Attachment in old age: theoretical assumptions, empirical findings and implications for clinical practice.

Contemporary theoretical models that conceptualize attachment as a biologically-based behavioral system that is activated under threat offer a heuristic theoretical framework to understand processes involved in aging and particularly individual differences in coping with the inevitable losses associated with aging and age-related disease, including dementia. This paper provides a systematic qualitative review of research concerning attachment in old age published between 1983 and June 2012. Four major findings emerged. First, studies suggest age-related changes with regard to the number and type of attachment figures, with older adults, compared to younger adults, having less attachment relations. Moreover, so-called symbolic attachments (e.g., to God or a deceased loved one) become more prominent in old age. Second, the quality of attachment changes with increasing age, with significant decreases in attachment anxiety, but not in attachment avoidance. Third, late-life attachment is in theoretically predicted ways associated with indices of intraindividual and interindividual functioning. Finally, insecure attachment has a negative impact on subjective caregiver burden and behavior of patients with dementia. There is some evidence suggesting that attachment-based interventions show positive effects in treating problem behaviors associated with dementia. However, these conclusions need to be interpreted within the context of important methodological limitations, stressing the need for future research in this domain. Guidelines for future research are outlined.