Attachment Style and Well-being in Elderly Adults: A Preliminary Investigation

Are social isolation and loneliness associated with cognitive decline in ageing?

Objective

Social isolation and loneliness are associated with poor health (immunity, inflammation, etc.) in ageing. The purpose of this scoping review was to investigate the link between social isolation, loneliness (as distinct constructs, in contrast to previous published work) and cognition in cognitively healthy older adults.

Method

We followed PRISMA-ScR guidelines. Our search, conducted between January 2017 and April 2021, yielded 2,673 articles, of which, twelve longitudinal studies were finally identified as meeting the inclusion criteria. Multiple cognitive functions (short-term and episodic memory, attention, and global cognitive functioning) were measured.

Results

The results showed that both social isolation and loneliness were associated with poor cognition in ageing, with depression as a possible mediator between loneliness and poor cognition. Some studies also suggested that the link between social isolation, loneliness and cognitive decline may be bidirectional.

Conclusion

We conclude that both social isolation and loneliness may have a different impact on cognition. While depression may be an important mediator between loneliness and cognitive decline, the lack of cognitive stimulation may be a greater mediator between social isolation and cognitive health.

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.

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.

Attachment style, loneliness and depression in older age women

Older adults tend to have more avoidant attachment styles, which may make them more vulnerable to becoming isolated and lonely and increase the risk for developing mental health problems. This study used intensive interviews and logistic regression to explore how insecure attachment styles were associated with poor social support, isolation, loneliness and depression. Avoidantly, attached adults were at an increased risk for social isolation. Specifically, older adults with an Angry-Dismissive style were more likely to be lonely and experience mental health problems. Attachment style should be taken into consideration when promoting healthy aging.

Aging, irony, and wisdom: On the narrative psychology of later life

This paper introduces the idea that aging inclines us naturally toward an ironic stance on life. The conscious cultivation of that stance through some form of narrative reflection is linked to the development of wisdom, where wisdom is understood in terms of deepened knowledge of the “stories” of our lives. Such reflection heightens our awareness of the inherently ironic nature of our inner world—a complex, quasi-literary world toward which we occupy multiple points of view. In exploring these ideas, the concept of narrative foreclosure is discussed, as is that of “positive aging.”

Attachment representations in people with dementia and their carers: implications for well-being within the dyad

OBJECTIVES

The process of developing and living with dementia may activate attachment feelings and behaviours in people with dementia (PwD) and their carers. By obtaining information from both PwD and carer, we aimed to provide information on the nature and concordance of attachment patterns within the dyad and to examine the relative contribution of attachment representations in PwD and carers to the well-being of both parties.

METHOD

Ninety-seven PwD and their carers completed categorical and dimensional ratings of attachment. PwD also rated their self-concept, mood and quality of life. Carers rated the functional ability of PwD and neuropsychiatric symptoms and measures of subjective well-being.

RESULTS

People with dementia reported more insecure than secure attachment, with the most frequently reported style being dismissive attachment. Attachment security for PwD was related to more positive self-concept and less symptoms of anxiety. Attachment was not related to quality of life in PwD, but mood and self-concept were strong predictors of quality of life. Carer attachment security was related to their psychological health. Distress at symptoms and MMSE score of the PwD were the strongest predictors of stress. There was no association between PwD and carer attachment styles; PwD working models of attachment did not predict carer well-being and vice versa.

CONCLUSION

Attachment representations may be important for the psychological well-being of PwD and carers, but there was no evidence of the reciprocal nature of attachment within these dyads.

Gender moderates the associations between attachment and discrete emotions in late middle age and later life

OBJECTIVES

Although patterns of attachment have been linked to patterns of emotional experience, studies in developmentally diverse samples are few and have not yet examined possible gender differences in attachment or their implications for emotional wellbeing. This article describes patterns of attachment in a diverse sample of 616 men and women from middle age and later life, examines the relations between attachment and nine discrete emotions, and tests the thesis that gender moderates these associations.

METHODS

Convenience sampling was used to derive a sample of 616 ethnically diverse men and women from seven ethnic groups.

RESULTS

Multiple regressions controlling for demographics found no gender differences in attachment categorizations although men reported greater dimensional fearful avoidance. Security predicted greater joy and interest whereas dismissingness was associated with lower shame and fear and with greater interest. Both preoccupation and fearful avoidance predicted most negative emotions but were not associated with positive emotions. Finally, gender moderated these associations such that (a) attachment security was more closely related to interest and, marginally, joy, among men; (b) fearful avoidance was more closely related to fear and contempt among men; and (c) preoccupation was associated with greater interest among men, whereas fear and contempt were associated with preoccupation among women only.

CONCLUSION

Interpreted in the context of theories of emotions, the social origins of emotional experience, and the different roles that social relationships have for aging men and women, our data imply that attachment styles may differentially predict male emotions because of their less diverse networks.

Age Differences in Attachment Orientations among Younger and Older Adults: Evidence from Two Self-Report Measures of Attachment

The attachment patterns of younger and older adults were studied using two-dimensional self-report measures of adult attachment. Community-dwelling younger ( n = 144, M = 22.5 years, SD = 3.6) and older ( n = 106, M = 68.6 years, SD = 8.3) adults completed the Measure of Attachment Qualities (MAQ; Carver, 1997) and the Relationship Style Questionnaire (RSQ; Griffin & Bartholomew, 1994). Although the MAQ and RSQ are believed to be measuring similar constructs, they are derived from different theoretical perspectives. Correlations between the two measures were in the expected directions proving modest evidence for their convergent validity. Regarding cross-sectional results, as was expected, older adults scored lower than younger adults on the ambivalent-worry attachment scale of the MAQ and the preoccupied attachment scale of the RSQ. There were no age differences regarding secure, avoidant, and dismissing attachment. It appears that older adults experience anxious types of attachment less frequently than younger adults. Although these results primarily speak to age differences and possible cohort effects, they also provide some support for socioemotional selectivity theory and its hypothesized improved relationships in later life.

The Role of Adult Attachment Styles in Psychopathology and Psychotherapy Outcomes

Attachment theory provides a model for understanding how the attachment styles formed in infancy systematically affect subsequent psychological functioning across the life span. Attachment styles provide the cognitive schemas, or working models, through which individuals perceive and relate to their worlds. In turn, these schemas predispose the development of psychopathologies and influence outcomes when people undergo psychotherapy. After reviewing recent empirical findings, the authors conclude that an understanding of attachment theory facilitates the conceptualization of clients' problems and the selection of appropriate interventions. Accordingly, attachment styles should be assessed as a standard part of treatment planning. Furthermore, the authors propose that attachment styles should be assessed as individual difference variables in psychotherapy outcome research because adult attachment styles dictate how people perceive and respond to their environments and, therefore, how clients respond differentially to various treatments.

Attachment theory, ageing and dementia: a review of the literature

The following review draws together recent theoretical contributions and research findings highlighting the pertinence of attachment issues for older adults. Beginning with a brief overview of the principles of attachment theory, the paper proceeds to illustrate that attachment remains a key feature of relationships throughout the life cycle. Research findings suggest that past and present secure attachment relationships function as a protective resource in later life and preliminary studies highlight the continuing salience of parents as attachment figures for older adults. Particular attention is given to the significance of attachment theory in thinking about the subjective experiences of people with dementia, for whom unwilling separation and disruption of attachment bonds can be common themes. Research indicates the frequent occurrence of attachment behaviours and parent fixation amongst people with dementia living in residential care. Pre-morbid attachment style has been shown to interact with emotional and behavioural expression during the course of dementia. Clinical applications of attachment theory in dementia care are discussed and initial evidence for the effectiveness of Simulated Presence Therapy is provided. Methodological issues raised by the review are considered, together with suggestions for future research.

God as the ultimate attachment figure for older adults

Attachment to God among older adults is an area of research that has been neglected thus far. The existence of such an attachment was explored in a study of 109 elders aged 70-97. A modest proportion of elders displayed a strong attachment to God, assessed by coding interview data for indicators of attachment. Strength of attachment to God was related (p < .05) to greater religiosity, greater fear of death, loss of other attachment figures, religious affiliation, and being younger in age, Black, and of lower socioeconomic status. Participants belonging to fundamentalist or evangelical Protestant denominations had a stronger attachment to God than those with other affiliations. Findings are interpreted in relation to existing literature on attachment to God.

Attachment behaviours and parent fixation in people with dementia: the role of cognitive functioning and pre-morbid attachment style

This study replicates and extends exploratory research into the occurrence of attachment behaviours and parent fixation amongst people with dementia. Relationships between cognitive functioning, pre-morbid attachment style, attachment behaviours and parent fixation were examined. Fifty-three people with dementia, living in residential or nursing homes, completed the Standardised Mini-Mental State Examination and were interviewed about their parents. A family member or friend rated pre-morbid attachment style and care staff made observations of attachment behaviour. Results indicated that parent fixation occurred more often in participants with lower levels of cognitive functioning. Parent fixation was not related to pre-morbid attachment style. The occurrence of overt attachment behaviour was inconsistently associated with both high and low levels of cognitive functioning, at different times of the day. Participants with an avoidant attachment style exhibited more overt attachment behaviour than participants with a secure attachment style. Findings are interpreted in terms of attachment theory and the clinical and research implications of the study are discussed.

Diagnostik von Ressourcen im Alter

Zusammenfassung: Als Ergänzung zur psychopathologisch orientierten Diagnostik zieht seit einiger Zeit die Beschäftigung mit Stärken, Kompetenzen und Ressourcen einer Person Aufmerksamkeit auf sich, zuletzt unter den Bemühungen der Positiven Psychologie. Gerade die Alterspsychotherapie kann von einer Ressourcenorientierung profitieren. Dieser Artikel verfolgt zum einen das Ziel, Instrumente zur Diagnostik verschiedener Ressourcen darzustellen, zum anderen Befunde zu positiven Konsequenzen dieser Ressourcen im Alter zusammenzufassen. Berücksichtigt werden emotionale Ressourcen (positiver Affekt, Lebenszufriedenheit, Selbstwerterleben), motivationale Ressourcen (Kontrollüberzeugung, Selbstwirksamkeitserwartung, dispositionaler Optimismus, optimistischer Attributionsstil, Hoffnung, intrinsische Lebensziele), volitionale Ressourcen (Handlungsorientierung, Selbstregulation und Selbstkontrolle, Aufmerksamkeitsregulation, Emotionsregulation), interpersonale Ressourcen (Bindung, Altruismus, soziale Verantwortung, Vergebung, Humor) und soziale Ressourcen (soziales Netzwerk, soziale Unterstützung, Partnerbeziehung). Diskutiert wird die Notwendigkeit einer Diagnostik der Ressourcen in der Psychotherapie, vorgeschlagene Änderungen am DSM-IV und Schlussfolgerungen für geplante Forschungsprojekte.

Attachment in African American and European American older adults: the roles of early life socialization and religiosity

The significance of attachment relationships in later life has recently emerged as an important topic of study. Yet little attention has focused on attachment dynamics among older minority adults. This paper extends the literatures on ethnicity, attachment, and later life by examining attachment patterns in two large community-dwelling samples of older (65 + years) African American (n = 671) and European American (n = 447) adults. Data gathered during face-to-face interviews included demographic information, adult attachment, early rearing experiences, and current religiosity. Hierarchical regression analyses revealed that adult attachment dimensions were differentially predicted by childhood socialization patterns and current religiosity. Significant ethnic differences in relations between adult attachment and childhood socialization practices also were found. The results highlight the importance of examining contextual differences in attachment in later life.

Attachment and emotion experience in later life: the view from emotions theory

Despite the large volume of research on attachment over the past three decades based on work with children and young adults, there has been scant attention to later life. As such, Bowlby's claim that attachment theory has implications for the entire lifespan remains relatively untested. In this paper we present exploratory data documenting the relations between attachment and emotion in older adults. A sample of 1118 community-dwelling adults ranging in age from 65 to 86 years completed measures of attachment and Izard's (1972) Differential Emotions Scale. Consistent with a developmental-functionalist theory of emotions, different dimensions of attachment were associated with different emotion profiles, even when background variables were controlled. Attachment security was associated with less guilt, contempt, and shame, and with greater joy, sadness interest, fear and anger. Dismissingness, in contrast, was associated with greater interest and with less joy, shame, and fear. Finally, fearful avoidance was associated with greater joy, disgust, shame and anxiety. Taken together, our data suggest that the later life relations between emotion and attachment are similar to those documented in younger samples, although there appear to be some important developmental differences. The data are interpreted in the context of developmental-functionalist theories of emotions and implications for how emotions function within attachment systems and moderate social relations across the lifespan are discussed.

Adult attachment and preparing to provide care for older relatives

A normative developmental task of middle-aged adults is to consider older family members' care needs. Preparing for future caregiving responsibilities may be an important way to prevent excessive stress responses when the caregiver role is taken on. The present study investigates the extent to which attachment style and dimensions of attachment insecurity predict whether middle-generation adults prepare for possible future caregiving responsibilities, feel prepared for these responsibilities and are satisfied with their preparation activities. Middle-generation parents of undergraduate students (N = 141) were sent questionnaires assessing adult attachment style, attachment insecurity, preparation for future care activities, feelings of preparedness, and satisfaction with preparation. Results suggest that secure attachment style and lower attachment insecurity had limited associations with preparation activities, whereas the associations with feelings of preparedness were more robust. Moreover, attachment variables predict feelings of preparedness even after controlling for the influence of actual preparation behaviors. Separate analyses for individuals already providing care vs. those not yet providing care suggest that secure attachment may be more important in predicting preparation activities for individuals not yet providing care.

Reminiscence and its relationship to attachment and personality in geropsychiatric patients

The relationships between reminiscence functions and attachment styles; reminiscence and personality factors; and attachment and personality were examined in forty patients attending a geropsychiatric outpatient clinic. They were administered the Reminiscence Functions Scale, NEO-FFI, and the Relationship Questionnaire. Compared with insecurely attached older patients, securely attached older patients score higher on the teach/inform reminiscence function. Consistent with prior research, relationships were found between the extraversion personality factor and conversation reminiscence; and between the openness personality factor and both identity and problem-solving reminiscence functions.

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

Although John Bowlby conceptualized attachment theory as applicable across the life span, researchers have been relatively slow to examine attachment phenomena specifically among older adults. The present article reviews the extant research applying attachment theory to older populations; preliminary findings suggest that attachment issues hold particular relevance for older adults, given the increased potential for separation, loss and vulnerability associated with aging. Although many of the studies reviewed are somewhat limited methodologically, the overall pattern of results suggests that attachment patterns are associated with a variety of outcomes in later life (such as adaptation to chronic illness and caregiver burden among family members, reactions to the death of a loved one, and general well-being) in a theoretically consistent manner. The implications of and questions raised by current findings are reviewed, and directions for future research are discussed.