Dorota Chapko is a Research Fellow at the University of Aberdeen in Scotland, and a graduate from the Massachusetts Institute of Technology (MIT) with a double-major in Brain & Cognitive Sciences and in Anthropology. In this blog she discusses her recent Age & Ageing paper on the triad of impairment; she tweets at @dorotachapko

Although frailty is a central concept in clinical assessment of older people, there is no consensus definition. The concept is certainly multifactorial but physical components dominate. However, it is known that age-associated physical decline is likely to be accompanied by cognitive and emotional deficits. The ‘triad of impairment’ (triad) recognises the co-occurrence of cognitive, emotional and physical deficits in late-life and might be a useful alternative to ‘frailty’.

Identification of pathways to prolong healthy living and decrease the degree of frailty in old age will have benefits for individuals and society. Employment is often undertaken until ~70 years of age and is a major feature of socioeconomic circumstances. Childhood mental ability is a major influence on educational achievements, work experience and opportunities for work-related training. Both factors are potentially modifiable in early-life and, due to their accumulating impact over the life-course, may determine a delayed onset of functional decline. In our recently published manuscript in Age and Ageing, we investigated how mid-life occupational profile and childhood mental abilities contribute to triad in late-life.

For this purpose, we analysed data from the Aberdeen Birth Cohort of 1936 (ABC1936) characterised by the almost unique availability of childhood mental abilities. We used a series of careful data reduction approaches and structural equation models to understand the relationships between the life-course risks for triad. We found that childhood mental abilities at age 11 has almost 2 times greater protective effect on triad than mid-life occupational profile. Simultaneously, primary lifetime occupations with greater complexity associated with working with data or people, higher social status and employment stress in mid-life, though less influential than childhood mental abilities, also had a significant effect on triad. Our statistical approach indicated that triad may provide a useful alternative to a frailty measure.

A major implication of our work is that clinical studies should consider a life-course perspective, with a focus on early-life, to accurately assess and to improve the health of older adults. Importantly, childhood mental abilities had a predominant effect on triad, emphasising the importance of successful cognitive development. Brain structure in early- and late-life is influenced by childhood socioeconomic status pointing to the importance of early-life environment such as better nutrition, access to health care and education. Further research should establish whether the occupational profile acts as a moderator in the relationship between brain burden and triad, and how the developing brain influences this relationship.