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ABANDONMENT FEARS IN PERSONS WITH ALZHEIMER’S DISEASE AT ADULT DAY CARE CENTERS Wayne Judkins Thesis submitted to the faculty of Virginia Polytechnic Institute and State University in partial fulfillment of the requirements for the degree of Master of Science in Family and Child Development Karen A. Roberto, Chair Mark Benson Rosemary Blieszner May 12, 1999 Blacksburg, Virginia Keywords: Adult day care, Alzheimer’s, abandonment Abandonment Fears in Persons with Alzheimer’s Disease at Adult Day Care Centers Wayne A. Judkins (Abstract) In my research, I examined abandonment fears in persons with Alzheimer’s disease at the Salem Veterans Affairs adult day care center. I observed fifty hours at the center, and conducted openended interviews with two of the participants and their respective caregivers. These two participants (Ellen and Opel) at the center expressed abandonment fears much more frequently than any of the other participants. I found that most of the time, these two women would express their abandonment fears in the form of repetitive questions about going home. Staff used two different methods to deal with the problem: “reassurance by fact” and redirection. The staff was divided as to the efficacy of their methods and whether more frequent attendance would help Ellen and Opel to adjust to the center. Some participants were bothered by the their constant questions, while others were not. Using an existing attachment questionnaire, Ellen’s daughter classified her mother as having an avoidant attachment style, but Opel’s daughter classified her mother as having secure attachment. Although Ellen’s behavior at the center fit with the description of a person with avoidant attachment (e.g., extreme self-reliance, activity disturbance), Opel’s fearful nature did not suggest that she had a secure attachment style as her daughter believed. Acknowledgments I would like to thank several persons without whose help this thesis could not have been completed. First, I would like to thank the staff at the Salem VA Adult Care Center. The staff allowed me into their world with no reservations, and their interviews added a crucial piece to my data. Second, I would like to thank my committee members, Mark Benson, Rosemary Blieszner, and Karen Roberto. Dr. Roberto in particular has been invaluable in shaping my research, reading and revising countless drafts. Thanks also to my committee for agreeing to read the thesis in a shorter time than is custom. Last, I would like to thank Dr. Katherine Allen. Although I did not consult Katherine often on this project, I took much from her Qualitative Methods class and applied it to my research. Her encouragement and empowering nature came as a much needed boost to my concept of myself as a graduate student capable of good research. iii Table of Contents Chapter One Introduction 1 Purpose of Research 1 Overview of Alzheimer’s Disease 2 Adult Day Care Centers for Persons with Alzheimer’s Disease 4 Personal experience and Interest in Abandonment Fears 5 Chapter II: Abandonment Fears 6 Dementia and Attachment 6 The Staff Experience in Adult Day Care 8 Caregiver Stress and Alzheimer’s Disease 9 Significance of Existing Research in Relation to Current Study 9 Summary 10 Chapter III 11 :Setting 11 Pilot Work/Participant Selection 12 Rationale for Methodology 13 Observation 13 Staff Interviews 15 Caregiver Interview 15 Data Analysis 16 Chapter IV: Results and Discussion 17 Abandonment Fears 17 Staff Members’ Perceptions of Abandonment Fears 31 Attachment Theory and Caregiver Insights 34 Chapter Five: Conclusions/Implications 38 Impact of Abandonment Fears 38 Staff Methods for Dealing with Abandonment Fears 39 Limitations of Current Study 40 Implications for Future Research/Practitioners 41 iv References 43 Appendix A 46 Appendix B 47 Appendix C 48 VITA 49 v