Attachment in old age: Theoretical assumptions, empirical findings and implications for clinical practice

Mechanisms Linking Attachment Orientation to Sleep Quality in Married Couples

There is emerging evidence for links between relationship factors and sleep quality. Existing research linking attachment orientation to sleep quality has yielded inconsistent effects, has focused on younger samples, and has not considered underlying mechanisms of action. This research addressed these gaps in two studies that investigated the links between attachment orientation and sleep quality in both younger/middle-aged (Study 1) and older (Study 2) adult couples using Actor-Partner Interdependence Models. We also tested mediating effects of relationship-specific security and negative affect. In both studies, participants completed surveys assessing their attachment orientation, sleep quality, and the proposed mediators. Both studies revealed that relationship-specific security and negative affect mediated the negative association between insecure attachment and one's own sleep quality. This research enhances our understanding of how attachment orientation affects sleep quality, provides a foundation for future research on relationship influences on sleep, and suggests avenues for improving sleep quality.

Changes in attachment dimensions during the treatment of acute post-traumatic stress disorder in sexually assaulted Brazilian women

Introduction

Attachment patterns are established during early childhood; however, extreme experiences throughout life may change this structure, either toward attachment security or insecurity. We analyzed changes in attachment dimensions in women with acute post-traumatic stress disorder (PTSD) following sexual assault, that were randomized to a 14-week treatment with either the medication sertraline or Interpersonal Psychotherapy.

Methods

Seventy-four adult women who presented significant reduction in PTSD symptoms across the trial responded to the Revised Adult Attachment Scale at baseline, on week 8 of treatment, and at the end of the trial, on week 14. We fitted a generalized linear model to explain the attachment anxiety and avoidance scores at baseline. A generalized linear mixed model investigated how attachment dimensions changed over time. Socioeconomic data, treatment type, history of childhood trauma, and PTSD severity over the 14-week period were the considered covariates.

Results

At baseline, attachment anxiety was associated with a history of early trauma. Attachment anxiety remained stable during the follow-up. Attachment avoidance, on the other hand, significantly increased from baseline to week 14. Higher avoidance was observed in patients with higher total PTSD scores and on the cluster of hyperarousal symptoms. Races other than White (black, mixed-race, or Asian) and younger age were associated with higher attachment avoidance.

Discussion

Contrary to our expectations, attachment avoidance increased during follow-up, indicating changes in the interpersonal realm beyond the symptoms of PTSD.

[Old age and attachment theory, a systematic review of attachment typology, continuity, prevalence and association with psychological and health variables in older adults]

The aim of this paper is to review the research on attachment theory during old age in the last 10 years, in order to obtain: a) the prevalence of different types of attachment, b) the assessment of attachment methods, c) the relationship established between attachment and other psychosocial and health variables in the aging process. A systematic search of PsycINFO, PsycArticles, WOS, and Scopus identified 17 studies, in which attachment had been assessed in a population of 7118 older adults. The results of this research present a clear evolution and some differences, with respect to the previous systematic 2010 review. Regarding the prevalence of the different types of attachment, it is confirmed that secure attachment and avoidant attachment are more abundant in old age than in adulthood or youth people. There is no consensus on the instruments used for the evaluation, and results are presented that associate insecure attachment with depression, life satisfaction, physical illness and loneliness. The attachment construct appears as an explanatory and mediating variable, directly involved in the psychology and psychopathology of old age.

Attachment in older adults is stably associated with health and quality of life: findings from a 14-year follow-up of the Whitehall II study

Objectives: Secure adult attachment may promote health and well-being in old age, yet is understudied in this life phase. Consequently, we aim to examine associations between adult attachment and mental and physical health and quality of life, both concurrently and longitudinally.Methods: We used three phases of the Whitehall II study (n = 5,222 to 6,713). Adult attachment was measured with the Relationship Questionnaire (RQ) at 48-68 years. Mental and physical health was measured concurrently and 14 years later; quality of life was measured five years later. We used linear regressions to examine associations, controlling for age, gender and education.Results: Almost half, 46% of participants, were classified as secure, 13% as preoccupied, 34% as dismissing and 7% as fearful. Adult attachment was associated with mental and physical health, concurrently and 14 years later, and with quality of life five years later. Preoccupied and fearful participants had poorest mental health and quality of life; dismissing participants held an intermediate position. Insecurely attached participants tended to report poorer physical health.Conclusions: Adult attachment has enduring associations with mental and physical health, which suggests that the construct of adult attachment itself is stable in this phase of the life course.

[Age images of older patients with psychiatric diseases -The importance of attachment and mentalization]

Objectives: The emergence and effects of self-perception of ageing (SPA) are central gerontological research topics. SPA has an influence on numerous psychological, cognitive and physical parameters.The question of its significance for mental illness in old age, which was investigated in the present study, has so far remained in the background. Of particular interest was the connection to attachment and mentalization. Method: A clinical sample (N = 150) was compared with a non-clinical sample (N = 153). Both were divided into three age groups (40-54, 55-69 and over 70 years).The survey instruments used were the Attitude to Own Ageing subscale of the Philadelphia Geriatric Center Moral Scale (PGCMS) and a mentalizing and an attachment questionnaire (MZQ and ECR). Results:The clinical sample showed significantly lower scores in all age groups (more negative SWA), but only the non-clinical sample showed a decrease in age across the three age groups, thus the SPA became more negative. In the regression analytic evaluation, a more negative SPA was associated with an avoidant attachment orientation as well as reduced mentalizing skills. Conclusions: The results highlight the importance of SWA as a clinically and therapeutically significant variable. Finally, therapeutic implications are discussed.

The role of self-compassion in the psychological (mal)adjustment of older adults: A repeated-measures study protocol

PURPOSE

Self-compassion is associated with healthy ageing and may be a protection factor of older adults' mental health in face of negative life events and other factors such as insecure attachment. However, fear of self-compassion may constitute an obstacle to promoting self-compassion. The role of self-compassion on the psychological (mal)adjustment of older adults requires further research with robust designs, and fear of self-compassion has not been studied in this population. We will test the moderator and mediator role, respectively, of self-compassion and fear of self-compassion, and we will analyse the longitudinal developmental trajectories of these variables.

METHODS

A repeated-measures design with three data collection moments across 6 months, using a sample (180-200 participants) of community residents aged ≥65 years. Data will be collected using traditional (i.e. pencil-and-paper questionnaires) and online (i.e. Google Forms) methods. Path analyses will be conducted to test moderation and mediation models. Latent growth curve analyses will be conducted to study the within-person change and between-person differences in change over time of self-compassion and fear of self-compassion.

CONCLUSIONS

We expect that participants with higher self-compassion will show better psychological adjustment, regardless of attachment quality and negative life events. We expect that insecure attachment and more negative life events will increase the participants' fear of self-compassion, which will decrease their psychological adjustment. Additionally, we expect that self-compassion and fear of self-compassion will show stable developmental trajectories during 6 months. Our results will contribute to better understand protection factors of older adults' mental health, which may guide future psychological interventions.

Assessing the Impact of Relationship Profile Test Scores, Self-Identified Ethnic Group, and Gender on Adult Attachment Style

Research shows that the subscales of the Relationship Profile Test (RPT) are related to adult attachment. Gender differences have been implicated, but findings are inconsistent in terms of replication. A limited amount of research has been conducted on ethnic differences in the context of interpersonal dependency. This study aims to bridge the gap in the literature in terms of using the RPT to predict attachment styles and to assess gender and ethnic group differences in RPT scores. Four samples from various treatment settings were combined to yield a heterogeneous group of ethnically diverse men and women (N = 470) with a mean age of 31.96. No gender differences were observed; however, ethnic differences were noted, with the RPT scales predicting unique variance in secure and insecure attachment styles. This study evidences the incremental validity of the RPT scales when predicting adult attachment style with consideration of ethnic group differences, which can help inform the treatment and assessment process.

[Older Patients in the Psychosomatic Clinic: Health, Attachment and Mentalisation]

Up to now, little is known about the group of older people treated in psychosomatic clinics, although the number of people in this age group who undergo treatment is increasing. In the study presented here, a sample of patients (age: 60 and above; n=83) from two psychosomatic clinics and a sample of clinically inconspicuous subjects (n=89) of the same age were examined. In addition to health variables, in which the group of older patients differed from the clinically inconspicuous as well as from younger patients, the connection between attachment and mentalization was examined more closely within the framework of two regression analyses. This showed that attachment-related anxiety and attachment-related avoidance were significantly more pronounced in the clinical group, but both were associated with different mentalization aspects. Based on these observations, some conclusions are drawn with regard to the treatment of older patients in psychosomatic clinics.

A Minimal Design of a Human Infant Presence: A Case Study Toward Interactive Doll Therapy for Older Adults With Dementia

We introduce a minimal design approach to manufacture an infant-like robot for interactive doll therapy that provides emotional interactions for older people with dementia. Our approach stimulates their imaginations and then facilitates positive engagement with the robot by just expressing the most basic elements of humanlike features. Based on this approach, we developed HIRO, a baby-sized robot with an abstract body representation and no facial features. The recorded voice of a real human infant emitted by robots enhances the robot’s human-likeness and facilitates positive interaction between older adults and the robot. Although we did not find any significant difference between HIRO and an infant-like robot with a smiling face, a field study showed that HIRO was accepted by older adults with dementia and facilitated positive interaction by stimulating their imagination. We also discuss the importance of a minimal design approach in elderly care during post–COVID-19 world.

When Collaborating in Constructive Task With Spouse: Attachment Orientation Predicts Exploratory Behavior Among Older Couples

In order to examine the function of the attachment system in later life, this study investigated the relationships between attachment orientation and exploratory behavior in a collaborative constructive activity with one’s spouse among older adults. In total, 49 older couples completed a collaborative constructive task, and their behaviors were videotaped. Each participant’s exploratory behavior (i.e., engagement, enjoyment, and distress) was coded by independent raters. The results revealed older adults highly engaged in the collaborative activity. In addition, based on the actor-partner interdependence model, the results indicated that attachment avoidance positively predicted the individuals’ enjoyment as well as their partners’ distress during the collaborative activity. The current findings extend the literature regarding the effects of attachment on exploration from early adulthood to later life, from the workplace to family life, and from individual’s own behavior to collaborative situation.

Within-Person Associations Between Attachment Security, Need Satisfaction and Psychological Adjustment in Daily Life of Older Adults

OBJECTIVES

Little is known about how attachment processes manifest within older adults in daily life and how these processes are associated with daily psychological adjustment. This study examined the within-person associations between states of attachment security and psychological adjustment. It is expected that this association is mediated by higher levels of satisfied needs in daily life.

METHODS

Microlongitudinal self-report data were collected in a sample of 136 older adults ranged in age from 60 to 90 years (ageM = 70.45 years) across 10 days with daily morning and afternoon measurement occasions.

RESULTS

Three main findings from multilevel analyses emerged. First, older adults showed significant within-person variation in attachment security, satisfaction of the needs for autonomy and competence, and psychological adjustment over time. Second, attachment security was positively associated with psychological adjustment within individuals. Third, both satisfaction of the needs for autonomy and competence mediated the within-person association between attachment security and psychological adjustment.

DISCUSSION

The results suggest that attachment security is associated with the experience of autonomy and competence in daily life of older adults which in turn is related with better psychological adjustment.

Ghosts from the past? The association between childhood interpersonal trauma, attachment and anxiety and depression in late life

Objectives: Research suggests that vulnerability for anxiety and depression in late life results from a complex interaction between (neuro)biological and environmental factors. In this context, there is growing evidence for the role of childhood trauma on vulnerability for both anxiety and depression throughout the course of life, mainly through its effects on attachment as a biologically based neurodevelopmental stress regulation system. Yet, the impact of childhood trauma on depression and anxiety in late life specifically remains unclear. The current study therefore aims to investigate the association between retrospectively reported childhood interpersonal trauma, attachment dimensions and levels of anxiety and depression in late life.Method: A sample of 81 community dwelling older adults completed measures of early and current adversity, attachment dimensions, and levels of anxiety and depression.Results: The occurrence and frequency of childhood trauma, but not later negative adult life events, was associated with late life anxiety and depression. Both attachment anxiety and avoidance were related to anxiety and depression. Only attachment anxiety affected the association between childhood trauma, and emotional neglect in particular, and late life anxiety and depression.Conclusion: Childhood trauma may be associated with anxiety and depression in late life. Part of this association is probably indirect, via the effect of insecure attachment and high levels of attachment anxiety in particular.

Role of Sex, Socioeconomic Status, and Emotional Support in Predicting Aging Perception Among Older Adults

Self-perception is found to be a central predictive factor in experiencing successful aging. The aim of this study was to explore the role of sex, socioeconomic status, and emotional support in elders' aging perception. A cross-sectional design was used with 300 older aged participants recruited from 23 clinics and health centers in Qazvin, Iran. Data were collected included questions to elicit demographic information and Barker's aging perception questionnaire. Exploratory multiple linear regression showed that the level of emotional support (β: -12.10; 95% CI: [-20.72, -3.48]), socioeconomic status (β: 2.84; 95% CI: [0.25, 5.43]), and women (β: -4.34; 95% CI: [-6.91, -1.77]) were associated with aging perception among elders. Educational level and marital status did not significantly contribute to the variance of AP. Findings revealed that aging perception was related to individual differences as well as social and emotional factors. Researchers, health-care professionals, and elders may benefit from thinking about old age as an inevitable life stage.

Stress and wellbeing during chronic illness and partner death in later-life: the role of social support

Chronic illness and the death of a romantic partner are two of the most significant stressors reported by older adults, resulting in various physical and mental health consequences. Evidence suggests that social support is a key factor in understanding the association between chronic illness and widowhood and the wellbeing of older adults. Nevertheless, research into social support is often approached in an atheoretical manner when investigating these stressors in older adulthood. We attempt to address this theoretical chasm by proposing an integrative model to explain social support processes in older couples which draws on models of social support and attachment theory. Our model provides an important framework for understanding existing research findings as well as guiding future research.

Attachment Style Is Related to Quality of Life for Assistance Dog Owners

Attachment styles have been shown to affect quality of life. Growing interest in the value of companion animals highlights that owning a dog can also affect quality of life, yet little research has explored the role of the attachment bond in affecting the relationship between dog ownership and quality of life. Given that the impact of dog ownership on quality of life may be greater for assistance dog owners than pet dog owners, we explored how anxious attachment and avoidance attachment styles to an assistance dog affected owner quality of life (n = 73). Regression analysis revealed that higher anxious attachment to the dog predicted enhanced quality of life. It is suggested that the unique, interdependent relationship between an individual and their assistance dog may mean that an anxious attachment style is not necessarily detrimental. Feelings that indicate attachment insecurity in other relationships may reflect more positive aspects of the assistance dog owner relationship, such as the level of support that the dog provides its owner.

Adult Children's Problems and Mothers' Well-Being

This article explores whether understanding of the effects of children's problems on older parents' well-being can be advanced by exploring differences in parent-child relationships within families. Using data from a study in which mothers reported on all adult children, we addressed the question: Do patterns of maternal favoritism moderate the impact of children's problems on psychological well-being? Based on the literature on the effects of children's problems and on parental favoritism, we hypothesized that problems in the lives of favored adult children will have a more detrimental impact than when they affect unfavored offspring. Results revealed strong and detrimental effects of any offspring's problems on mothers' well-being; these effects occurred, however, regardless of parental preference for an adult child. The findings suggest that the well-documented effects of parental preference may be limited in domains such as problems and difficult transitions in adult children's lives.

The Nature of Attachment Relationships and Grief Responses in Older Adults: An Attachment Path Model of Grief

Background

Various researchers have theorized that bereaved adults who report non-secure attachment are at higher risk of pathological grief. Yet past findings on avoidant attachment representations and grief have yielded limited and contradictory outcomes. Little research has been conducted with older adults to identify the psychological processes that mediate between self-reported attachment representations and the patterns of grief.

Objective

To examine the impacts of avoidant attachment and anxious attachment dimensions on emotion and non-acceptance, in response to the loss of a conjugal partner, and the mediating effect of yearning thoughts.

Design

Men (N = 21) and women (N = 68) aged 60 years and above who had lost a partner within the last 12 to 72 months were invited to participate. Participants rated their levels of yearning thoughts about the deceased, emotions and non-acceptance on the Texas Revised Inventory of Grief (TRIG-Present), and their type and level of general romantic attachment on the Experiences In Close Relationship questionnaire (ECR).

Results

Structural equation modelling (SEM) indicated that individuals who reported higher levels of avoidant attachment reported less emotional responses and less non-acceptance. SEM also showed that individuals who reported higher levels of anxious attachment reported greater emotional responses and greater non-acceptance. SEM further indicated that these relationships were mediated by yearning thoughts.

Conclusion

People adopt different grief coping patterns according to their self-reported attachment representations, with the nature of their yearning thoughts influencing the process. Grief therapy may be organized according to individual differences in attachment representations.

Can Doll therapy preserve or promote attachment in people with cognitive, behavioral, and emotional problems? A pilot study in institutionalized patients with dementia

Doll therapy is a non-pharmacological intervention aimed at reducing behavioral and psychological disorders in institutionalized patients with dementia. This therapy as a care tool has been integrated into the context of long-term care institutions, in which the need to find solutions to cognitive, behavioral and emotional problems showed by people with dementia meets the primary objective of developing good care practices focusing on patients and their needs. In the present work we adopt the Bowlby's theory of attachment to investigate the effectiveness of Doll therapy. The hypothesis that we here propose is that the emotional experience of the person with dementia during Doll therapy activates caregiving and exploration systems together with the attachment one. To test this hypothesis we compared institutionalized patients with dementia undergoing Doll therapy with a control group and assessed measures of the relational dimension with the environment, such as gaze direction, behaviors of exploration, and behaviors of caregiving. We used an experimental protocol consisting of 10 non-consecutive sessions structured with the goal of recreating a situation of (1) separation from a known figure and (2) interaction with the environment in order to partially recreate the prototypical phases of the "Strange situation." All sessions were videotaped and analyzed through an observational grid. Results support the effectiveness of Doll therapy in promoting and maintaining the affective-relational dimension of attachment-caregiving and the attentive dimension of exploration in patients with advanced stage of dementia. Thus, our results suggest that the use of Doll therapy promotes clinically significant improvements in the ability to relate with the surrounding world. This may be important for managing and caring for patients with dementia in institutionalized context.

Influence of psychological attachment patterns on periodontal disease - a pilot study with 310 compliant patients

OBJECTIVES

Psychosocial variables have received increased attention in periodontology. Attachment theory adds to known risk factors by linking early interactional experiences with adult tendencies of stress-regulation, health behaviour, symptom reporting, and healthcare utilization. The study investigates associations between attachment patterns and periodontal parameters.

METHODS

Within the context of a longitudinal study on periodontal diseases, 310 patients with aggressive (AgP) and chronic periodontitis (CP) filled out questionnaires on psychological attachment patterns. The influence of attachment style on health behaviour, treatment attendance and utilization, and periodontal variables was tested.

RESULTS

We found associations between psychological attachment anxiety on smoking and higher number of session use, independent of disease severity, which was more pronounced for women. Patients with higher attachment avoidance attended periodontal treatment later when diagnosed with CP and earlier with AgP. For men, we found differential associations for attachment avoidance and anxiety and number of teeth at beginning of treatment.

CONCLUSION

Psychological attachment patterns are a promising target for understanding periodontal disease in addition to known psychosocial risk factors.

[The impact of attachment on behavioral and psychological symptoms in dementia]

Contemporary research has increasingly acknowledged the importance of attachment on stress-related processes in ageing. Congruent with this, there has been much research on attachment in older adults over the past three decades. In this article, the main findings of this research are summarized, with a focus on attachment and dementia. Results show that, in general, the number of attachment figures decreases in old age. Moreover, their identity changes as adult children, deceased loved ones and God become more prominent. With relation to the quality of attachment, anxiety in close relations appears to diminish as people age, while attachment avoidance remains relatively stable. Individuals with high levels of attachment security also report greater well-being and a more positive attitude towards ageing compared to persons with low levels of attachment security. Furthermore, individuals characterized by insecure attachment show more behavioral and psychological problems in dementia. Also, caregiver burden, depression, as well as the quality of care giving and future caregiver commitment differ depending on the quality of attachment of the caregiver. There is preliminary evidence for the efficacy of attachment-based interventions in dementia. Finally, there is a need for greater methodological uniformity and the use of measures that are validated for an older population.