Safe Enough to Grow Old: ReAttach as a Transdiagnostic, Salutogenic Intervention in Psychogeriatric Care

Samenvatting

Background: Mental health problems in later life rarely fit into clean diagnostic categories. Depression, anxiety, cognitive decline, loneliness, functional symptoms, and the late effects of early adversity often occur together, while pharmacological options are limited by the vulnerability of older adults to adverse effects. Many established psychotherapies assume intact reflective capacity, working memory, and cognitive flexibility, which are often compromised in this population.

Objective: To develop a theoretical framework for ReAttach approach, a brief, multisensory, bottom-up intervention, as a transdiagnostic and salutogenic approach in psychogeriatric care, including the application of the Safety Override Technique (SOT) in dementia care.

Method: Narrative theoretical synthesis integrating literature on late-life mental health, cognitive aging and cognitive flexibility, cognitive dissonance, attachment in dementia, autonomic regulation, and recent practice-based ReAttach research.

Conclusion: ReAttach may address late-life dysregulation at three levels: physiological (lowering arousal to protect the frontal resources the aging brain relies on for compensation), sensory-integrative (offering multiple sensory routes and building cognitive reserve), and social-cognitive (restoring flexible self–other switching and strengthening adaptive schemas anchored in secure experience). In dementia, SOT delivered face-to-face by trained nurses and care assistants may offer a structured, relational way of meeting the basic need for safety. Empirical testing in psychogeriatric settings is needed.