N U R S I N G T H E O R Y A N D C O N C E P T D E V E L O P M E N T O R A N A LY S I S

Attachment in older adulthood: concept clarification

Craig Cookman PhD RN
Assistant Professor, Health Sciences Center, School of Nursing,Texas Tech University, Lubbock, Texas, USA

Accepted for publication 2 September 2004

Correspondence: COOKMAN C. (2005) Journal of Advanced Nursing 50(5), 528–535

Craig Cookman, Attachment in older adulthood: concept clarification
Health Sciences Center, Aims. This paper is an analysis to clarify the concept of attachment by: (1) speci-
School of Nursing,
fying the antecedents of attachment in older adulthood, (2) describing the defining
Texas Tech University,
or critical attributes of attachment as relevant for development beyond adulthood,
3601 4th Street,
Lubbock, including older adulthood and old age, and (3) specifying the consequences of
Texas, attachment in older adulthood.
USA. Background. Attachment is a concept that has been studied both within and outside
E-mail: craig.cookman@ttuhsc.edu the discipline of nursing. Most of the scholarly work on the concept has involved
investigations of the concept as it applies at very early developmental phases of the
lifespan. Despite this concentration of effort on the concept in childhood, theorists
have consistently called for attention to the concept in adulthood and older adult-
hood to advance our understanding of how such close and supportive relationships
relate to health.
Results. Antecedents of attachment behaviour include any number of fear-provo-
king or challenging situations, as well as interactions that involve conflict. Illnesses
commonly have these characteristics and so are broadly included as antecedents.
Defining attributes of attachment behaviour include three distinct behaviours:
(1) proximity, or keeping to one or more ‘preferred others’, (2) protest following
involuntary and perceived permanent separation from a preferred other and, (3) the
presence of a secure base, viewed as necessary for developmental exploration and
growth. Consequences include environmental interaction secure in the belief that a
safe haven exists should reliable clues to danger present themselves, and the
mobilization of personal and interpersonal assets called developmental resources.
Conclusions. Nursing implications include the ability of nurses to intervene posi-
tively with older clients who may be experiencing age-related transitions that affect
health. Knowledge about attachment will help nurses mediate the potentially neg-
ative impact of health transitions on developmental tasks and promote high-level
wellness and successful ageing.

Keywords: attachment, concept analysis, gerontological nursing, nursing theory,

older adults

1995, Schwartz–Barcott & Kim 2000). More recently, the

Introduction
Scientific analysis of concepts for use in theory, practice and
research is not new to nursing. Nurses have developed
so-called Wilson-derived (Wilson 1969) methods of concept
analysis to describe more precisely important concepts for use
in the discipline (Chinn & Jacobs 1983, Walker & Avant
adequacy and relevance for nursing of these methods have
been questioned (Hupcey et al. 1996). Researchers and
theorists have been encouraged to consider carefully addi-
tional strategies for concept development, including qualit-
ative methods, critical analysis, and quantitative methods
(Morse et al. 1997).

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2005 Blackwell Publishing Ltd

Nursing theory and concept development or analysis
What follows is a clarification of the concept of attachment
in older adulthood. Selected elements of Wilson-derived
methods of concept analysis are used to assist in this process.
A critical appraisal of the concept considers principles of
lifespan development alongside the clarified concept. Strat-
egies for continued development of the concept complete the
analysis.
Beginning with a mother’s bond to her unborn child and
progressing through life, attachment has been identified as a
critical factor in healthy human development. Researchers in
human development and nursing have studied attachment
extensively, but almost exclusively in infancy and childhood.
Development of nursing theory using the concept of attach-
ment has most frequently involved the study of maternal–fetal
(Cranley 1981, Kemp & Page 1987, Mercer et al. 1988) and
parental–infant attachment (Gaffney 1986, Koniak-Griffin
1988). Understanding attachment in the later developmental
phases is clearly needed, considering the hypothesized impli-
cations of early attachment patterns for subsequent health
(Ainsworth 1985, Bowlby 1988, Paterson & Moran 1988).
Consistent with this emphasis, a systematic analysis of the
concept of parent–infant attachment has been described
(Goulet et al. 1998). The relevance and significance of
attachment in later developmental phases is theorized to be
important, but has been studied relatively little (Lipson-Parra
1990). Advocates of inquiry into attachment in adulthood
and ageing call for rigorous work on clearly defining the
concept (Knudtson 1976), as its exact meaning and structure
thus far remained unaddressed.
Understanding healthy development in later life
Exploring concepts as they present in older adulthood
requires a gerontological perspective in which characteriza-
tions of ageing as progressive decline and loss are critically
scrutinized. Ageing as the time of life when one’s family and
friends are lost can lead to an overall view of older adulthood
as a time of loss and decline (Phillips 1990). Loneliness,
depression and isolation are all too often the expectation
among caregivers of older adults and perhaps worse, older
adults themselves. A central principle of the lifespan devel-
opment perspective is that development occurs according to
the orthogenetic principle (Werner 1957), where develop-
ment is an irreversible process of increasing differentiation
and hierarchical integration. Reed (1983) characterized this
principle as an essential feature of development, meaning
that, with development, behaviours will become more com-
plex but more internalized or integrated within the person to
define a higher level of human development for that person.
Bowlby (1973) echoed this developmental principle when he

2005 Blackwell Publishing Ltd, Journal of Advanced Nursing, 50(5), 528–535
Attachment in older adulthood
wrote: ‘Psychological development is characterized …by the
individual’s becoming increasingly aware of the set-goals he
(sic) has developed, by his developing increasingly sophisti-
cated plans for achieving them, and by his increasing ability
to relate one plan to another’ (p. 154). Bowlby’s (1969, 1973,
1980 descriptions of attachment involved ‘increasing aware-
nesses’, ‘increasingly sophisticated plans’, and ‘increasing
abilities’ resulting from the ‘activation within a particular
environment of behavioural systems that are integrated’
(Bowlby 1973, p. 134). Knowledge about attachment, and in
particular about the formation of new attachment relation-
ships with ageing, would lend important support to the
development of models of health development for older
adults. The promise of knowledge about attachment in older
adulthood lies in the positive consequences resulting from the
vulnerabilities of ageing.
Assumptions
Attachment is viewed as a continuous concept throughout the
lifespan. Central to any investigation of attachment is the
assumption that ‘the capacity to make bonds with other
individuals …is regarded as a principal feature of effective
personality functioning and mental health’ (Bowlby 1988,
p. 3); this has far-reaching implications throughout the life of
the individual. Accordingly, phenomena such as attachment
are of particular interest to nurses who strive to optimize
growth and development as critical components of health
promotion and illness prevention.
Aims
The major aim of this analysis is to clarify the concept of
attachment as it applies to development in older adulthood
and old age. Attachment has been described as social bonds
(Rajecki et al. 1978), social relationships (Rutter 1978),
symbolic interdependence (Stephen 1984) and object rela-
tions (van den Daele 1986), but there remains no generally
accepted meaning or definition of attachment. A second aim
of this analysis is to specify antecedents, defining attributes
and consequences of attachment in older adulthood. In
particular, the defining attributes are needed to guide
research-exploring attachment among older adults.
History of the conceptual work on attachment
Conceptual development has generally proceeded from
earlier to later developmental phases of the life course. The
earliest writings were almost exclusively about the very early
bonds formed between infants and their mothers. Once this
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C. Cookman
base of knowledge was established, the concept was explored
among increasingly older groups, including adolescents,
adults and most recently older adults.
Beginning descriptions
Freud (1926) described a theory of secondary drive to explain
the bonds that developed between human infants and their
mothers. According to this view, there are a small number of
primary drives designed to meet survival needs such as food,
warmth, sex and liquids. Secondary drives, including attach-
ment, were proposed as learned behaviours that supported
these primary drives. As stated by Freud (1926), ‘The reason
why the infant in arms wants to perceive the presence of its
mother is only because it already knows by experience that
she satisfies all its needs without delay’ (Vol. 20, p. 137). This
theory was first brought into question by the work of Lorenz
(1935) in his experiments with young birds. These demon-
strated that, in the hours following hatching, ducklings would
follow any moving object they saw, including rubber
balloons and cardboard boxes. Over time, the ducklings
would follow these objects and no others – findings that
brought serious questions about the validity of any theory of
secondary drive. Experiments by Harlow and Zimmerman
(1959) added to the scepticism. These researchers raised eight
infant monkeys with two surrogate mothers – one of cloth
and another made from wire. Half of the infants were then
‘fed’ by these surrogate mothers. Monkeys of both groups
spent no more than 1 or 2 hours a day on the wire monkey
and an average of 15 hours a day on the cloth monkey. Some
of the monkeys who were fed by the wire model managed to
suck the teat of the wire model while maintaining a grasp on
the cloth one. The researchers concluded that ‘an infant fed
from a lactating wire mother does not become more
responsive to her, as would be predicted from a drive-derived
theory, but instead becomes increasingly more responsive to
its non-lactating cloth mother’ (Harlow & Zimmerman
1959, p. 423). At this point in the evolution of thinking
about attachment, substantive doubts arose about the role of
attachment strictly viewed as a strategy for meeting basic
needs.
These doubts led Bowlby (1969, 1973, 1980) to propose a
new definition of attachment based on his studies of the
concept among young war orphans. Bowlby (1980) described
attachment as a natural protective system that evolved within
the species because it enhanced an individual’s chances for
survival. This view holds that infants who are predisposed to
maintain proximity to an attachment ‘figure’ are afforded
protections from predation. This system promotes healthy
development wherein an individual can confidently explore
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2005 Blackwell Publishing Ltd, Journal of Advanced Nursing, 50(5), 528–535
the environment with the knowledge that, should the threat
of danger arise, a quick return to an attachment ‘object’ will
afford safety (the so-called ‘secure base effect’). Attachment
behaviours, then, are the observable components of this
system, seen when this system is invoked to protect the
individual displaying the behaviours. According to Bowlby,
an attachment is a bond developed with ‘some other
differentiated and preferred individual, who is usually con-
ceived as stronger and/or wiser’ (1977, p. 203). Attachments
are directed toward a differentiated other, are characterized
by their relatively long duration and serve the biologi-
cal function of survival. Importantly, Bowlby described
attachment as a lifespan development concept ‘held to
characterize human beings from cradle to grave’ (Bowlby
1979, p. 129).
Ainsworth (1985) viewed attachment as a type of ‘affec-
tional bond’ that individuals may form throughout their lives,
some of which ‘may be identifiable as attachments, some as
having attachment components, whereas others may not
resemble attachments in some critical way’ (p. 799). Accord-
ing to this description, an attachment is an affectional bond.
Ainsworth extended Bowlby’s conceptualizations about
attachment. In particular, she demonstrated that individuals
at a very young age develop cognitive schemas, or internal
representations about the relative degree of safety afforded by
attachment figures. Called ‘patterns of attachment’, Ains-
worth et al. (1978) demonstrated that most infants display
confidence in the protective abilities of their attachment
figure (mothers), and this is indicative of a ‘secure’ pattern of
attachment behaviours. Others, however, display behaviours
indicative of ‘insecure’ attachment and characterized by
angry and resistant behaviour mingled with contact-seeking
(Ainsworth 1982).
Hinde (1982) differentiated between attachment beha-
viour, an attachment behavioural system and attachment.
Attachment behaviour refers to proximity keeping. An
attachment behaviour system ‘refers to a system postulated
as controlling several types of attachment behaviour’ where
‘…the system is either switched on, with the resultant display
of attachment behaviour or, when a ‘‘set goal’’ is reached,
switched off’ (Hinde 1982, p. 64). Attachment is defined as a
‘label for a relationship or for aspects of a relationship,
assessed over a span of time’ that ‘…refers to an aspect of
interpersonal relationships’ (Hinde 1982, p. 65).
Attachment in adolescence
In adolescence, the parental attachment system is believed to
persist, although peer relationships become increasingly
important. At the same time, however, the secure base
Nursing theory and concept development or analysis
provided by parents ‘remains indispensable nonetheless for
optimal functioning and mental health’ (Bowlby 1988, p.3).
Further evidence for the hypothesized persistence of parents
as primary attachment figures for adolescents are provided by
Weiss (1982) in his description of a Separation Distress
Syndrome, likened to homesickness and seen most acutely
during hospitalization of children. Weiss (1982) described
four elements of this syndrome:
• Focusing of attention on the parent’s absence
• Difficulty focusing on other matters
• A state of tension that discourages sleep and appetite
• An impulse to search for parents
Weiss (1982) concluded that adolescents ‘…continue to
demonstrate…that their sense of security is dependent on
their parents’ continued accessibility’ (p. 175). Developmen-
tal growth results in ever more frequent and long-lasting
excursions away from the secure base provided by the
parents. Eventually, attachments involving peers as signifi-
cant attachment figures come to supplement those established
in childhood.
Adult attachment
From his earliest writings, Bowlby (1969) asserted that
‘attachment behaviour in adult life is a straightforward
continuation of attachment behaviour in childhood’ (p. 207).
Later attachment theorists echoed this appreciation for the
continuous quality of attachment with development. Accord-
ing to Parkes and Stevenson-Hinde (1982): ‘…the properties
of attachment in children are just those required for effective
pair bonding in adults, and (that) this may account for the
very evident capacity of human adults to display attachment’
(p. 183). Heard and Lake (1986) wrote that: ‘Individuals
have a natural propensity to have ‘‘companionable interac-
tions’’ in specifiable circumstances with peers, that is, people
of broadly equivalent intelligence, stamina, capacity to
handle fear and panic, and competence in pursuit of interests’
(Heard & Lake 1986, p. 431). Companionable interaction
with select others (commonly referred to in attachment
literature as ‘attachment figures’) leads to a state of assuage-
ment where ‘…an affective experience of mental and physical
well-being’ (Heard & Lake 1986, p. 431) is experienced.
Attachment figures were viewed within a system theory of
social networks. Individuals develop networks of ‘preferred
relationships’ that refer to ‘relationships in which individuals
regularly expect to find opportunities for companionable
and/or supportive interactions which are experienced as more
rather than less effective’ (p. 433).
Weiss (1991) identified three features of adult attachment
as evidence that attachment is a developmentally continuous

2005 Blackwell Publishing Ltd, Journal of Advanced Nursing, 50(5), 528–535
Attachment in older adulthood
concept: (1) the similarity of emotional characteristics, (2) the
generalization of experience, and (3) the temporal linkage. As
theorized by Weiss (1991), ‘in adults as well as in children,
attachments appear to be relationships critical to continuing
security and so to maintenance of emotional stability’ (p. 75).
Attachment in older adulthood
Attachment has been examined in older adulthood (Knudtson
1976, Troll & Smith 1976, Weiss 1986, West et al. 1987,
Shaver et al. 1988, Cicirelli 1989). Bradley and Cafferty
(2001) described attachment as relevant for ageing in three
major areas: (1) care giving and chronic illness, (2) bereave-
ment and coping with loss, and (3) adjustment to ageing and
well-being in old age. Writers have acknowledged that the
conditions imposed by severe chronic illness such as Alzhei-
mer’s disease and stroke are significant attachment-related
phenomena (Wright et al. 1995) that involve both the ill
person and their caregiver. Issues surrounding loss and
bereavement have long been acknowledged as developmental
challenges that confront older adults (Havighurst 1952).
Similarly, the influence of attachment processes on well-being
in older adulthood has long been acknowledged (Antonucci
1976, Troll & Smith 1976, Kahn & Antonucci 1980).
Beyond hypothesizing about the continued relevance of
attachment for ageing, systematic efforts specifically designed
to explore the specialized nature of concept for older
adulthood are sparse (Cookman 1996).
Wilsonian concept analysis elements
The following section uses the three main components of a
concept analysis as described by Walker and Avant (1995) to
further this clarification of attachment: antecedents, critical
attributes and consequences.
Antecedents
Common to many perspectives on attachment is the notion of
humans as potentially vulnerable to dangers that are lessened
when in the company of another or others: ‘Separation from
an attachment figure is found to be one of a class of situations
each of which is likely to elicit fear’ and ‘comprise(s), among
others, darkness, sudden large changes of stimulus level
including loud noises, sudden movement, strange people and
strange things’ (Bowlby 1977, p. 205). Kobak and Duemmler
(1994) described three categories of antecedents to attach-
ment, defined as ‘attachment system activators’. Fear-provo-
king situations that lead to searches for ‘safe havens’ are the
first. This is consistent with Bowlby’s (1969) and Ainsworth’s
531
C. Cookman
et al. (1978) initial descriptions of attachment as serving
evolutionary and protective functions. Additionally, the
fearful experiences associated with vulnerability and depend-
ence are thought to precede attachment behaviours (Bradley
& Cafferty 2001), as are exhaustion, distress, and illness
(Rholes et al. 1998). Challenging situations that lead adults
to seek out attachment figures to provide a secure base are a
second antecedent of adult attachment. Thirdly, conflictual
interactions are hypothesized to be attachment system acti-
vators by Kobak and Duemmler (1994). Importantly, ante-
cedents of attachment need not represent actual or ‘real’
danger; simply being alone is sufficient to result in attachment
behaviour (Bowlby 1977).
Defining attributes
Defining attributes are a ‘list of characteristics’ that ‘help you
and others name the occurrence of a specific phenomenon as
differentiated from another similar or related one’ (Walker &
Avant 1995, p. 39). Ainsworth (1985) listed three criteria of
attachment that can serve as defining or critical attributes.
Firstly, Ainsworth (1985) stated that ‘…attachment figures
are never wholly interchangeable with or replaceable by
another, even though there be another with whom one is also
attached’ (p. 799). This notion of an attachment figure as
‘preferred and differentiated’ is a widely accepted central
feature of attachment. A ‘…desire to maintain closeness to
the partner as well as a need to keep proximity to him’
(Ainsworth 1985, p. 800) is reflective of a notion of
proximity-keeping that is a second defining attribute. Her
third criterion is the secure base effect, described as ‘the
experience of comfort and security in relationship to the
other and yet the ability to move off from this secure base
with confidence to engage in other activities’ (Ainsworth
1985, p. 800).
Weiss (1991) identified three critical features of adult
attachment: (1) proximity-keeping (to a parent or other
attachment figure), (2) secure base effect, and (3) separation
protest. The first two closely mirror those identified by
Ainsworth (1985). Separation protest arises when proximity
between the person and attachment figure is interrupted
(Weiss 1991). Weiss asserted that the secure base effect
described by Ainsworth (1982) also applied to adult forms of
the concept, and also that whereas, the infant displayed more
immature behaviours to represent the ‘secure base effect’,
adults displayed mature forms of what was essentially the
same behaviour. In adulthood, separation protest leads to
active attempts at reunion with the attachment object, as
opposed to the crying or withdrawal that may evidence it in
infancy. Taken together, these three criteria seem to represent
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2005 Blackwell Publishing Ltd, Journal of Advanced Nursing, 50(5), 528–535
the central, core ideas used to represent the phenomenon of
attachment both in earlier development and in adulthood and
beyond.
Consequences
The consequences of attachment seemingly follow from the
early directions provided by Bowlby. Consequences repre-
sent linear extensions of early attachment experiences and
subsequent personality development initially formed by the
infant towards the mother. Hence, the consequence of
attachment would be the relative persistence of a specified
pattern of behaviour throughout one’s life. According to
Bowlby (1988), the scientific task remaining for researchers
interested in attachment is to test the hypothesis that ‘each
person’s resilience or vulnerability to stressful life events is
determined to a very significant degree by the pattern of
attachment he or she develops during the early years and
…to clarify to what degrees and in what ways the early-
developed patterns influence subsequent development’ (p. 8)
Ainsworth (1985) described these consequences of attach-
ment in terms of secure, anxious and avoidant patterns of
attachment.
Heard and Lake (1986) described assuagement as an
outcome of attachment, defined through a description of its
three features: ‘(1) an affective experience of mental and
physical well-being, a feeling of satisfaction and enjoyment
in what one is doing, (2) a sense of confidence and self-
esteem in the ability to achieve short or longer-term aims,
which are consistent with stages of life, abilities and
interests, and (3) awareness that one’s personal supportive
environment is secure and that opportunities for compan-
ionable and supportive interactions are available’ (p. 431).
Assuagement enables individuals to consider the conse-
quences of their actions, to see issues from another’s point
of view, to reappraise past experiences and to integrate new
approaches with known routines to carry out short- and
longer-term plans. It appears that this view offers a
confounding view of the defining attributes and conse-
quences – namely in its reference to the ‘secure base’ as a
result of the concept. For the purposes of this clarification,
the notion of a secure base is a central defining attribute of
the concept, not what follows from it. According to Heard
and Lake’s conceptualization, attachment results in the
possibility of two dichotomous outcomes: assuagement as
described above, and a negative outcome called dissasuage-
ment. Here ‘…an individual suffers loss of a sense of
confidence and competence in his (sic) ability to manage not
only to external circumstances, but also to his own feelings
and thoughts, and tends to lose faith in what previously
Nursing theory and concept development or analysis
gave him a sense of security and significance’ (Heard &
Lake 1986, p. 435).
It is, however, also possible to adopt a broader conceptua-
lization of the concept by keeping the secure base effect within
the domain of defining, or critical attributes. This allows the
possibilities for ‘what follows’ to be defined as consequences
of the concept. Viewed as a developmental process, what
follows is interaction with the environment and the mobiliza-
tion of resources associated with task achievement. From the
experiences of infants, to children and on through adulthood,
what attachment affords is a safe haven from which to explore
the environment. It follows, then, that these confident excur-
sions into the environment to grow, learn and explore
represent the most robust conceptualization of the outcomes
of attachment. Two consequences then become possible: (1)
environmental interaction, and (2) resource mobilization.
Environmental interaction refers to the physiological, psycho-
logical, spiritual, social and cultural interplay between
dimensions that interact with the client and have individual,
as well as global implications for health and health care.
Nurses routinely engage in therapeutic nursing interventions
to manage, modify and, manipulate internal and external
environmental dimensions to promote optimal health and
prevent disease. Resource mobilization involves the employ-
ment of intrapersonal as well as extrapersonal assets to meet
basic needs and to promote developmental growth. Figure 1
depicts these elements of attachment, including antecedents,
defining attributes and consequences of the concept.
A definition
Attachment as defined from this concept clarification is as
follows: attachment refers to feelings of safety and security
afforded by proximity to attachment figures in response to
reliable clues to danger, challenge or conflict. To the extent
that the person is confident in attaining these feelings when
needed, they can more fully interact with the environment,
mobilize developmental resources, and address develop-
mental tasks.
Elements of later life attachment
Antecedents Defining attributes Consequences
Fear provoking situations Proximity keeping
Environmental interaction
Challenging situations Separation protest
Resource mobilization
Conflictual interactions Secure base effect
Figure 1 Antecedents, defining attributes, and consequences of
attachment in older adulthood

2005 Blackwell Publishing Ltd, Journal of Advanced Nursing, 50(5), 528–535
Attachment in older adulthood
Related concepts
Several concepts are sometimes used interchangeably with
attachment. These related concepts can cause confusion unless
clearly differentiated from attachment. Hagerty and Williams
(1999) described attachment as ‘an individual’s level of
involvement with persons, objects, groups or natural envi-
ronments and the concurrent level of comfort or discomfort
associated with that involvement’ (p. 292). Another related
concept is emotional bondedness (Snow & Crapo 1982,
Bitzan 1998), ‘conceptualized as comprising three compo-
nents: (a) the sense that one receives emotional support from a
given other; (b) the sense of mutual sharing with another; and
(c) feelings of positive affect with another’ (Snow & Crapo
1982, p. 609). While the critical attributes of a secure base and
separation protest are not specifically included as defining the
concept, the notion of positive affect is shared by both.
Another related concept is dependence. Bowlby addressed this
potential confusion with attachment when he wrote: ‘Whereas
dependence is maximum at birth and diminishes more or less
steadily until maturity is reached, attachment is altogether
absent at birth and is not strongly in evidence until after an
infant is past 6 months’ (Bowlby 1969, p. 228).
Conclusion
Promoting nursing research
Concepts have been described as the essential building blocks
or basic elements of theory for a discipline (Rodgers & Knafl
2000). The challenge of clarifying the basic structure of the
concept of attachment in older adulthood remains, despite
this paper. This analysis has offered a basic definition and
outlined the antecedents, critical attributes, and consequences
of attachment from a very general perspective. It is hoped
that this clarification will serve as a stimulus for further
clarification efforts using systematic and rigorous approaches
(Morse et al. 1996). In particular, it was suggested that with
development, attachment can exist not only between people,
but also be meaningful between people and places, pets,
cherished possessions, and even symbolic representations of
these such as memories (Cookman 1996). Interesting ques-
tions about the nature of the concept within all these different
types of expression could be posed by researchers wishing to
clarify this concept further.
Practice implications
Nurses and others working with older adults can use
knowledge about attachment to enhance care for their older
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C. Cookman
What is already known about this topic
• Attachment is a critical concept for understanding
healthy human development across the lifespan.
• Concepts are the building blocks of nursing theory.
• Nursing theories composed of clearly defined concepts
contribute to the construction of useful nursing know-
ledge.
What this paper adds
• Attachment is a concept with consistent defining ele-
ments across all life phases, but the behaviours repre-
sentative of these elements can differ across life phases.
• Older adulthood and ageing represent particularly sali-
ent life phases for the study of attachment owing to the
importance of establishing new attachment bonds to
replace lost ones.
• Clarification of the concept is an important first step in
furthering knowledge in this important health-related
area of human development, and continued, systematic
work is needed to further this clarification and incor-
porate it into gerontological nursing theory and prac-
tice.
clients. Awareness that attachment is as relevant a concept
for senior citizens as at other life phases will help combat
stereotypes of older adulthood as only a time of loss and
deterioration. Nurses can use knowledge about attachment to
search for ways to connect older people with others, and also
to explore connections with other attachment figures such as
pets, places, and cherished possessions. Reminiscence ther-
apies may provide a rich source of insight into older people’s
previous attachments, the effect of those losses, and ways to
move on. Just as with clients from earlier life phases, nurses
should continue to enhance ever higher levels of develop-
mental growth and mastery of developmental tasks.
References
Ainsworth M.D. (1982) Attachment: retrospect and prospect. In
The Place of Attachment in Human Behavior (Parkes C.M. &
Stevenson-Hinde J., eds), Basic Books, New York, NY, pp. 3–30.
Ainsworth M.D. (1985) Attachments across the lifespan. Bulletin of
the New York Academy of Medicine 61(9), 792–812.
Ainsworth M.D., Blehar M.C., Waters E. & Wall S. (1978) Patterns
of Attachment. Lawrence Erlbaum Associates, Hillsdale, NJ.
Antonucci T. (1976) Attachment: a life-span concept. Human
Development 19, 135–142.
534
2005 Blackwell Publishing Ltd, Journal of Advanced Nursing, 50(5), 528–535
Bitzan J.E. (1998) Emotional bondedness and subjective well-being
between nursing home roommates. Journal of Gerontological
Nursing 24(9), 8–15.
Bowlby J. (1969) Attachment and Loss. Vol. I. Attachment. Hogarth
Press, London, UK.
Bowlby J. (1973) Attachment and Loss. Vol. II. Separation, Anxiety
and Anger. Hogarth Press, London, UK.
Bowlby J. (1977) The making and breaking of affectional bonds.
British Journal of Psychiatry 130, 201–210, 421–431.
Bowlby J. (1979) The making and breaking of affectional bonds.
British Journal of Psychiatry 130, 201–210.
Bowlby J. (1980) Attachment and Loss. Vol. III. Loss. Basic Books,
New York, NY.
Bowlby J. (1988) Developmental psychiatry comes of age. The
American Journal of Psychiatry 145(1), 1–10.
Bradley J.M. & Cafferty T.P. (2001) Attachment among older adults:
current issues and directions for future research. Attachment and
Human Development 3(2), 200–221.
Chinn P.L. & Jacobs M.K. (1983) Theory and Nursing: A Systematic
Approach. Mosby, St Louis, MO.
Cicirelli V.G. (1989) Feelings of attachment to siblings and well-
being in later life. Psychology and Aging 4(2), 211–216.
Cookman C.A. (1996) Older people and attachment to things, places,
pets, and ideas. Image: Journal of Nursing Scholarship 28(3), 227–
231.
Cranley M.S. (1981) Roots of attachment: the relationship of parents
with their unborn. Birth Defects: Original Article Series 17(6),
59–83.
van den Daele L. (1986) Homeostasis and attachment: an integration
of classical and object relational approaches to the good-enough
mother. The American Journal of Psychoanalysis 46(3), 203–218.
Freud S. (1926) The Standard Edition of the Complete Psychological
Works of Sigmund Freud, Vol. 20. The Hogarth Press, London,
UK.
Gaffney K.F. (1986) Maternal–fetal attachment in relation to self-
concepts and anxiety. Maternal–Child Nursing Journal 15, 91–
101.
Goulet C., Bell L., Tribble D.S., Paul D & Lang A. (1998) A concept
analysis of parent–infant attachment. Journal of Advanced Nursing
28(5), 1071–1081.
Hagerty B.M. & Williams A.R. (1999) The effects of sense of
belonging, social support, conflict, and loneliness on depression.
Nursing Research 48(4), 215–219.
Harlow H.F. & Zimmerman R.R. (1959) Affectional responses in the
infant monkey. Science 130, 421.
Havighurst R.J. (1952) Developmental Tasks and Education. David
McKay, Inc., New York, NY, pp. 92.
Heard D.H. & Lake B. (1986) The attachment dynamic in adult life.
British Journal of Psychiatry 149, 430–438.
Hinde R.A. (1982) Attachment: some conceptual and biological
issues. In The Place of Attachment in Human Behavior (Parkes
C.M. & Stevenson-Hinde J., eds), Basic Books, New York, NY,
pp. 60–70.
Hupcey J.E., Morse J.M., Lenz E.R. & Tason M.C. (1996) Wilsonian
methods of concept analysis in nursing: a critique. Scholarly
Inquiry for Nursing Practice: An International Journal 10(3), 185–
210.
Nursing theory and concept development or analysis
Kahn R.L. & Antonucci T.C. (1980) Convoys over the life course:
attachment, roles, and social support. In Life-span Development
and Behavior, Vol. 3. (Baltes P.B. & Brim O.G., eds), Academic
Press, New York, NY, pp. 253–286.
Kemp V.H. & Page C.K. (1987) Maternal prenatal attachment in
normal and high-risk pregnancies. Journal of Obstetric, Gyneco-
logic, and Neonatal Nursing 16, 179–184.
Knudtson F.W. (1976) Life-span attachment: complexities, questions,
considerations. Human Development 19, 182–196.
Kobak R.R. & Duemmler S. (1994) Attachment and conversation:
toward a discourse analysis of adolescent and adult security. In
Attachment Processes in Adulthood (Bartholomew K. & Perlman
D., eds), Jessica Kingsley, London, pp. 121–149.
Koniak-Griffin D. (1988) The relationship between social support,
self-esteem and maternal attachment behavior in adolescents.
Research in Nursing and Health 2, 269–278.
Lipson-Parra H. (1990) Development and validation of the adult
attachment scale: assessing attachment in elderly adults. Issues in
Mental Health Nursing 11(1), 79–92.
Lorenz K.Z. (1935) Der Kumpan in der umvelt des vogels. F. Orn.
Berl., 83. English translation. In Instinctive Behavior (Schiller
C.H., ed.), International Universities Press, New York, NY.
1957.
Mercer R.T., May K.A., Ferketich S., DeJoseph J. & Sollid D. (1988)
Further exploration of maternal fetal attachment. Research in
Nursing & Health 11, 83–95.
Morse J.M., Hupcey J.E. & Lenz E.R. (1996) Concept analysis in
nursing research: a critical appraisal. Scholarly Inquiry for Nursing
Practice: An International Journal 10(3), 253–277.
Morse J.M., Hupcey J.E. & Lenz E.R. (1997) Choosing a strategy for
concept analysis in nursing research: Moving beyond Wilson. In
Clarifying Concepts in Nursing Research (Gift A. ed.). Springer,
New York, NY.
Parkes C.M. & Stevenson-Hinde J. (eds), (1982) The Place of
Attachment in Human Behavior. Basic Books, New York, NY.
Paterson R.J. & Moran G. (1988) Attachment theory, personality
development, and psychotherapy. Clinical Psychology Review 8,
611–636.
Phillips L.R. F. (1990) The elderly, the nurse, and the challenge. In
Nursing Care in an Aging Society (Corr D.M. & Corr C.A., eds),
Springer Publishing Company, New York, NY, pp. 3–21.
Rajecki D.W., Lamb M.E. & Obmascher P. (1978) Toward a general
theory of infantile attachment: a comparative review of aspects of
the social bond. The Behavioral and Brain Sciences 3, 417–436.
Reed P.G. (1983) Implications of the life-span developmental
framework for well-being in adulthood and aging. Advances in
Nursing Science 6(1), 18–25.
Rholes W.S., Simpson J.A. & Stevens J.G. (1998) Attachment
orientations, social support, and conflict resolution in close
relationships. In Attachment Theory and Close Relationships

2005 Blackwell Publishing Ltd, Journal of Advanced Nursing, 50(5), 528–535
Attachment in older adulthood
(Simpson J.A. & Rholes W.S., eds), Guilford Press, New York,
NY, pp. 166–188.
Rodgers B.L. & Knafl K.A. (eds), (2000) Concept Development
in Nursing: Foundations, Techniques, and Applications. W.B.
Saunders, Philadelphia, PA.
Rutter M. (1978) Attachment: its meaning and consequences. The
Behavioral and Brain Sciences 3, 455–456.
Schwartz-Barcott D. & Kim H.S. (2000) An expansion and
elaboration of the hybrid model of concept development. In
Concept Development in Nursing, 2nd edn. (Rodgers B.L. & Knafl
K.A. eds), W.B. Saunders, Philadelphia, PA, pp. 129–159.
Shaver P.R., Hazen C. & Bradshaw D. (1988) Love as attachment:
the integration of three behavioral systems. In The Psychology
of Love (Sternberg R. & Barnes M. eds), Yale University Press,
New Haven, CT, pp. 68–99.
Snow R. & Crapo L. (1982) Emotional bondedness, subjective
well-being, and health in elderly medical patients. Journal of
Gerontology 37(5), 609–615.
Stephen T.D. (1984) Symbolic interdependence and post-break-up
distress: a reformulation of the concept of the attachment con-
struct. Journal of Divorce 8(1), 1–16.
Troll L.E. & Smith J. (1976) Attachment through the life-span: some
questions about dyadic bonds among adults. Human Development
19, 156–170.
Walker L.O. & Avant K.C. (1995) Strategies for Theory Construc-
tion in Nursing 3rd edn. Appleton & Lange, Norwalk, Conn.
Weiss R.S. (1982) Attachment in adult life. In The Place of Attach-
ment in Human Behavior (Parkes C.M. & Stevenson-Hinde J.,
eds), Basic Books, New York, NY, pp. 171–184.
Weiss R.S. (1986) Continuities and transformations in social rela-
tionships from childhood to adulthood. In Relationships and
Development (Hartup W. & Rubin Z. eds), Erlbaum, Hillsdale,
NJ, pp. 95–110.
Weiss R.S. (1991) The attachment bond in childhood and adulthood.
In Attachment Across the Life Cycle (Parkes C.M., Stevenson–
Hinde J. & Marris P. eds), Routledge, London, UK, pp. 66–76.
Werner H. (1957) The concept of development from a comparative
and organismic point of view. In The Concept of Development
(Harris D.B., ed.), University of Minnesota Press, Minneapolis,
MN, pp. 125–148.
West M., Sheldon A. & Reiffer L. (1987) An approach to the
delineation of adult attachment: scale development and reliability.
The Journal of Nervous and Mental Disease 175(12), 738–741.
Wilson J. (1969) Thinking with Concepts. Cambridge University
Press, New York, NY.
Wright L.K., Hickey J.V., Buckwalter K.C. & Clipp E.C. (1995)
Human development in the context of aging and chronic illness:
the role of attachment in Alzheimer’s disease and stroke.
International Journal of Aging and Human Development 41(2),
133–150.
535