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. 2025 Jan 27;13(1):73.
doi: 10.1186/s40359-025-02396-7.

Adverse childhood experiences, sleep quality/duration and later-life lower extremity function among older adults in China: evidence from CHARLS

Jiaqiang Xiao #  1 , Xiaosheng Dong #  2   3 , Meng Ding  1 , Tao Kong  4
Affiliations

Adverse childhood experiences, sleep quality/duration and later-life lower extremity function among older adults in China: evidence from CHARLS

Jiaqiang Xiao et al. BMC Psychol. .

Abstract

Objective: This study aimed to explore the relationship between adverse childhood experiences (ACEs), sleep, and lower extremity function in older adults using a nationally representative cohort.

Methods: This study included 4,439 participants aged 60 years or older (mean age: 67.2 ± 5.7 years) from the China Health and Retirement Longitudinal Study (CHARLS) 2015 national survey and the 2014 Life History Survey. ACEs, sleep duration, and sleep quality were assessed through self-report, and lower extremity function was measured using the Short physical performance battery (SPPB). The relationships between ACEs, sleep, and lower extremity function were analyzed using multivariate linear regression model and restricted cubic splines.

Results: After adjusting for covariates, older adults with four or more ACEs exhibited worse lower extremity function compared to those with no ACEs (β: -0.175). 6-8 h of sleep was associated with improved lower extremity function (β: 0.119), while good sleep quality was also associated with higher lower extremity function scores (β: 0.177). Age-related differences revealed that the association between four or more ACEs and reduced lower extremity function (β: -0.431) was significant only in individuals aged 70 years and older. In the 60-69 years age group, the sleep duration of 6-8 h was significantly related to better lower extremity function (β: 0.150), however, in those aged 70 years and older, more than 8 h of sleep was associated with poorer function (β: -0.378). Furthermore, good sleep quality was associated with better lower extremity function in individuals aged 70 years and older (β: 0.246).

Conclusion: ACEs, particularly household mental illness and parental disability, are associated with poorer lower extremity function in older adults. Normal sleep duration and good sleep quality are linked to better lower extremity function and may mitigate the negative effects of ACEs. However, these associations vary by age.

Keywords: Adverse childhood experiences; Lower extremity function; Sleep duration; Sleep quality.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The Ethics Committee of Peking University granted approval for CHARLS (IRB00001052-11015). All participants provided written informed consent. This research followed the guidance of the Declaration of Helsinki. Consent for publication: Not applicable. Competing interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Flowchart of study participant selection
Fig. 2
Fig. 2
Association Between the Number of ACEs and sleep with lower extremity physical performance in restricted cubic spline model. The models were adjusted for age, gender, residence, job status, smoking status, drinking status, and chronic diseases
Fig. 3
Fig. 3
Association Between the combination of the ACEs and sleep with lower extremity physical performance in restricted cubic spline model. The models were adjusted for age, gender, residence, job status, smoking status, drinking status, and chronic diseases
Fig. 4
Fig. 4
Association Between the Number of ACEs and sleep duration with lower extremity physical performance by age. The models were adjusted for gender, residence, job status, smoking status, drinking status, and chronic diseases
Fig. 5
Fig. 5
Association Between the combination of the ACEs and sleep with lower extremity physical performance in restricted cubic spline model grouped by age. The models were adjusted for gender, residence, job status, smoking status, drinking status, and chronic diseases
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