experiences, bringing together empirical findings regarding their influence on risk interpretations and actions. Variations in responses to health risks across social groups also reflect power relations between those who define risks and implement mitigation measures and those who experience them amidst their daily circumstances. The discussion suggests that by not considering the influence of social positions and resources, the dominant risk model exacerbates inequalities rather than reducing them.
Objectives:
Socioeconomic status impacts emotional health outcomes, but a lifecourse approach is necessary to understand the timing of these effects. The current analyses examined the impact of financial strain in childhood and adulthood on longitudinal changes in three measures of emotional health: depressive symptoms, loneliness, and anxiety.
Method:
Data were from 1596 adults from the Swedish Twin Registry, aged 45 to 98 at intake (mean = 72.6) who participated in up to 9 waves over 25 years. Measures of financial strain (FS) included questions about how well finances met family needs. Latent growth curve models (LGCM) were used to estimate the impact of childhood and adult FS on changes in emotional health.
Results:
Results indicated that both childhood and adult FS independently influenced trajectories of emotional health in mid to late adulthood. For all 3 emotional health variables, both childhood and adult FS were associated with the LGCM intercept and childhood FS was associated with linear change with age. Interaction effects of childhood and adult FS were found for the LGCM intercept for loneliness, only.
Conclusion:
Results corroborate the accumulation of risk models, with effects of both childhood and adult FS on emotional health, and possible social mobility effects for loneliness.
Background and Objectives
Being or becoming disabled over the life course can have profound effects on one’s financial well-being and health-related quality of life. Adults of different ages and abilities who need long-term services and supports (LTSS) may perceive and experience financial strain and its impact on their health and well-being differently. Yet research on LTSS has typically studied defined age groups separately. This study explores how age may differentiate the associations between disability status, financial strain, and the subjective health and well-being of adults with LTSS needs in California.
Research Design and Methods
Using representative population-level data from the 2019-2020 California Long-Term Services and Supports survey, merged with data from the California Health Interview Survey (N = 2,030), descriptive and conditional process analyses were applied to answer the primary research questions.
Results
Findings indicate that young and middle-aged adults with LTSS needs struggled more than older adults to make financial ends meet. Middle-aged and older adults reported worse self-rated health, while younger adults were more likely to experience serious psychological distress. The indirect effects of difficulty in performing instrumental activities of daily living and the experience of serious psychological distress through financial strain were significant for young and middle-aged adults but not significant for older adults.
Discussion and Implications
These findings suggest the need to calibrate services to be more responsive to diverse experiences of disability, and to reset aging and disability silos to create coordinated LTSS networks for people with disabilities of all ages.
Background and Objectives
This study examines the relationship between lifetime victimization and health in later life and asks whether level of lifetime victimization is associated with an earlier onset of an IADL limitation.
Research Design and Methods
Using data from the Health and Retirement Study (N=11,143), we construct three levels of lifetime victimization (none, monovictimization, and polyvictimization). We use Weibull accelerated failure time models to examine the relationship between level of lifetime victimization and onset of an IADL limitation.
Results
Monovictimization and polyvictimization were associated respectively with a 9% and 18% earlier time to onset of an IADL limitation compared to individuals who did not experience victimization. Additionally, polyvictimization respondents had an earlier onset of an IADL limitation compared to monovictimization respondents.
Discussion and Implications
Lifetime victimization is a life course antecedent to IADL limitations in later life, especially among individuals who have experienced multiple types of victimization. Future research should examine resources that slow health declines among people who have experienced victimization.
This study aims to evaluate the bidirectional relationship between family functioning and depressive symptoms, considering life satisfaction as a potential mediator and gender, age and income as a moderator of these associations. A longitudinal study was conducted with 708 Chinese adults with diabetes and hypertension (51.6% women; mean age: 64.1 ± 7.7 years) recruited from 12 community health services. Data were collected at baseline (T1), one‐year follow‐up (T2), and two‐year follow‐up (T3) using self‐reported assessments of family functioning, depressive symptoms, and life satisfaction. Depressive symptoms negatively predicted family functioning from T1 to T2, and family functioning negatively predicted depressive symptoms from T2 to T3. Furthermore, life satisfaction mediated the relationship between family functioning and depressive symptoms from T1 to T3, and vice versa. Differences in gender, age, and income showed distinct patterns. Life satisfaction at T2 mediated the effect of family functioning at T1 on depressive symptoms at T3 for men, women, middle‐aged and low‐income adults, whereas life satisfaction mediated the effect of depressive symptoms at T1 on family functioning at T3 only among women and low‐income adults. This study explores the relationships among family functioning, life satisfaction, and depressive symptoms, noting potential differences based on gender, age and income. Family‐level interventions targeting life satisfaction could a helpful approach to addressing depressive symptoms among Chinese adults aged 45 and older with type 2 diabetes and/or hypertension.
Introduction
Housing insecurity is a social determinant of health, as evidenced by its associations with mental, physical, and biological outcomes. The scientific understanding of the mechanisms by which housing insecurity is associated with health is still limited. This review adapts existing stress process models to propose a conceptual model illustrating potential pathways linking the specific stressor of housing insecurity to physiological and epigenetic manifestations of stress among aging adults.
Methods
This narrative review examines literature across multiple fields, including public health, psychology, and sociology. The literature selected for this review was identified through scientific databases including Web of Science, PubMed, JSTOR, and Google Scholar; primarily peer-reviewed empirical studies, literature reviews, and research reports published in English between 1981 and 2024; and principally based in the United States context. A synthesis of this literature is presented in a proposed conceptual model.
Results
The literature supports the existence of two main predictors of housing insecurity: sociodemographic characteristics and the historical/current context. The main mediating pathways between housing insecurity and manifestations of stress include health behaviors, psychosocial resources, and structural resources. Moderating factors affecting the associations between housing insecurity and manifestations of stress include government assistance, chronic discrimination/unfair treatment, and individual differences. These interdependent mediating and moderating mechanisms affect stressor reactivity, a proximal manifestation of stress, which contributes to the physiological and epigenetic distal manifestations of stress in aging adults.
Discussion and implications
The prevalence of housing insecurity among aging adults is growing in the United States, with significant implications for public health and health disparities, given the growing percentage of aging adults in the population. Further empirical testing of the mediating and moderating mechanisms proposed in the conceptual model will elucidate how housing insecurity is connected to health and provide insight into preventive strategies to ameliorate the adverse effects of housing insecurity on biological health among aging adults.
Introduction
Compared to their exclusively gay/lesbian or heterosexual identifying peers, young people identifying as bisexual+ (e.g. bisexual, pansexual, asexual, queer or questioning) are at elevated risk for suicidal ideation (SI) and attempts (SA). The present study aimed to establish whether the prevalence of, and psychosocial risk factors for, SI and SA vary as a function of sexual identity.
Methods
Young adults ( N = 274; 18–29 years old) were recruited via online crowdsourcing. They completed questionnaires assessing adverse childhood experiences (ACEs), emotion dysregulation, impulsivity, depression symptoms and lifetime history of SI and SA. Spearman correlations, Kruskal‐Wallis H ‐tests and binomial logistic regression models were used.
Results
No variable was associated with SI. Bisexual+ individuals reported greater SA than the heterosexual group, though statistically similar to the gay/lesbian group. A similar pattern emerged for ACEs. The bisexual+ group reported greater depression symptoms than the gay/lesbian group. Impulsivity and emotion dysregulation did not vary by sexual identity. Controlling for these psychosocial and sociodemographic variables did not alter results: bisexual+ individuals were almost three times more likely to report SA than heterosexual individuals, OR = 2.93 95% CI [1.16, 7.44]; gay/lesbian and heterosexual individuals had a statistically similar likelihood of reporting SA, OR = 1.09, 95% CI [0.27, 4.37].
Conclusion
This is the first study to establish that young adults identifying as bisexual+ are at greater risk for SA after controlling for well‐established psychosocial correlates; this was not the case for SI. Further work is needed to establish the aetiology of this risk.
Rich sociological literature invokes both individual life course and macro-institutional perspectives to explain gender disparities in depression. While life course theories suggest that women’s mental health is more vulnerable to adverse childhood socioeconomic status (SES), institutional theories highlight macro-level drivers of gender disparities. Integrating these perspectives, I argue that female-friendly macro-institutional contexts ameliorate gendered health disparities by reducing the gendered effects of childhood SES on adult depression. Empirically, I employ data from the European Social Survey, which is the largest cross-nationally comparable dataset containing rich information on childhood experience and health. These data thus allow me to decompose the two-way association between gender, childhood SES, and depression across countries with varying gender regimes. The empirical evidence is largely consistent with my intervention. Women experience more pernicious mental health effects from adverse childhood SES than men, but this gender inequality, and the overall harmfulness of childhood adversity among women, is smaller in countries with more female-friendly gender regimes. I conclude by implicating these findings in broader debates about the interplay between childhood SES, gender, institutional contexts, and mental health.
Knowledge about life course trajectories and intercohort changes in mental health is limited mainly to Western populations. To address this gap, our study analyzes mental health trajectories in China, drawing on data on depressive symptoms from the China Family Panel Studies over the period 2012–2020 ( N = 31,700 individuals aged 16–70; N = 87,787 person‐years). Employing hierarchical linear regression models, our findings reveal moderate increases in depressive symptoms over the life course and across cohorts. Subgroup analyses indicate that women, people with lower educational attainment, and people with rural hukou experienced more depressive symptoms and a more pronounced increase in depressive symptoms with age. These disparities narrowed across cohorts. We discuss these patterns in the context of Chinese cultural dynamics, including son preference, the impact of education and hukou on the accumulation of stress over the life course, family policy and equity policy transitions, and the changing stigma of mental health.
Objective
Determine how preventable causes of death contribute to the life expectancy gap between Mexico and Spain.
Methods
We used a linear integral decomposition to analyze the impact of preventable mortality on life expectancy between ages 30-75 (temporary life expectancy) between Mexico and Spain in 2018. Additionally, we computed cause-deleted life tables to estimate potential gains in temporary life expectancy. Analyses were stratified by educational attainment, sex, and age.
Results
Low-educated Mexicans showed the largest gains in temporary life expectancy from removing preventable deaths (3.4 years for males, 1.6 for females), partially explaining the gap with Spain. Removing these deaths would close the gap almost entirely due to a higher relative decrease for middle- and high-educated individuals.
Discussion
While access to adequate healthcare is crucial for improving population health, appropriate non-medical public policies can significantly reduce mortality disparities between Mexico and Spain, especially for individuals from higher educational backgrounds.
While bereavement, particularly the loss of a child, is a well-known risk factor for mental health in the short
term, its long-term consequences on depressive mood in old age and across different welfare regimes have
been investigated less. This study focused on the combined role of child loss and divorce on depressive
symptoms, measured using the EURO-D scale in Central, Nordic, Southern, and Eastern European
countries. We used data from the European SHARE project, covering 22,959 participants aged 50+ over a
16-year period. Using OLS regressions, we found that, compared to no child loss and no divorce, the
association between depressive symptoms and child loss was significant (𝛽 = 0.22, 95% C.I. = [0.13, 0.30]),
among both women and men. The absolute increase was even stronger when the mutual effect of child loss
and divorce was considered (𝛽 = 0.34, 95% C.I. = [0.18, 0.48]). Employing Generalized Estimating
Equations, we found that depressive symptoms related to divorce did not increase over time, regardless of
past bereavement. Compared with people in the Nordic countries, those living in Southern Europe
experienced more depressive symptoms related to child loss and no divorce, but fewer depressive symptoms
related to the combined effect of child loss and divorce. In sum, our findings indicate that bereavement due
to child loss may lead to more depressive symptoms among both women and men in old age, especially in
combination with divorce. In the latter case, we posit that participants living in Southern European countries
may be protected by higher levels of social support through family ties or informal social networks.
Objective
Drawing from the extended Grossman health capital and demand theory and the life course theory, this study examined whether childhood SES has direct and significant correlation with health in middle and old age in a specific historical context in China.
Methods
A sample of 9,861 respondents was obtained from the China Health and Retirement Longitudinal Study (CHARLS). Childhood SES was measured by objective indices of recall. Health was assessed by self-reported, physician diagnosis and the Center for Epidemiologic Studies Depression Scale (CESD). The Propensity Score Matching (PSM) was used to estimate the treatment effect between childhood SES and later life health. The Karlson-Holm-Breen (KHB) method was employed to examine the associative mediation effects.
Results
Compared to respondents with low SES in childhood, respondents with high SES in childhood had, on average, 5.1% more likely to report their health as good, an average 2.4% lower prevalence of chronic diseases and an average 7.6% lower in the score of depression in middle and old age. The indirect relationships of childhood health, adulthood SES and adulthood lifestyle with health in middle and old age were all significant. SES upward mobility in adulthood can diminish the association between childhood disadvantage and poor health in middle and old age.
Conclusion
The health effects of childhood SES can persist into middle and old age, this is more noticeable in rural areas, particularly in females. The critical period, cumulative risk and social mobility models produce synergistic effects in China. Our results also promote a paradigm shift in health interventions from old age to early life for health-vulnerable populations.
The evolutionary theory of ageing explains why ageing occurs, giving
valuable insight into the mechanisms underlying the complex cellular and
molecular changes that contribute to senescence. Such understanding also
helps to clarify how the genome shapes the ageing process, thereby
aiding the study of the genetic factors that influence longevity and
age-associated diseases.
In people trying to lose weight, there are often repeated cycles of weight loss and regain. Weight cycling is, however, not limited to obese adults but affects people of normal weight, particularly young women, who are unhappy with their appearance. Furthermore, the onset of a pattern of weight cycling is shifting towards younger ages, owing to the increasing prevalence of overweight and obesity in children and adolescents, and the pressure from the media and society for a slim image even for normal weight children. Although there is still controversy whether weight cycling promotes body fat accumulation and obesity, there is mounting evidence from large population studies for increased cardiovascular risks in response to a behavior of weight cycling. Potential mechanisms by which weight cycling contributes to cardiovascular morbidity include hypertension, visceral fat accumulation, changes in adipose tissue fatty acid composition, insulin resistance and dyslipidemia. Moreover, fluctuations in blood pressure, heart rate, sympathetic activity, glomerular filtration rate, blood glucose and lipids that may occur during weight cycling--with overshoots above normal values during weight regain periods--put an additional load on the cardiovascular system, and may be easily overlooked if humans or animals are studied during a state of relatively stable weight. Overshoot of those risks factors, when repeated over time, will stress the cardiovascular system and probably contribute to the overall cardiovascular morbidity of weight cycling.
The explanation of increasing heterogeneity and inequality within aging cohorts is a central concern of the life-course perspective and common ground for demographers, economists, historians, sociologists, and psychologists alike. Income and wealth inequality among the aged is one area of shared interest where cross-disciplinary fertilization is occurring. While indices of aged economic inequality applied across different data sets replicate the level of inequality among the elderly, theoretical and methodological concerns are focused more and more on identifying and specifying the long-term interactions between institutional and life-course processes producing this outcome. Institutional mechanisms incorporated in opportunity structures such as labor markets and pensions stratify the availability of resources and rewards, and they interact with life-course processes related to labor force history and job mobility to produce complex patterns of cumulative advantage and cumulative disadvantage. However, the examination of long-term mechanisms of stratification requires finer-grained observations of work, employer, and pension histories than current data-collection strategies afford. Two biases--the steady worker bias and the one pension bias--are inherent in most longitudinal data bases and hamper progress in our understanding of the production of aged inequality.
After performing the miracles that takes us from conception to birth, and then to sexual maturation and adulthood, natural selection was unable to favor the development of a more elementary mechanism that would simply maintain those earlier miracles forever. The manifestations of this failure are called aging. Because few feral animals age, evolution could not have favored a genetic program for age changes. Natural selection favors animals that are most likely to become reproductively successful by developing better survival strategies and greater reserve capacity in vital systems to better escape predation, disease, accidents, and environmental extremes. Natural selection diminishes after reproductive success because the species will not benefit from members favored for greater longevity. The level of physiological reserve remaining after reproductive maturity determines longevity and evolves incidental to the selection process that acts on earlier developmental events. Physiological reserve does not renew at the same rate that it incurs losses because molecular disorder increases at a rate greater than the capacity for repair. These are age changes, and they increase vulnerability to predation, accidents, or disease. Failure to distinguish aging from disease has not only blurred our efforts to understand the fundamental biology of aging, but it has profound political and economic consequences that compromise the field of biogerontology. Changes attributable to disease, or pathological change, can be distinguished from age changes for at least four important reasons. Unlike any known disease, (1) age changes occur in every human given sufficient time, (2) age changes cross virtually all species barriers, (3) no disease afflicts all members of a species only after the age of reproductive success, and (4) aging occurs in all feral animals subsequently protected by humans, even when that species probably has not experienced aging for thousands or millions of years. The resolution of age-associated diseases will not advance our knowledge of aging, just as the resolution of the diseases of childhood did not advance our knowledge of childhood development. We have failed to convey that greater support must be given to a question that is rarely posed. It is a question that is applicable to all age-associated diseases, and its resolution will also advance our fundamental knowledge of aging: "Why are old cells more vulnerable to pathology and disease than are young cells?" During the first half of this century it was believed that because cultured normal cells were immortal, aging must be caused by extra-cellular events. Thirty-five years ago we overthrough this dogma when we found that normal cells do have a limited capacity to divide, and that age changes can occur intracellularly. We also observed that only abnormal or cancer cells are immortal. Normal cells are mortal because telomeres shorten at each division. Immortal cancer cells express the enzyme telomerase that prevents shortening. Recently, it was discovered that when the catalytic subunit of the telomerase gene is inserted into normal cells they become immortal.
Our analysis examines whether childhood health has long-term and enduring consequences for chronic morbidity. As a part of this analysis, we address two methodological issues of concern in the literature. Is adult height a surrogate for childhood health experiences in modeling chronic disease in later life? And, are the effects of adult socioeconomic status on chronic disease overestimated when childhood health is not accounted for? The analysis is based on a topical module to the third wave of the Health and Retirement Study, a representative survey of Americans aged 55-65 in 1996. Our results support the hypothesis that poor childhood health increases morbidity in later life. This association was found for cancer, lung disease, cardiovascular conditions, and arthritis/rheumatism. The associations were highly persistent in the face of statistical controls for both adult and childhood socioeconomic status. No support was found for using adult height as a proxy for the effects of childhood health experiences. Further, the effects of adult socioeconomic status were not overestimated when childhood health was excluded from the explanatory models. Our results point to the importance of an integrated health care policy based on the premise of maximizing health over the entire life cycle.
We used path analysis on data from the British 1946 birth cohort to model lifetime antecedents of cognitive reserve, represented by the NART at 53 years, and compared this model for verbal memory and psychomotor function at this age, cognitive outcomes that are sensitive to age-associated decline. We showed independent paths from childhood cognition, educational attainment and adult occupation to cognitive reserve, with that from childhood cognition the strongest, and that from adult occupation the weakest. A similar pattern was found for the verbal memory and psychomotor outcomes, although the pathways were weaker than those to the NART. The pattern was also mirrored by the paths from paternal occupation to childhood cognition, educational attainment and adult occupation, with that to childhood cognition the strongest, and that to adult occupation the weakest. The direct influence of paternal occupation on cognitive reserve was negligible, and almost entirely mediated by childhood cognitive ability and educational attainment.
Age and cumulative advantage/disadvantage theory have obvious logical, theoretical, and empirical connections, because both
are inherently and irreducibly related to the passage of time. Over the past 15 years, these connections have resulted in
the elaboration and application of the cumulative advantage–disadvantage perspective in social gerontology, especially in
relation to issues of heterogeneity and inequality. However, its theoretical origins, connections, and implications are not
widely understood. This article reviews the genesis of the cumulative advantage/disadvantage perspective in studies of science,
its initial articulation with structural-functionalism, and its expanding importance for gerontology. It discusses its intellectual
relevance for several other established theoretical paradigms in sociology, psychology, and economics. On the basis of issues
deriving from these perspectives and from the accumulating body of work on cumulative advantage and disadvantage, I identify
several promising directions for further research in gerontology.
Most explanations of the increase in life expectancy at older ages over history emphasize the importance of medical and public health factors of a particular historical period. We propose that the reduction in lifetime exposure to infectious diseases and other sources of inflammation--a cohort mechanism--has also made an important contribution to the historical decline in old-age mortality. Analysis of birth cohorts across the life-span since 1751 in Sweden reveals strong associations between early-age mortality and subsequent mortality in the same cohorts. We propose that a "cohort morbidity phenotype" represents inflammatory processes that persist from early age into adult life.
Objectives: This study examines the relationship between reports of childhood abuse and self-rated health in adulthood, and the potential of personal control to serve as a mediator. Method: Regression models were estimated using data from the National Survey of Midlife Development in the United States (MIDUS). Results: Reported emotional abuse was associated with lower personal control. In addition, women who reported emotional abuse by mother or both parents were more likely than women who were not abused to report lower self-rated health. The relationship between emotional abuse by both parents and self-rated health was mediated by personal control. Discussion: The findings suggest that there are long-term health consequences of early childhood abuse. The effects of childhood abusive experiences, however, operate differently for men and women and are dependent on the outcome examined. Childhood abuse compromises personal control that, in turn, leads to lower health ratings.
The authors examined longitudinal change in chess skill using a multilevel model analysis of a large database of active, elite chess players (N = 5,011). Parameters estimated from quadratic growth curves indicated that the age of peak performance occurs later in life than originally proposed and that this peak is independent of initial skill level. The findings are also consistent with the hypothesis that aging is slightly kinder to the initially more able, who show milder decline past their peak. Higher tournament activity levels predicted higher ratings overall and interacted with age in the initially more able sample, suggesting that activity had smaller effects on rating for older adults. The authors discuss implications of these findings for lifetime changes in skilled performance.
In this article, we aim to identify the sources of mastery--the understanding that individuals hold about their ability to control the circumstances of their lives. The sample for our inquiry was drawn from the Medicare beneficiary files of people 65 and older living in Washington, DC, and two adjoining Maryland counties. We find that past circumstances, particularly those reflecting status attainment and early exposure to intractable hardships, converge with stressors experienced in late life to influence elders' level of mastery. The impact of past conditions, however, does not necessarily directly affect the current mastery of older people. Instead, the effect of prior experiences on current mastery is mediated by what we refer to as life-course mastery: one's belief that one has directed and managed the trajectories that connect one's past to the present. Our analyses show that life-course mastery largely serves as the mediating channel through which individuals connect their past to their present.
The Adverse Childhood Experiences (ACE) Study is a long term, in-depth analysis of over 17,000 adult Americans, matching their current health status against adverse childhood experiences that occurred on average a half-century earlier. We found that such adverse childhood experiences are quite common although typically concealed and unrecognized; that they still have a profound effect a half century later, although now transmutated from psychosocial experience into organic disease; and that they are the main determinant of the health and social well-being of the nation. Our findings are of direct importance to the everyday practice of medicine and psychiatry because they indicate that much of what is recognized as common in adult medicine is the result of what is not recognized in childhood. The ACE Study challenges as superficial the current conceptions of depression and addiction, showing them to have a very strong dose-response relationship to antecedent life experiences.
The reward and communication systems of science are considered.
The life course has emerged over the past 30 years as a major research paradigm. Distinctive themes include the relation between human lives and a changing society, the timing of lives, linked or interdependent lives, and human agency. Two lines of research converged in the formation of this paradigm during the 1960s; one was associated with an older "social relationship" tradition that featured intergenerational studies, and the other with more contemporary thinking about age. The emergence of a life course paradigm has been coupled with a notable decline in socialization as a research framework and with its incorporation by other theories. Also, the field has seen an expanding interest in how social change alters people's lives, an enduring perspective of sociological social psychology.
Eponymy in science is the practice of affixing the names of scientists to what they have discovered or are believed to have discovered,(1) as with Boyle's Law, Halley's comet, Fourier's transform, Planck's constant, the Rorschach test, the Gini coefficient, and the Thomas theorem.
While there is consistent evidence that inequality in economic resources follows a process of cumulative advantage, the application of this framework to another aspect of life course inequality, health, has not produced consensus. This analysis uses longitudinal data from the Panel Study of Income Dynamics to examine the over-time relationship between health and socioeconomic status, considering how multiple dimensions of socioeconomic resources and economic history are related to health disparities as people age. The authors find cautious support for path- and duration-dependent processes of cumulative advantage in health. Results suggest that in studies of mechanisms of inequality over time, the cumulative advantage process may appear to be bounded by age because of the disproportionate attrition and mortality of those with low socioeconomic status.
The life course paradigm has replaced child-based, growth-oriented (“ontogenetic”) accounts of the person with models that emphasize the timing, social context, and organization of lives from birth to death. The chapter begins with a story of this intellectual change from the thematic precursors of life course studies to the present. The next section identifies heuristic concepts that capture the dynamic properties of settings and contextualize the individual, including social pathways, the cumulation of experiences, trajectories and transitions, and turning points. The life course paradigm also offers core principles that link social change and developmental trajectories, including those of life-span development, human agency, timing, linked lives, and historical time and place. In combination, these principles represent key contributions to the study of human development. They establish development as a life-long phenomenon that includes aging into late adulthood; to highlight the agentic nature of people as they create and shape their settings within limits; view development as the confluence of age, the generations, and history; and situate each person's trajectory in terms of family, neighborhood, community, and society. Life course insights have been especially revealing in research on health, and offer great promise in the study of biology, experience, and adjustment.
Keywords:
social pathways;
birth cohorts;
contexts of human development;
developmental and social trajectories;
historical change;
transitions
Recent contributions of sociologists and others have brought a new awareness and new theoretical understanding of the extent to which human aging and life-course patterns are shaped by social conditions and influenced by social change. Yet the potential of many social processes to account for individual aging patterns remains untapped, because research and theory have focused heavily upon comparisons between cohorts rather than the internal differentiation of cohorts. This paper shows that focusing upon intracohort differentiation over the life course leads to a mobilization of sociological findings whose age-related implications have not been exploited. Using the phenomenon of aged heterogeneity as an illustrative case, it is suggested that intracohort differentiation—operating through macro-level, organizational, and micro-level processes—can explain significant phenomena of aging previously neglected by theory, or else assumed to be psychological in origin. These processes specify Merton's Matthew effect. Implications for biological aging and for research are briefly discussed.
Drawing from cumulative disadvantage theory, the health consequences of obesity are considered in light of the accumulation of risk factors over the life course. Two forms of compensation are also examined to determine if the risk due to obesity is persistent or modifiable. Analyses make use of data from a national survey to examine the consequences of obesity on disability among respondents 45 years of age or older, tracked across 20 years (N = 4,106). Results from tobit models indicate that obesity, especially when experienced early in life, is consistently related to lower-body disability. The results also show that obesity has long-term health consequences during adulthood, altering the life course in an enduring way. Compensation was not manifest from risk-factor elimination (weight loss), but rather through regular exercise. Although there is evidence for long-term consequences of risk factors on health, the findings suggest that more attention should be given to compensatory mechanisms in the development of cumulative disadvantage theory.
That early nutrition and growth could affect cardiovascular disease (CVD) later in life has intrigued the public and scientific community. However, most published data are observational and retrospective, making interpretation difficult and providing an insecure basis for practice.
Prompted by animal studies on long-term effects of early nutrition, we initiated intervention studies with strict experimental design to test the importance of early nutrition in humans. Long-term findings are now emerging. We showed that early postnatal nutrition permanently affects the major components of the metabolic syndrome—hypertension, dyslipidaemia, obesity, and insulin resistance—that affect propensity to CVD.
Here we discuss our new findings together with existing studies in man and animals, and propose a synthesis with major implications for public-health practice and future research.
This Kleemeier Lecture is dedicated to persuading the reader that the issues of heterogeneity of aging processes, the modifiability of these processes, and choices in constructing alternative futures of aging made possible by this modifiability are logically and historically related in gerontological research and theory. Persistent heterogeneity observed among older adults indicates aging processes are the synergistic products of biological, psychosocial, and cultural factors. Evidence of modifiability promotes consideration of alternative policies regarding the construction of alternative futures for older adults and aging societies.
This account of the Matthew effect is another small exercise in the psychosociological analysis of the workings of science as a social institution. The initial problem is transformed by a shift in theoretical perspective. As originally identified, the Matthew effect was construed in terms of enhancement of the position of already eminent scientists who are given disproportionate credit in cases of collaboration or of independent multiple discoveries. Its significance was thus confined to its implications for the reward system of science. By shifting the angle of vision, we note other possible kinds of consequences, this time for the communication system of science. The Matthew effect may serve to heighten the visibility of contributions to science by scientists of acknowledged standing and to reduce the visibility of contributions by authors who are less well known. We examine the psychosocial conditions and mechanisms underlying this effect and find a correlation between the redundancy function of multiple discoveries and the focalizing function of eminent men of science-a function which is reinforced by the great value these men place upon finding basic problems and by their self-assurance. This self-assurance, which is partly inherent, partly the result of experiences and associations in creative scientific environments, and partly a result of later social validation of their position, encourages them to search out risky but important problems and to highlight the results of their inquiry. A macrosocial version of the Matthew principle is apparently involved in those processes of social selection that currently lead to the concentration of scientific resources and talent (50).
The relationship of health risk behavior and disease in adulthood to the breadth of exposure to childhood emotional, physical, or sexual abuse, and household dysfunction during childhood has not previously been described.
A questionnaire about adverse childhood experiences was mailed to 13,494 adults who had completed a standardized medical evaluation at a large HMO; 9,508 (70.5%) responded. Seven categories of adverse childhood experiences were studied: psychological, physical, or sexual abuse; violence against mother; or living with household members who were substance abusers, mentally ill or suicidal, or ever imprisoned. The number of categories of these adverse childhood experiences was then compared to measures of adult risk behavior, health status, and disease. Logistic regression was used to adjust for effects of demographic factors on the association between the cumulative number of categories of childhood exposures (range: 0-7) and risk factors for the leading causes of death in adult life.
More than half of respondents reported at least one, and one-fourth reported > or = 2 categories of childhood exposures. We found a graded relationship between the number of categories of childhood exposure and each of the adult health risk behaviors and diseases that were studied (P < .001). Persons who had experienced four or more categories of childhood exposure, compared to those who had experienced none, had 4- to 12-fold increased health risks for alcoholism, drug abuse, depression, and suicide attempt; a 2- to 4-fold increase in smoking, poor self-rated health, > or = 50 sexual intercourse partners, and sexually transmitted disease; and 1.4- to 1.6-fold increase in physical inactivity and severe obesity. The number of categories of adverse childhood exposures showed a graded relationship to the presence of adult diseases including ischemic heart disease, cancer, chronic lung disease, skeletal fractures, and liver disease. The seven categories of adverse childhood experiences were strongly interrelated and persons with multiple categories of childhood exposure were likely to have multiple health risk factors later in life.
We found a strong graded relationship between the breadth of exposure to abuse or household dysfunction during childhood and multiple risk factors for several of the leading causes of death in adults.
The disciplinary status of gerontology has long been the subject of much debate, but recent changes in higher education suggest the early development of a more integrated, interdisciplinary approach to gerontological education and research. We assert that gerontology is currently a multidisciplinary field of inquiry, but at selected schools it is moving toward an interdisciplinary field and may ultimately evolve into a new discipline. The risks and benefits attendant with this disciplinary evolution are reviewed in light of the historical development of other disciplines. Factors that may accelerate the development of interdisciplinary gerontology education include paradigm development in gerontology and the success of gerontology PhD programs, especially the placement of their graduates.
Recent research suggests that several of the major diseases of later life, including coronary heart disease, hypertension, and type 2 diabetes, originate in impaired intrauterine growth and development. These diseases may be consequences of "programming," whereby a stimulus or insult at a critical, sensitive period of early life has permanent effects on structure, physiology, and metabolism. Evidence that coronary heart disease, hypertension, and diabetes are programmed came from longitudinal studies of 25,000 UK men and women in which size at birth was related to the occurrence of the disease in middle age. People who were small or disproportionate (thin or short) at birth had high rates of coronary heart disease, high blood pressure, high cholesterol concentrations, and abnormal glucose-insulin metabolism. These relations were independent of the length of gestation, suggesting that cardiovascular disease is linked to fetal growth restriction rather than to premature birth. Replication of the UK findings has led to wide acceptance that low rates of fetal growth are associated with cardiovascular disease in later life. Impaired growth and development in utero seem to be widespread in the population, affecting many babies whose birth weights are within the normal range. Although the influences that impair fetal development and program adult cardiovascular disease remain to be defined, there are strong pointers to the importance of the fetal adaptations invoked when the maternoplacental nutrient supply fails to match the fetal nutrient demand.
Explaining why ageing occurs is a solution to the longstanding enigma of the role of senescence in nature. Even after half a century of progress, this solution continues to unfold. Evolution theory argues strongly against programmed ageing, suggesting instead that organisms are programmed for survival, not death. In the current view, ageing results from the twin principles that (i) the force of natural selection declines with age, and (ii) longevity requires investments in somatic maintenance and repair that must compete against investments in growth, reproduction and activities that might enhance fitness. In addition to explaining why ageing occurs, the evolutionary theory also provides insight into the mechanisms underlying the complex cellular and molecular changes that contribute to senescence, as well as an array of testable predictions. Some of the most interesting current problems are to understand how the genetic factors influencing ageing and longevity are predicted to respond to fluctuating environments, such as temporary periods of famine, as well as to other kinds of spatial and/or temporal heterogeneity. Rapid progress in human genomics raises the prospect of greatly increasing our knowledge of the determinants of human longevity. To make progress in understanding the role and evolution of genetic and non-genetic factors in human longevity, we need more detailed theoretical studies of how intra-population variables, such as socio-economic status, influence the selection forces that shape the life history.
The Adverse Childhood Experiences (ACE) Study is a long term, in-depth analysis of over 17,000 adult Americans, matching their current health status against adverse childhood experiences that occurred on average a half-century earlier. We found that such adverse childhood experiences are quite common although typically concealed and unrecognized; that they still have a profound effect a half century later, although now transmutated from psychosocial experience into organic disease; and that they are the main determinant of the health and social well-being of the nation. Our findings are of direct importance to the everyday practice of medicine and psychiatry because they indicate that much of what is recognized as common in adult medicine is the result of what is not recognized in childhood. The ACE Study challenges as superficial the current conceptions of depression and addiction, showing them to have a very strong dose-response relationship to antecedent life experiences.
That early nutrition and growth could affect cardiovascular disease (CVD) later in life has intrigued the public and scientific community. However, most published data are observational and retrospective, making interpretation difficult and providing an insecure basis for practice. Prompted by animal studies on long-term effects of early nutrition, we initiated intervention studies with strict experimental design to test the importance of early nutrition in humans. Long-term findings are now emerging. We showed that early postnatal nutrition permanently affects the major components of the metabolic syndrome—hypertension, dyslipidaemia, obesity, and insulin resistance—that affect propensity to CVD. Here we discuss our new findings together with existing studies in man and animals, and propose a synthesis with major implications for public-health practice and future research. Historical perspective More than 100 years ago, critical windows in development were first described in relation to imprinting in chicks. That nutrition can act during such windows to affect later biology was shown in the 1960s by McCance, 1 who found that rats raised in small litters, and therefore overfed postnatally, were larger in adulthood. Subsequently, early overfeeding in rats was shown to raise later concentrations of plasma insulin and cholesterol, 2
Many common chronic and mental disorders have modifiable precursors that arise during childhood. The life-course model of how health is produced provides a scientific basis for understanding the continuity between child and adult health. Life-course health policy seeks to promote the well-being of the young, both because of its intrinsic value and because doing so will improve the health of the population at all ages. It mandates increased attention to the promotion of biopsychosocial adaptability and other approaches to preventing the precursors to future disorders. Finally, it requires health policies to foster positive long-term outcomes focused on the individual, family, and community.
Two neuroendocrine systems are of specific interest in the study of stress and health; the sympathetic adrenomedullary system with the secretion of epinephrine and norepinephrine, and the hypothalamic pituitary adrenocortical (HPA) system with the secretion of cortisol. These hormones have often been used as objective indicators of stress in the individual. However, through their bodily effects, they are also a link between the psychosocial environment and various health outcomes. From a series of studies of women and men, it was concluded that gender roles and psychological factors are more important than biological factors for the sex differences in stress responses. The stress responses have been important for human and animal survival and for protection of the body. However, in modern society, some of these bodily responses may cause harm rather than protection. The catecholamines have been linked to cardiovascular disorders such as hypertension, myocardial infarction and stroke, cortisol to cardiovascular disease, Type 2 diabetes, reduced immune function and cognitive impairment. An adequate balance between catabolic (mobilization of energy) and anabolic processes (growth, healing) is considered necessary for long term health and survival. In modern society, which is characterized by a rapid pace of life, high demands, efficiency and competitiveness in a global economy, it is likely that lack of rest, recovery and restitution is a greater health problem than the absolute level of stress.
We previously reported that psychological stress is linked to and possibly accelerates cellular aging, as reflected by lower PBMC telomerase and shortened telomeres. Psychological stress is a major risk factor for cardiovascular disease (CVD), with multiple behavioral and physiological mediators. Telomere shortness has been associated with CVD, but the relationship between low telomerase activity, a potential precursor to telomere shortening, and CVD risk factors has not been examined in humans. Here we examine whether telomere length and telomerase in leukocytes are associated with physiological signs of stress arousal and CVD risk factors in 62 healthy women. Low telomerase activity in leukocytes was associated with exaggerated autonomic reactivity to acute mental stress and elevated nocturnal epinephrine. Further, low telomerase activity was associated with the major risk factors for CVD -smoking, poor lipid profile, high systolic blood pressure, high fasting glucose, greater abdominal adiposity-as well as to a composite Metabolic Syndrome variable. Telomere length was related only to elevated stress hormones (catecholamines and cortisol). Thus, we propose that low leukocyte telomerase constitutes an early marker of CVD risk, possibly preceding shortened telomeres, that results in part from chronic stress arousal. Possible cellular mechanisms by which low telomerase may link stress and traditional risk factors to CVD are discussed. These findings may implicate telomerase as a novel and important mediator of the effects of psychological stress on physical health and disease.
Much of the research on health decline in older adulthood has specified a single causal direction between two health domains, often measured at the same time point, making it difficult to disentangle the mechanisms of health decline over time. Using three waves of data over seven years from older residents of North Carolina, a 3-D model is used to examine the temporal ordering of general health decline and the pathways of influence across three health domains (disease, disability, and depression). In addition, we test whether the 3-D model of health decline is similar for Black and White older adults. Results indicate that both prevalent and incident disease lead to increases in depression and that prevalent disease leads to greater disability three years later. Depression, in turn, leads to disease, identifying a cycle of health decline that is, for the most part, similar for Black and White older adults. The effect of widowhood is more deleterious to the health of Black older adults than for their White counterparts.
We assess whether socioeconomic status (SES) is associated with basal levels of cortisol and catecholamines and determine if any association between SES and these hormones can be explained (is mediated) by behavioral, social, and emotional differences across the SES gradient.
One hundred ninety-three adult subjects, including men and women and whites and African-Americans, provided 24-hour urine catecholamine samples on each of 2 days and seven saliva cortisol samples on each of 3 days beginning 1 hour after wake-up and ending 14 to 16 hours later. Values for both hormones were averaged across days to obtain basal levels.
Lower SES (income and education) was associated with higher levels of cortisol and epinephrine and marginally higher levels of norepinephrine. These associations were independent of race, age, gender, and body mass. Low SES was also associated with a greater likelihood of smoking, of not eating breakfast, and with less diverse social networks. Further analyses provided evidence consistent with the hypothesis that these behavioral and social variables mediate the link between SES and the three stress hormones.
Lower SES was associated in a graded fashion with higher basal levels of cortisol and catecholamines. These associations occurred independent of race, and the data were consistent with mediation by health practices and social factors.
The subjective sense of future time plays an essential role in human motivation. Gradually, time left becomes a better predictor
than chronological age for a range of cognitive, emotional, and motivational variables. Socioemotional selectivity theory
maintains that constraints on time horizons shift motivational priorities in such a way that the regulation of emotional states
becomes more important than other types of goals. This motivational shift occurs with age but also appears in other contexts
(for example, geographical relocations, illnesses, and war) that limit subjective future time.
Scholars have debated the legitimacy of gerontology as a discipline since Metchnikoff coined the term more than 100 years
ago. Recent developments such as the emergence of interdisciplinary aging theories and consensus on longitudinal research
methods suggest that gerontology is materializing as a unique discipline, rather than a subset of another more established
disciplinary tradition. In this article we review substantive evidence from gerontological theory and scholarship to suggest
orienting principles for the emerging discipline of gerontology. We offer a conceptual framework of gerontology as a discipline
that integrates contributions of biopsychosocial perspectives with well-established concepts of age, aging, and aged and multiple
contextual elements. We conclude with a discussion of how our model relates to gerontology's progress, including examples
of successful interdisciplinary research, and offer questions for gerontologists to consider for further advancement of the
field.
If aging is understood as some process of damage accumulation, it does not necessarily lead to increasing mortality rate. Within the framework of a suggested generalization of the Strehler-Mildwan (1960) [B.L. Strehler, A.S. Mildvan (1960). General theory of mortality and aging, Science, 132, 14] model, we show that even for models with monotonically increasing degradation, the mortality rate can still decrease. The decline in vitality and functions, as manifestation of aging, is modeled by the monotonically decreasing quality of life function. Using this function, the initial lifetime random variable with ultimately decreasing mortality rate is 'weighted' to result in a new random variable, which is already characterized by the increasing mortality rate.
Stress researchers have typically controlled for the role of personal agency, or self-selection, in the stress process, rather than examining it. People in better mental health (those with high levels of coping resources and low levels of distress or disorder) should be more likely to exercise agency. Such individuals should, through problem-solving efforts and purposeful acts, experience fewer negative controllable events and more positive controllable events in their lives and be able to transform or compensate for stressors that they cannot avoid or eliminate. These agentic processes may account for the stress-buffering effects of coping resources; and, because coping resources are unequally distributed by social status, these processes should further help to explain how status differences in mental health are maintained and amplified over time.
Cross-sectional analyses show that an index of aging-associated health/well-being deficits, called the "frailty index", can characterize the aging process in humans. This study provides support for such characterization from a longitudinal analysis of the frailty index properties. The data are from the National Long Term Care Survey assessed longitudinally health and functioning of the U.S. elderly in the period 1982-1999. In cross-sectional analysis, the frailty index exhibits accelerated increase with age till oldest-old ages (95+), with possible deceleration thereafter. Longitudinal analysis confirms the accelerated accumulation of deficits in aging individuals. The time-dynamics of the frailty index is affected by two sex-sensitive processes: (i) selection of robust individuals, resulting in a decline of the mean frailty index with age and (ii) accumulation of deficits associated with physiological aging and its interaction with environment, which results in an accelerated increase of individual frailty index prior to death irrespective of chronological age. Current frailty index levels in individuals are more predictive of death than the index past values. Longitudinal analysis provides strong evidence that the cumulative index of health/well-being deficits can characterize aging-associated processes in humans and predict death better than chronological age during short-term periods.