Declining autobiographical memory and the loss of identity: Effects on well-being

Abstract

We investigated the impact of cognitive deterioration and identity loss on well-being in older adults with dementia. We predicted that in addition to the negative effects that decline in cognitive ability has on dementia sufferers' well-being, there are also independent negative effects of identity loss. Participants (N = 48) were residents receiving standard care with mild dementia, residents receiving specialized care with severe dementia, and an age-matched community comparison group. Predictably, autobiographical memory and cognitive performance decreased linearly as a function of care level. Life satisfaction was lower for the standard care group with mild dementia than for the community sample, but, unexpectedly, life satisfaction was just as high for the severe dementia group receiving specialized care as for the community group. A similar U-shaped pattern was found in ratings of personal identity strength, and this mediated the life satisfaction effect. We conclude that amongst those suffering from dementia, loss of memory serves to compromise well-being primarily because it is associated with loss of identity.

Keywords:

• Identity
• Autobiographical memory
• Well-being
• Dementia
• Cognitive functioning

We are grateful to staff and residents of Somerset Care for allowing us to conduct this research and for their help collecting the data and to Bill von Hippel, Nancy Pachana, and Eric Vanman for helpful comments on an earlier draft of this paper. This research was supported by the Economic and Social Research Council (RES–062–23–0135).

Notes

¹There are two reasons why we chose to analyze the data by care level (i.e., the three groups as an indicator of autobiographical memory decline) rather than autobiographical memory scores. First, participants were recruited on the basis of their care level and not their autobiographical memory performance. Thus, autobiographical memory was assessed to confirm the validity of our groups. Second, if we were to include autobiographical memory scores into our analysis, we would confound care level with memory loss. Thus, while autobiographical memory scores were lower for those residing in care than for those in the community, these groups also differed in a number of other ways (e.g., whether participants lived independently, etc.). Accordingly, by analyzing the data according to care level and not by autobiographical memory, we avoid this confound.

²One item assessing the extent to which participants were satisfied with their marriage was dropped because, in consultation with care staff, we anticipated that this item would upset some participants who had recently lost their spouse.

³To assess whether the care level can serve as an indicator of autobiographical memory decline, we also examined whether similar effects would emerge in the relationship between autobiographical memory and life satisfaction, and whether this relationship was mediated by personal identity strength or by the cognitive performance (i.e., the ACE-R score). Regression analysis revealed a marginally significant relationship between autobiographical memory performance and life satisfaction, β = .28, p = .058, indicating that higher autobiographical memory scores were associated with higher levels of self-reported well-being. Bootstrapping testing mediation by personal identity strength revealed that the confidence interval for the indirect effect did not include zero (IE lower 95% CI = 0.00, upper 95% CI = 0.01), the relationship between autobiographical memory and personal identity strength was significant (t = 4.85, SE = 0.002, p = .001), and the relationship between personal identity strength and life satisfaction was marginally significant, t = 1.85, SE = 0.13, p = .071. In contrast, bootstrapping analyses testing whether cognitive performance, as measured by the ACE-R, mediated the relationship between autobiographical memory and life satisfaction did include zero in the confidence interval (IE lower 95% CI = −0.01, upper 95% CI = 0.009), and, as before, the relationship between cognitive performance and life satisfaction was not significant, t = −0.65, SE = 0.005, p = .519. In sum, similar conclusions can be drawn from these analyses compared to the ones where care level was used as a predictor, thus providing empirical support for the appropriateness of care level groups as an indicator of autobiographical memory decline.

⁴Note that our argument is not so much related to experiencing poor memory per se, but is concerned with the psychological experience of memory loss.