REPORT: Dementia – attachment matters

A fascinating report exploring the relevance of attachment to our understanding of dementia and its impact on people has recently been released as part of the Iriss Insight series. Written by Jan Beattie (Scottish Government) and Janice West (Freelance Consultant), this evidence summary argues that understanding attachment helps us to understand behaviours and responses to dementia. It also includes implications for practice and a case study example. We thoroughly recommend a full read through, the article can be found here.

Key points

Attachment theory, most developed and applied to the early years, has relevance to our understanding of dementia and its impact on people and their family carers. Understanding attachment helps us to understand behaviours and responses to dementia.
Attachment, an emotional link between two people which lasts through space and time, affects people’s ability and willingness to relate to the world around them and can be a preventative factor in managing the symptoms and effects of dementia.
Attachment can enhance the safety and security experienced by people living with dementia, can support them to maintain relationships, connect with their community and engage in support and care.

Introduction

Dementia is an umbrella term for symptoms caused by over 100 brain conditions with Alzheimer’s Disease being the most common. This complex range of conditions commonly referred to as dementia has been a global health priority since 2012 and described as ‘an increasing threat to global health’. Indeed, the authors considered their report to be ‘a resource that will facilitate governments, policy makers and other stakeholders to address the impact of dementia’ (WHO, 2012, p7). Over 90,000 people in Scotland live with dementia and this is expected to rise in coming years at a rate of 20,000 per year (Scottish Government, 2017).

Prioritising dementia in Scotland

Before dementia was established as a global health priority Scotland became one of the first countries to acknowledge the need for action on dementia when the first Scottish Dementia Strategy was launched (Scottish Government, 2010). It focussed on improvement to existing care pathways, strengthening integrated approaches and improving diagnosis levels. The strategy was arguably the first in the world to reflect a rights-based approach, drawing as it did on the Charter of Rights for People with Dementia and their Carers in Scotland (Scottish Government, 2009).

A second national strategy (Scottish Government, 2013) introduced a guarantee of one year of support from a named practitioner for everyone in Scotland receiving a diagnosis of dementia. This was the first such guarantee in the world and was heavily informed by this rights-based approach. The second strategy also introduced a series of commitments that recognised people’s rights to maintain community connections and social support, to be recognised as active citizens and to live in dementia friendly communities where they would feel included and at the heart of community life.

Now at the end of Scotland’s third dementia strategy, (Scottish Government, 2017) the national commitments continue to make reference to the need to be person-centred in all approaches to support and care. Overall, the three national strategies to date, while not referencing attachment specifically, recognise the importance of connectedness and personal history in planning support and care.

Summary points for practice

The article goes on to look at loss, identity, resilience and family carers in a very insightful manner, making links to the importance peer connection, sense of self, community and person centered approaches.

Summary points for practice

Understanding people’s experience of attachment, as someone requiring support or as a family carer, is an important element in a person-centred approach to assessing need and planning for care.
Supporting a person to reflect on their experience of attachment contributes to their capacity to build resilience and maintain their rights and choices through their dementia.
Understanding attachment complements a rights-based approach by recognising the need for love and care throughout life.