Mediators of attachment, frailty, and mild cognitive impairment in older adults

Poor social relations of older adults have been linked to cognitive decline, dementia risk, morbidity, and mortality. We investigated how characteristic ways people relate to romantic partners (adult attachment) might function as risk/protective factors for overall health or dementia risk. Specifically, we evaluated whether attachment anxiety and/or attachment avoidance at midlife predicted cumulative deficit frailty (CDF) and mild cognitive impairment (MCI) in early old age.

Participants were 1,608 men in the Vietnam Era Twin Study of Aging. Participants' attachment was assessed at a mean age of 56 (starting 2003) and health mediators at a mean age of 62 (2009-2014; e.g., perceived stress, doctor visits, smoking, alcohol consumption, and social isolation). Outcomes at a mean age of 68 (2016-2019) included CDF based on a 37-item scale and MCI. Structural equation modeling assessed associations between attachment, mediators, and outcomes.

The effect of attachment anxiety on CDF was indirect, mediated by perceived stress, doctor visits, and smoking at age 62 (total indirect effect: β = .147, p < .001). Its effect on MCI was also indirect, mediated by its association with perceived stress (total indirect effect (β = .090, p = .001). Attachment avoidance did not predict CDF, but it directly predicted MCI (β = .134, p = .033).

Attachment anxiety and attachment avoidance predict frailty and cognitive function through different pathways in older adults. Viewing others as trustworthy and dependable in midlife may be protective against frailty and dementia risk in old age. Focusing on improving the quality of interpersonal relationships may thus help to reduce risk. (PsycInfo Database Record (c) 2026 APA, all rights reserved).