The secure base script and the task of caring for elderly parents: implications for attachment theory and clinical practice

Abstract

This study explores links between adults’ attachment representations and the task of caring for elderly parents with dementia. Participants were 87 adults serving as primary caregivers of a parent or parent-in-law with dementia. Waters and Waters’ (2006) Attachment Script Assessment was adapted to assess script-like attachment representation in the context of caring for their elderly parent. The quality of adult–elderly parent interactions was assessed using the Level of Expressed Emotions Scale (Cole & Kazarian, 1988) and self-report measures of caregivers’ perception of caregiving as difficult. Caregivers’ secure base script knowledge predicted lower levels of negative expressed emotion. This effect was moderated by the extent to which participants experienced caring for elderly parents as difficult. Attachment representations played a greater role in caregiving when caregiving tasks were perceived as more difficult. These results support the hypothesis that attachment representations influence the quality of care that adults provide their elderly parents. Clinical implications are discussed.

Keywords:

• attachment
• secure base
• scripts
• aging
• dementia
• caregiving
• expressed emotion

Acknowledgements

This research was supported by Grant 1T32 AG00272-01 A1 from the University of North Carolina Institute on Aging, Carolina Program in Healthcare and Aging Research Fellowship Program, VA Career Development Award Health Services Research and Development, CDA 10-023 and Sigma Xi Scientific Research Society Grant in Aid of Research (Cory K. Chen, Principal Investigator). The authors would also like to express appreciation to Melanie Elliott Wilson for her contribution to the modified version of the Attachment Script Assessment for adult children caring for their elderly parents.

Notes

1.The correlation between script knowledge scores from the standard prompt word sets (Baby’s Morning and Doctor’s Office) was 0.44; thus, the alpha reliability of the average of these two scores was 0.61.

2.Without being adapted to refer specifically to adult child–elderly parent caregiving interactions, the standard ASA also predicted a significant degree of variability in negative expressed emotion, F(3, 81) = 9.68, p < .0001 and the interaction term was significant (p < .05). At low and moderate levels of stress there was no significant relationship between generalized secure base script knowledge and expressed emotion (b =0.59 and b = −0.66 respectively, ns). At high levels of stress, there was a significant relationship between generalized secure base script knowledge and expressed emotion (b = –1.90, p < .05). The region of significance analysis indicated that the relationship between secure base script knowledge and expressed emotion becomes significant at a z-score of 1.02 (p < .05) on the combined caregiver stress measure.