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

Abstract

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.

Keywords:

• Alzheimer's disease
• vascular dementia
• quality of life
• caregiving
• relationships
• depression
• anxiety

Acknowledgements

This work was supported by the Economic and Social Research Council (RES-000-22-4117) grant awarded to S.M. Nelis (PI), L. Clare and C.J. Whitaker. The MIDAS study was supported by the Economic and Social Research Council through grant RES-062-23-0371 to L. Clare (PI), R.T. Woods, I.S. Markova, R.G. Morris and I. Roth. The Cognitive Rehabilitation Trial was funded by a grant from the Alzheimer's Society (UK) to L. Clare (PI), D.E.J. Linden, R.T. Woods and M.D. Rugg. The authors are grateful to Anthony Martyr, Caroline Parkinson, Jorien Van Paasschen and Sue Evans for assistance with data collection. They thank Clinical Studies Officers Julia Roberts and Martin Wynne Jones and the staff of Memory Clinics across North Wales for assistance with participant recruitment and acknowledge the support of NEURODEM Cymru.