Attachment bonds between adult daughters and their older mothers: associations with contemporary caregiving.

This study examined associations between attachment bonds and the care that daughters were providing to their community-dwelling mothers. Adult daughters (40 African American, 40 European American) completed assessments of adult attachment, instrumental and emotional caregiving, and caregiver burden. The author performed hierarchical linear regressions to examine the relationships between attachment dimensions (Security and Anxiety) and the provision of instrumental and emotional care. Both attachment dimensions were unrelated to the provision of instrumental care. In contrast, high scores on the Security dimension and low scores on the Anxiety dimension were associated with the provision of more emotional care to mothers. A final analysis revealed that high scores on the Security dimension were associated with less caregiver burden. These results suggest that practical care that daughters provide to their mothers may be independent of attachment patterns within the child-parent relationship, whereas affective, discretionary care may be promoted or hindered by attachment patterns. Moreover, the stress of caregiving may be mediated by a more secure attachment bond. The potential impact of adult attachment patterns has implications for both family intervention and public policy, given that more families are expected to participate in caregiving in coming decades.

The psychosocial preferences of older adults: a pilot examination of content and structure.

Individualizing care for older persons depends on knowing about a care recipient's psychosocial preferences. Currently, however, no comprehensive, empirically derived instruments exist to assess these preferences. As part of an effort to develop such an instrument, this pilot study examined the content and structure of psychosocial preferences in older adults using the statistical technique known as concept mapping. Results suggest two underlying dimensions to psychosocial preferences (Enrichment-Self-Maintenance and Extrapersonal-Intrapersonal) and six distinct content domains (Social Contact, Growth Activities, Leisure Activities, Self-Dominion, Support Aids, and Caregivers and Care). Both the dimensions and the content domains provide valuable information for the construction of psychosocial preference instruments. They also might assist formal and informal caregivers in tailoring their interventions to provide individualized care that enhances quality of life for older adults.

Conversational cohesion patterns in men and women with Alzheimer's disease: a longitudinal study.

The use of cohesion devices in conversations was examined in 60 individuals (31 women, 29 men) with early to midstage Alzheimer's disease (AD) and 47 non-demented elderly (NE) (27 women, 20 men). AD individuals produced more referent errors than NE, although AD and NE subjects otherwise demonstrated similar use of cohesion devices. AD women showed more frequent use of two elliptical devices (clause omission and word omission) compared with AD men and NE men and women. A subset of 23 AD subjects (13 women, 10 men) who completed four data collections (entry, 6, 12 and 18 months) was followed longitudinally. They demonstrated a significant decline in the number of ellipses and conjunctions at 18 months post-entry. As AD subjects produced fewer and shorter utterances across time, their use of all cohesive devices declined. No gender differences were found over time. Although referencing errors differentiated early to midstage AD from NE, conversational discourse tasks alone may have limited clinical value to assess and monitor communication competence.

Behavior and affect in Alzheimer's disease.

The behavioral symptoms associated with AD are a critical aspect of the disease. They provide an additional avenue not only for understanding AD but for implementing interventions. The nature of behavioral disorders in AD is complicated by a number of factors that interact and contribute to the development of problematic behavior. It is difficult to determine whether the behavior is the result of neurodegeneration, cognitive dysfunction, previous experiences, current stressors, independently coexisting psychopathology, or a combination of these factors. In any case, behavioral disturbances need to be more clearly defined and objectively measured. To understand and treat behavioral disturbances in AD, all biopsy-chosocial factors must be examined simultaneously. Currently, there is little that can be done to treat the cognitive components of AD. Consequently, our most successful and beneficial interventions may focus on the remediable behavioral manifestations of the disease. The most valuable treatment approach for patients with AD and their caregivers interweaves medications, psychosocial services, environmental strategies, and caregiver education.

A review and new look at ethical suicide in advanced age.

Suicide is common in old age, but public opinion remains negative. Following a review of theories of suicide and a summary of arguments against suicide, this essay constructs an argument for why the elderly have a unique claim to an ethical, unobstructed suicide. That claim rests on their "developmental autonomy," based on the experience and wisdom of the elderly.