The contribution of adult child socio-economic status to parents' risk and outcomes of Alzheimer's disease and related dementias (ADRDs) in cross-national settings

Globally, nearly 10 million older adults are diagnosed with Alzheimer’s disease and related dementias (ADRDs) each year. Given the current absence of effective pharmacological treatments, along with global disparities in dementia care, there is an urgent need to identify population-level targets of ADRDs prevention and intervention, including at the family and societal level. Much of the population-level ADRDs research focuses on the contributions of one’s own socio-economic status (SES) to later life ADRDs risk. However, in many global settings, the SES of adult children may be a critical driver of parents’ economic, informational, and behavioral resources in late life. Nevertheless, very little research has evaluated the impact of adult child SES on parents’ ADRDs risk or outcomes of ADRDs. This is a surprisingly overlooked opportunity given prior literature suggesting that adult child educational attainment may influence parents’ physical and mental health and mortality outcomes, independent of parents’ own education. The objective of this proposed study is to rigorously evaluate the potential for adult child SES to reduce parental ADRDs risk and improve outcomes among older parents with ADRDs in global settings. We will additionally evaluate a comprehensive set of economic and non-economic pathways that may underlie observed associations and identify subgroups of older adults who may benefit most from improvements to their children’s education. We propose to use population-level cohort data on over 156,000 adults representing 20 countries in North and Central America, Asia, and Europe, and with similar measures of adult child education and rich data on candidate mediators and multi-level modifiers. These global data will allow us to achieve excellent external validity not possible with single- country studies, and we will use rigorous observational approaches for analyses of main effects and mediation. To maximize internal validity, we will validate observational estimates with a quasi-experimental approach that leverages changes to compulsory schooling laws as “natural experiments” to identify the causal effect of increases to adult child education on parents’ longitudinal cognitive outcomes. We have gathered an interdisciplinary team with deep expertise in these global aging cohort data and the application of rigorous epidemiologic and econometric methods to population-level research on cognitive aging to carry out the following Specific Aims: 1) Quantify the influence of adult child SES on older parents’ cognitive decline, risk of probable dementia or cognitive impairment, and outcomes for older parents after dementia onset, 2) Evaluate economic and non-economic mediators of observed associations between adult child SES and parents’ ADRDs risk and outcomes, and 3) Identify within and cross-country heterogeneity in the association between adult child SES and parents’ ADRD risk and outcomes. Our study makes use of the over 20 years of investment of the National Institute on Aging in global aging cohort studies to evaluate largely unanswered questions regarding the influence of adult child SES on parents’ ADRDs risk and outcomes.