Do you know what hoarding looks like?
You have probably seen articles in newspapers about hoarding of possessions and/or animals in a living space. There are also television shows about hoarding, showing rooms piled high with everything from newspapers to dirty dishes, to food, to trash bags to newly purchased items still in original containers.
Often the person living in this unsafe and dangerous environment cannot accomplish the daily functions of living because of the excessive clutter; even sleeping in the bed or taking a bath is impossible. I recently saw a photo of a man who was sleeping on the floor in a hallway of his home because there was no other space or surface on which he could sleep.
This article is intended to increase the reader's knowledge and awareness of hoarding behaviors in older adults. In order to meet that objective, I am relying heavily on information presented by Barbara A. Soniat, MSW, Ph.D., and her co-author, Monica Melady Micklos, MSW, in their book, "Empowering Social Workers for Practice with Vulnerable Older Adults," particularly the chapter in the book titled "Working with Older People Who Hoard."
A resident of Columbia, Barbara Soniat joined the faculty of the National Catholic School of Social Service in 2005. She is an associate professor and director of the NCSSS Center on Global Aging at The Catholic University of America.
Prior to joining NCSSS, Soniat served on the faculties of The George Washington University Medical Center and Howard University School of Social Work. She has worked for more than 30 years in the fields of social work and gerontology. She is a licensed clinical social worker in Maryland and the District of Columbia, and is board certified as a Diplomat in Clinical Social Work.
As the principal investigator for a law/social work research team, she and other professionals studied legal, ethical and mental-health issues related to community interventions with elderly persons who struggle with hoarding behaviors.
In "Empowering Social Workers for Practice with Vulnerable Older Adults," hoarding is described as "a multifaceted problem that involves difficulty with information processing, difficulty with emotional attachments, erroneous beliefs about possessions and behavioral avoidance." Hoarding is characterized by "the acquisition of, and failure to discard, a large number of possessions that appear to be useless or of limited value; living spaces sufficiently cluttered so as to preclude activities for which those spaces were designed; and significant distress or impairment in function resulting from the hoarding" (Frost & Hartl, 1996).
Documentation on problems relating to compulsive hoarding did not begin until the late 1940s, and it has only been in the last 12 years or so that studies of hoarding behaviors in older adults have been published in professional literature.
Compulsive hoarding might not be only a mental-health problem; it can also become a housing, legal and public health issue. Often, community social workers, who work with older adults, may need to get involved in some very complex cases. The social worker must balance the rights and interests of the older adult client with the rights of neighbors and communities, when pursuing interventions to protect a vulnerable client from dangerous and unsafe conditions.
Mental disorders and hoarding behaviors do not always coexist.
The link between hoarding behavior and obsessive-compulsive disorder is not as strong as it was once considered. "Only 17 percent of individuals who have problems with hoarding behaviors are diagnosed with OCD. (Tobin, 2007)" One study reported that 22 percent of clients who had problems with hoarding behaviors had no other mental-health disorder, and the majority of clients (76 percent) had no problems with cognitive functioning or deficits in memory (67 percent). "In addition to OCD, hoarding behaviors have been observed in patients with dementia, schizophrenia, major depressive disorder, generalized anxiety disorder and social phobias."
It is important to know the demographics of compulsive hoarding behaviors.
Hoarding behavior can occur at any age. Elderly hoarders are more likely to come to the attention of social workers and public health authorities.
Hoarding cuts across social-economic status. There is no data regarding racial, gender or cultural differences in relation to hoarding.
Renters may be more "at risk" for involuntary interventions than homeowners. For example, a homeowner does not have to allow anyone inside the home; whereas, a renter sometimes needs work done. A maintenance worker or repairman who enters an apartment might notice hoarding conditions and report the renter to the landlord or another authority.
The Boston University Hoarding Study and the Hartford Hospital Anxiety Disorder Clinic are testing approaches to treatment, using modified cognitive-behavioral therapy. This approach consists of "26 individual therapy sessions, frequent home visits by clinicians to teach skills in organizing and managing clutter, a room-to-room approach to de-cluttering, clinician monitoring of progress in the home, homework exercises, exposure to stimuli that may cause fear and anxiety, and help for clients to recognize errors in thinking." This modified CBT approach has resulted in "significant reductions in severity of clutter, difficulty discarding and acquisition."
Individuals who identify themselves as having a problem with hoarding often volunteer for research studies on compulsive hoarding. It is, in large part, because of these volunteers that there are published research studies on the subject. In most cases of excessive hoarding individuals refer people with this behavior to adult protective service agencies, hoarding task forces, community social workers, home care workers and court systems.
Insight and motivation are keys to most psychotherapy interventions with the hoarder. Some adult hoarders recognize their problem, and seek diagnosis and treatment. Others recognize their hoarding behavior as a problem but do not seek help, lack the insight to recognize their behavior and cluttered conditions as a problem or recognize their behavior and condition as a problem but lack the motivation to do something about it.
Professionals often need to intervene to work with clients who lack insight and motivation.
Private industries have emerged around hoarding issues — such as professional organizers, de-cluttering specialists, heavy-duty cleaning services and move managers. All of these services can help with the environmental conditions resulting from hoarding behaviors.
There are also volunteer services, such as the Elder Buddies Program, a part of AARP's Legal Counsel for the Elderly's Alternatives to Landlord/Tenant for the Elderly Project. Started in 1999 and based inWashington, D.C., Elder Buddies, an intergenerational volunteer program, addresses the needs of older people and people with disabilities who are at risk of eviction, some of whom have hoarding problems.
In an email to me, Barbara Soniat wrote, "Hoarding conditions vary in their level of severity. With the exception of animal hoarding cases and extreme hoarding conditions — usually of long-term duration — that create serious environmental hazards, the best outcomes result from engaging the older person in an authentic, supportive, person-centered relationship, through which a professional allows time to understand the problem from the individual's perspective and works with the individual to establish and implement de-cluttering goals and plans. We now know enough about the problems associated with hoarding behaviors to begin to develop preventive practice models that help older persons to recognize that their behavior and living conditions are problematic and that problem solving strategies are available to effectively avoid crisis situations and involuntary interventions."
As a caregiver, friend, relative or neighbor, please seek professional help for an older adult who exhibits hoarding behaviors.
If you recognize these types of hoarding behaviors in yourself and you are under distress because of your living conditions, please seek professional help.
You are probably overwhelmed by your situation, but there is no reason to feel ashamed. There are reasons for your behavior that, hopefully, can be reversed and overcome with professional help. Don't put yourself at risk for falls and fire because of unsafe, cluttered conditions in your home.