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The Complexities of Hoarding Among Older Adults

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Understanding Hoarding & What You Can Do To Help

When I was enlisted to help a successful yet overwhelmed elderly woman transition to senior living, I was unprepared for the extent of her hoarding issues. Prior to our meeting, my knowledge of her was limited: her home was worth $1.5 million, and her professional achievements contrasted starkly with her personal life, which was burdened by both physical and mental clutter. The depth of her challenges required a consortium of experts familiar with the psychological complexities involved. Through time, patience, and persistent support, she is now flourishing in her new environment.

Hoarding is certainly not a new phenomenon, affecting approximately 2-5% of today’s adult population. It was only in 2013 that the Disorder was classified as a distinct mental disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-V, 2013). Hoarding Disorder is assigned to individuals who excessively save items and have great difficulty parting with these items, so much so that it may impair functioning and create health and safety risks. 

The Realities of Hoarding

People with HD often manage to conceal their living conditions for years, with the disorder usually taking root early in their lives. Effective intervention goes beyond mere clean-ups, which can aggravate the situation by ignoring underlying issues. Instead, a comprehensive, multidisciplinary approach is essential, particularly one that includes mental health support.

Identifying and Assisting Hoarders

Observations can range from an unkempt personal appearance to an untidy home. Behaviors include avoidance of home visits and a decline in social interactions, which often indicate deeper issues. Physical risks involve mobility restrictions due to clutter and the presence of unaddressed health issues like untreated injuries or poorly managed medications.

  • PHYSICAL APPEARANCE OF PERSON OR HOME – Do you notice a body odor or unkept clothing/hair? Or, do you visit the home and notice from the outside that it seems unmaintained?
  • BEHAVIORS – When you ask to visit the individual’s home or refer to services, are you consistently turned away or told they are not in need of assistance? Take notice of habits outside the home (i.e. visiting the Senior Center for many meals or use of bathroom for personal care).
  • CHANGE IN SOCIALIZATION – Look for changes in the engagement of the individual (someone who was once social is now self-isolating).
  • TAKE THE TIME – Since the common denominator in many cases is a lack of personal relationships, trust is going to need to be built over time with the person in order for them to let you in to help them both physically and emotionally.
  • PHYSICAL DANGER – Look for increased risk of falls or inability to move around due to extreme clutter. Keep note of a lack of durable medical equipment (DME). 
  • REFUSING HELP – Observe resistance to allowing anyone visit their home, whether family, professionals, or services like VNAs, Meals on Wheels or Elder Services.
  • HEALTH – Signs of injury such as lacerations, bruising, skin conditions, scalp/hair condition, overall weakness and cognitive decline are all signs of deteriorating health.
  • MEDICATIONS  How are they being stored, organized, consumed and managed? Notice the potency of medications being taken. 
  • INFLUENCERS – Ask if there are other key influencers in this person’s life such as providers, friends, community support, church members, family or other professionals you can connect with to learn more about this individual’s baseline behavior and hear of any recent changes in personality or health. 

Common Characteristics of Hoarding Disorder:

  • Over-generalizing
  • All-or-nothing thinking
  • Emotional reasoning vs. logic
  • Perfectionism
  • Avoidance 
  • Indecisiveness 
  • Exaggeration
  • Procrastination
  • Jumping to conclusions
  • Moral reasoning

Effective Treatment Approaches

  1. Motivational Interviewing: This therapeutic approach aims to align intervention with the individual's values, fostering internal motivation for change without confrontation.

  2. Cognitive Behavioral Therapy (CBT): CBT targets the dysfunctional emotions and behaviors typical of HD, with strategies that include:

    • Decluttering during home visits.

    • Promoting social interactions to reduce isolation.

    • Sustaining motivation for change through family or group therapy.

    • Ongoing engagement to maintain progress.

How to move forward

Supporting someone with HD or working with the elderly requires an understanding of the disorder's complexity. By integrating strategies like Motivational Interviewing and CBT, and fostering a community-based support network, significant improvements can be made in the lives of those affected by Hoarding Disorder.

Hoarding Disorder is a complicated diagnosis with the need for ongoing clinical support. If you know someone suffering from HD and want additional information, please contact us today.

Feel like you need additional guidance or individualized support?

Our team of Certified Senior Advisors® and Certified Dementia Practitioners® has successfully assisted hundreds of families. We offer a single point of contact for all services you or your loved one might need when transitioning from longtime homes. We ensure a stress-free move that allows you to focus on the transition rather than the logistics.

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