Clinical Manifestations.

Abstract

Despite the well-known deleterious health effects of childhood and adulthood trauma and the aging of the global population, little is known about trauma experiences in older adults. Moreover, childhood trauma may beget adulthood trauma and alter life-course trajectories of trauma exposure, and thus exhibit certain patterns in older adults. Using a national sample, this study aimed to (1) determine patterns of childhood and adulthood trauma, (2) examine their association with cognition and depression, and (3) investigate whether the association between trauma and depression is moderated by cognition. Data were from participants aged 60+ in the Health and Retirement Study in 2008 and 2012. Latent class analysis (LCA) was conducted to identify childhood and adulthood trauma patterns in 2008 (N = 6545). Depressive symptoms were measured by Center for Epidemiological Studies-Depression scale (CESD) and cognition was assessed by total cognition summary score (range 0-35 and cognitive impairment defined as 8 or less) in both 2008 and 2012. The final sample size is 4684. Multiple regressions were conducted to examine cross-sectional and longitudinal associations between trauma patterns, cognition, and depression, while moderation analyses were conducted to examine the moderating role of cognition, adjusting for age, gender, race, education, marital status, and body mass index. Participants had a mean age of 71.5(7.53) years, 58.4% female, and 85.7% White. A 3-class LCA model was determined to be the best fit for the data with three patterns: (1) low trauma exposure (61.04%), (2) family life-threatening events (20.07%) and (3) moderate trauma exposure (i.e., moderate probability of having experienced every type of trauma) (18.89%). Older adults experiencing family life-threatening events or moderate trauma exposure have significantly worse cognition and higher depression. Furthermore, cognition moderated the association between trauma exposure and depression, especially for older adults who experienced family life-threatening events. Findings indicated significant associations between three distinct trauma patterns and depression, and the buffering role of cognition. Educating health professionals about trauma patterns, rather than only considering accumulation, could optimize targeted, integrated public health and clinical strategies to improve cognitive performance and decrease depression in vulnerable older adults who have experienced trauma.