More people will care for an aging parent in the coming years than ever before. Advances in modern medicine have extended life expectancy and the relationship between the aging and their caregivers, whether they are family members or not, is of critical importance. “Arguably, at no time is understanding care-seekers’ wishes more important than when care-seekers are incapacitated, especially when life-or-death decisions about medical interventions are required,” said Bulent Turan of the Department of Psychology at the University of Alabama, Birmingham, and lead author of a recent study. “In this study, we assessed surrogates’ decision makers’ accuracy in predicting their older relatives’ end-of-life health care wishes—whether they would choose intensive and painful life-sustaining procedures or would refuse those treatments in order to maximize the quality of their remaining life.”
Surrogates often base their decisions for life-sustaining or life-ending means on what they would choose for themselves. Another theory is that caregivers’ decisions for their loved ones are based on the attachment style that they possess. “A secure attachment orientation is characterized by comfort in support exchanges in relationships and by regarding the self as competent in dealing with stress,” said Turan. “There are two insecure attachment orientations: Attachment-related anxiety is characterized by chronic worries about relationship partners’ availability, and attachment-related avoidance is characterized by keeping emotional distance from close others.”
Turan interviewed caregivers and their family members and found that insecure attachment styles led to the wrong prediction of a patient’s final wishes. “It is interesting to note that even though surrogates’ attachment-related anxiety was associated with lower accuracy of end-of-life health care wishes of their loved ones, it was associated with higher accuracy in the non-stressful task of predicting their loved ones’ everyday living conditions,” said Turan. “Our findings have implications for interventions aimed at increasing surrogates’ accuracy and the quality of their caregiving. Changing surrogates’ attachment orientation may not be easy.” He added, “However, interventions can (a) focus on detecting surrogates’ emotional reactions and coping strategies when faced with the stressful possibility of making end-of-life decisions for loved ones (being overwhelmed or emotionally avoiding the topic) and (b) target the limiting emotion regulation strategies associated with insecure attachment orientations.”
Turan, Bulent, Mary K. Goldstein, Alan M. Garber, and Laura L. Carstensen. “Knowing Loved Ones’ End-of-life Health Care Wishes: Attachment Security Predicts Caregivers’ Accuracy.” Health Psychology 30.6 (2011): 814-18. Print.
© Copyright 2011 by By Noah Rubinstein, LMFT, LMHC, therapist in Olympia, Washington. All Rights Reserved. Permission to publish granted to GoodTherapy.org.
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