Attachment among older adults: current issues and directions for future research

'They're Going to Die at Some Point, but We're all Going to Die' - A Qualitative Exploration of Bereavement in Later Life

This article reports on a qualitative study to investigate what bereavement means to older people. Drawing upon 80 in-depth interviews collected from eight British and Australian retirement communities, our study revealed that facing bereavement while ageing includes experiences of losing both others and the wholeness of the self. Core themes identified how the experience of losing others can be compounded by ageing-related challenges, undermining older people's defence from bereavement and frustrating their fundamental meaning and being. The older people's dynamic responses were also captured, highlighting the importance of supporting their agency to deal with the deeper pain of loss. By extending the concept of bereavement in later life, we also called for a more grief literate culture to mitigate the multifaceted and often deeper distresses of bereavement that older people may face alongside ageing.

Attachment across the lifespan: Examining the intersection of pair bonding neurobiology and healthy aging

Increasing evidence suggests that intact social bonds are protective against age-related morbidity, while bond disruption and social isolation increase the risk for multiple age-related diseases. Social attachments, the enduring, selective bonds formed between individuals, are thus essential to human health. Socially monogamous species like the prairie vole (M. ochrogaster) form long-term pair bonds, allowing us to investigate the mechanisms underlying attachment and the poorly understood connection between social bonds and health. In this review, we explore several potential areas of focus emerging from data in humans and other species associating attachment and healthy aging, and evidence from prairie voles that may clarify this link. We examine gaps in our understanding of social cognition and pair bond behavior. Finally, we discuss physiologic pathways related to pair bonding that promote resilience to the processes of aging and age-related disease. Advances in the development of molecular genetic tools in monogamous species will allow us to bridge the mechanistic gaps presented and identify conserved research and therapeutic targets relevant to human health and aging.

Parenting Stress and Attachment Insecurity in Young Adulthood: A Social Relations Model

Objective

We used the Social Relations Model to inspect the individual- and dyad-specific components of attachment among young adults and their parents, and examined relations between these components and parenting stress.

Background

Young adulthood is a transitional period in which the whole family is concerned with "launching" the young adult and exploring new ways to interact with and attach to one another. However, research on young adulthood attachment has primarily focused on young adults' attachment style rather than reciprocal attachments among family members.

Method

When the young adults were age 23, mothers, fathers, and young adults from 156 families reported their mutual attachment security. At ages 18 and 23, parents of the adolescent/young adult reported their parenting stress in interparental and parent-child relationship domains.

Results

Attachment in the families of young adults can be separated into three components: 1) actor effects (each family member's internal working model of attachment), 2) partner effects (characteristics of each family member as an attachment figure), and 3) relationship effects (dyad-specific attachment between family members). Increase of parenting stress in a family subsystem (dyad of family members) predicted attachment insecurity within the subsystem. Additionally, compensatory effects across family subsystems were observed.

Conclusion

Attachment in the family during young adulthood is explained by family members' own characteristics as well as dyad-specific interactions and is predicted by parenting stress in family subsystems.

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.

Effect of Spousal Loss on Depression in Older Adults: Impacts of Time Passing, Living Arrangement, and Spouse's Health Status before Death

In addition to increasing the mortality among older adults, spousal death (SD) increases their risk of depression. This study explored the factors affecting depression among widowed older adults to provide health care strategies for successful aging. A total of 710 adults older than 60 years completed a questionnaire before and after their spouses’ deaths. The survey data included age, sex, ethnic group, education level, financial station socioeconomic status, SD (including time point), smoking status, alcohol consumption, self-rated health status, Center for Epidemiologic Studies Depression Scale score, mobility, and degree of support from relatives and friends. The proportion of participants with depression after SD was 1.7 times that of before SD (p < 0.0001). Worsened mobility (odds ratio [OR] = 1.3, p < 0.01), low self-rated health status (OR = 0.5, p < 0.01), and a high degree of support from relatives and friends (OR = 1.5, p < 0.01) had a significant positive correlation with depression after SD. The proportion of depression that occurred within 6 months after SD was 6.0 times higher than that of depression before SD. Participants who lived alone after losing their spouses who were healthy before their deaths exhibited a significantly increased proportion of depression after their spouses’ deaths. Male sex, spouse’s health, and the period of 6 months after SD are risk factors for depression in older adults. The maintenance of mobility, positive self-rated health status, and a shorter period of depression after a spouse’s death result in more favorable adaptability among women. Social workers or family members should focus on older adults whose spouses died unexpectedly or within the last 6 months. Living with family members after SD can alleviate depression in older adults.

Carer burden and dyadic attachment orientations in adult children-older parent dyads

BACKGROUND AND OBJECTIVES

This study takes an interpersonal approach to the study of carer burden in families where adult children care for older parents. The aim of the study was to determine whether different pairings of attachment insecurity in older parent-adult child dyads are predictive of carer burden.

RESEARCH DESIGN AND METHODS

Seventy dyads whereby adult children provided weekly care to their older parents completed self-report measures of attachment. Adult children also completed a measure of carer burden.

RESULTS

Anxious-avoidant attachment insecurity pairings in parent-child dyads were associated with increases in carer burden. However, anxious-anxious and avoidant-avoidant attachment insecurity pairings were not associated with burden.

DISCUSSION AND IMPLICATIONS

The attachment insecurity of the care-recipient was found to moderate the association between a carer's attachment insecurity and burden, but only when the care-recipient's attachment insecurity differed to that of the carer's. These findings have implications for research, policy, and practice in aged care. The findings highlight the importance of focusing on attachment insecurity in aging families as well as taking a dyadic perspective when studying caregiving outcomes such as carer burden. The findings suggest that carers who may require the greatest support are those whose parents demonstrate contrasting orientations of attachment insecurity.

Doll therapy intervention for women with dementia living in nursing homes: a randomized single-blind controlled trial protocol

BACKGROUND

Doll therapy is a non-pharmacological intervention for people with dementia aimed to reduce distressing behaviours. Reliable results on the efficacy of Doll therapy for people with dementia are needed. The concept of attachment theorised by Bowlby has been proposed to explain the Doll therapy process, but it has not been proven to influence the response to doll presentation.

METHODS/DESIGN

This single-blind, randomised controlled trial will involve people with dementia living in nursing homes of the Canton Ticino (Switzerland). Participants will be randomised to one of two interventions: Doll Therapy Intervention or Sham Intervention with a non-anthropomorphic object, using a 1:1 allocation ratio. The two interventions will consist of 30 daily sessions lasting an hour at most, led by a trained nurse for an hour at most. We will enrol 64 participants per group, according to power analysis using an estimated medium effect size (f = 0.25), an alpha level of 0.05, and a power of 0.8. The primary goal is to test the efficacy of the Doll Therapy Intervention versus the Sham Intervention as the net change in the following measures from baseline to 30 days (blinded outcomes): the Neuropsychiatric Inventory-Nursing Home administered by a trained psychologist blinded to group assignment, the professional caregivers' perceived stress scale of the Neuropsychiatric Inventory-Nursing Home, patients' physiological indices of stress (salivary cortisol, blood pressure and heart rate) and interactive behaviours. The secondary goal is to assess the relationship between attachment styles of people with dementia (detected by means of the Adult Attachment Interview to the patients' offspring) and their caregiving behaviours shown during the Doll Therapy Intervention.

DISCUSSION

This is the first single-blind, randomised controlled trial on the efficacy of Doll therapy for dementia and an explanatory model of the response of people with dementia to doll presentation.

TRIAL REGISTRATION

ClinicalTrials.gov, ID: NCT03224143. Retrospectively registered on 21 July 2017.

Dying to Belong: The Importance of Familiarity in Later Life

Despite the large amount of research into loneliness, the evidence base around effective ways of tackling loneliness among older adults is limited. Up to one-half of all older adults regularly feel lonely, negatively impacting physical and mental health. In light of population aging, family dispersal, and in the aftermath of COVID-19, it is vital that we grow the evidence base around the lived experience of older people, knowing what they want and why, and ensuring community services and supports are meaningful to them. Method: Three focus groups were held with community-dwelling older adults in Ireland. Results: Loneliness is associated with the loss of familiarity and connection to community. Conclusions: Understanding loneliness in later life is increasingly important with population aging. As plans for ending confinement linked to COVID-19 are devised, a mechanism is urgently needed to sustain the positive changes to communities which have meaningfully connected with older adults.

Early Secure Attachment as a Protective Factor Against Later Cognitive Decline and Dementia

The etiology of neurodegenerative disorders such as dementia is complex and incompletely understood. Interest in a developmental perspective to these pathologies is gaining momentum. An early supportive social environment seems to have important implications for social, affective and cognitive abilities across the lifespan. Attachment theory may help to explain the link between these early experiences and later outcomes. This theory considers early interactions between an infant and its caregiver to be crucial to shaping social behavior and emotion regulation strategies throughout adult life. Furthermore, research has demonstrated that such early attachment experiences can, potentially through epigenetic mechanisms, have profound neurobiological and cognitive consequences. Here we discuss how early attachment might influence the development of affective, cognitive, and neurobiological resources that could protect against cognitive decline and dementia. We argue that social relations, both early and late in life, are vital to ensuring cognitive and neurobiological health. The concepts of brain and cognitive reserve are crucial to understanding how environmental factors may impact cognitive decline. We examine the role that attachment might play in fostering brain and cognitive reserve in old age. Finally, we put forward the concept of affective reserve, to more directly frame the socio-affective consequences of early attachment as protectors against cognitive decline. We thereby aim to highlight that, in the study of aging, cognitive decline and dementia, it is crucial to consider the role of affective and social factors such as attachment.

Best practice in the management of behavioural and psychological symptoms of dementia

Behavioural and psychological symptoms of dementia (BPSD) occur in most patients with dementia. They cause great suffering in patients and caregivers, sometimes more so than the cognitive and functional decline inherent to dementia. The clinical features of BPSD include a wide variety of affective, psychotic and behavioural symptoms and signs. The causes and risk factors for BPSD are multiple and include biological, psychological and environmental variables. Frequently, their combination, rather than any specific factor, explains the occurrence of BPSD in an individual patient. Thus, a sound etiopathogenetic investigation including the patient and the family or care team is essential. The aim is to develop an individualized treatment plan using a therapeutic decision tree modified by the individual and environmental risk profile. Still, treatment may be difficult and challenging. Clinical empiricism often steps in where evidence from controlled studies is lacking. Psychosocial treatment approaches are pivotal for successful treatment of BPSD. Often a combination of different non-pharmacological approaches precedes drug treatment (most of which is off-label). Regular assessments of the treatment plan and any prescriptions must be carried out to detect signs of relapse and to stop any medicines that may have become inappropriate. Even with optimal management, BPSD will not disappear completely in some cases and will remain challenging for all involved parties. This article is a narrative review based closely on the interprofessional Swiss recommendations for the treatment of BPSD. To establish the recommendations, a thorough research of the literature has been carried out. Evidence-based data were provided through searches of Medline, Embase, ISI and Cochrane-Database research. Evidence categories of the World Federation of Biological Societies were used. Additionally, the clinical experience of Swiss medical experts was considered.

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.

Attachment and Psychological Health in Older Couples Coping with Pain

Attachment theory is useful for understanding how couples cope with stress across the lifespan. This study used the the Actor Partner Interdependence Model to examine the extent to which attachment related to one's own (actor effect) and one's partner's (partner effect) depressive symptoms and marital satisfaction among older, married couples with a musculoskeletal condition. Pain and support were also examined as mediators. A group of 77 couples completed self-report measures as part of a larger study in which support was manipulated. Results revealed that, when one or both partners were insecurely attached, both partners reported greater depressive symptoms and lower satisfaction; however, pain and support were not significant mediators. Findings have implications for targeted, dyadic interventions to improve psychological health of couples coping with pain.