Intimate Partner Violence and Dementia Risk: Challenges and Opportunities for Longitudinal Studies of Aging

Abstract

By 2060, the burden of Alzheimer’s disease and related dementias (ADRD) in the U.S. is expected to double to 13.9 million, with women being overrepresented among cases. However, many powerful aspects of women’s lives–including exposure to gender-based violence–have received almost no attention in ADRD research. Women’s exposure to gender-based violence, particularly intimate partner violence (IPV), is pervasive though; nearly 30% of older women have experienced IPV in their lifetime. Thus, this dissertation investigates the long-term, aging-related health consequences of IPV among women relevant to ADRD risk by evaluating (1) the overall scientific premise that experiences of IPV have deleterious impacts on ADRD risk using trajectories of midlife cognitive functioning, (2) whether earlier and greater burdens of trauma over the life course have disproportionately deleterious impacts, and (3) whether the estimated impacts of IPV on ADRD-relevant health outcomes are greater in magnitude in a more racially and socioeconomically diverse, population-representative sample. To do so, this dissertation examines both common methodological challenges and novel substantive inquiry via measures of exposure to intimate partner violence, longitudinal assessments of cognitive functioning and cardiovascular disease, and/or measures of childhood and adulthood trauma in Nurses’ Health Study II (NHS2) and in Health and Retirement Study (HRS). More specifically, Chapter 2 first evaluates the nature and magnitude of potential practice effects, changes in test performance due to repeated cognitive assessments, utilizing availability of randomized follow-up schedules in NHS2, an important threat to internal validity among studies of longitudinal cognitive functioning. Chapter 3 then focuses on estimating associations between exposure to IPV experiences and trajectories of midlife cognitive functioning among women in NHS2. Chapter 4 subsequently evaluates if experiences of childhood abuse modify the associations observed between IPV and cognitive functioning in NHS2 to understand how interpersonal violence across individual lifecourse impacts cognitive health. Chapter 5 then utilizes a novel application of causal inference methods to attempt to quantify the population-level impacts of IPV experiences on long-term health outcomes relevant to ADRD risk, accounting for differences between the highly selected study sample (NHS2) and a sample of a relevant US target population (HRS). Chapter 6, in recognition of the necessity for measurement of IPV in longitudinal aging cohorts to overcome challenges presented in Chapters 3-5, concludes the dissertation via a shorter commentary discussing drivers of the paucity of epidemiological evidence on traumatic experiences. Altogether, this dissertation highlights the importance of gendered social experiences in shaping observed trajectories and inequalities in long-term health outcomes relevant to ADRD risk and argues for improved methodological approaches to inquiry as well as critical measurement of these relevant constructs in longitudinal aging cohorts as a primary starting point.