Research has indicated that hoarding, a relatively common disorder among the elderly, gets progressively worse as a person gets older. A study conducted by researchers at Johns Hopkins University School of Medicine found that the overall prevalence of hoarding behavior is around four percent, but this number increases to 6.2 percent for those age 55 and older.
Dealing with an elder’s hoarding is not something that many family caregivers anticipate. Extreme clutter and unsafe and unsanitary conditions hinder common senior goals like remaining independent and aging in place. Achieving a better understanding of why hoarders hoard and learning productive steps you can take to address this behavior will help you minimize hazards in your loved one’s home.
Why Does Hoarding Get Worse With Age?
As we age, many people face a dramatic decline in the quality and frequency of their social interactions. This often leaves seniors feeling lonely and separated from the outside world. Consequently, they may begin to engage in behaviors that seem to help them cope with isolation and depression. In some cases, these behaviors revolve around the accumulation of “things”—everything from clothes and knickknacks to food and even living, breathing animals.
Researchers at the University of California, San Francisco (UCSF) conducted a study that found a whopping 13 percent of older adults experiencing late life depression report severe compulsive hoarding. Hoarding and depression are similar in that they are what the researchers at UCSF refer to as “frontally mediated.” This essentially means that both disorders impact the frontal lobes of the brain. This area of the brain is responsible for skills and behaviors like organizing and arranging. People with hoarding disorder are also likely to experience other mental health conditions, such as depression, anxiety, personality disorders like obsessive-compulsive disorder (OCD), alcohol dependence and attention deficit hyperactivity disorder (ADHD).
It is unclear whether hoarding habits worsen with age or if an individual’s ability to cope with hoarding habits worsens, but there is no question that the disorder has a greater impact on older adults.
The Dangers of Hoarding Behavior in the Elderly
Out of control collecting creates hazards for hoarders of all ages, but seniors are particularly vulnerable. For example, age-related mobility issues compound the dangers of hoarding. Together, hoarding and limited mobility dramatically increase an elder’s risk of falling and fall-related injuries. When conducting a home safety assessment for an older adult, one of the first recommendations is to inspect walking paths and hallways throughout the house and remove all clutter to prevent falls.
“In particular, late life hoarding poses a significant fall risk by creating trip-and-fall hazards throughout the home,” explains Catherine Ayers, Ph.D., ABPP, division director of the VA San Diego Healthcare System (VASDHS) La Jolla Mental Health Outpatient Clinics, assistant professor in the University of California San Diego (UCSD) Department of Psychiatry, and faculty member in the SDSU/UCSD Joint Doctoral Program in Clinical Psychology. “Other risks include fire hazards, poor hygiene and nutrition, and poor sanitary conditions.”
Ultimately, a hoarder's household can become a hazardous environment very quickly. Not only does this jeopardize a senior’s health, safety and independence, but it also prevents them from getting the assistance they may need to age in place. Family caregivers and professional caregivers from in-home care agencies can’t provide adequate support to elders who live in cramped, unsafe and unsanitary homes. Older adults who hoard are often the targets of adult protective services (APS) investigations because of the dangers their hoards present to themselves and others.
How to Treat Hoarding in the Elderly
The Hoarding Research Team at the Boston University School of Social Work has conducted some illuminating research on the treatment of hoarding through cognitive behavioral therapy (CBT). In one study, a group of seniors between 60 and 90 years of age who were engaging in classic hoarding behavior were assigned to social workers who endeavored to gain their trust and work with them on establishing organizational and decision-making skills. Trust proved to be the crucial factor in effectively treating hoarding behavior. Once an elder established a trusting relationship with their social worker, they were more receptive to proposed behavioral changes.
The trust component is one major reason why a plan to enter an elder’s home and dispose of their hoard is ineffective—at least in the long run. After these kinds of interventions, most people begin hoarding again immediately. Even as a family member or a close friend, you will find that most hoarders respond to this act with hostility and deep mistrust. The social workers in the Boston University study understood this correlation and tried to ensure that the elders felt in control of the cleaning and organization processes. By the end of the study, the elderly hoarders were able to handle alterations to their home environments without experiencing extreme distress.
5 Steps to Help A Senior Who Hoards
Find SupportSupporting an elderly hoarder is a huge undertaking and you will need support of your own. Look to a friend, a therapist or an online support group to deal with the frustrations of tackling this mess. Although you know you are working with your loved one's best interests in mind, you may be treated as the “enemy.” Hoarders become very anxious and are often angered by the thought of parting with or disposing of their collections; you may become the target of that anger. It’s important that you have a safe place to vent and talk through the difficult emotions that can arise throughout this process.
Establish TrustYou may think that your relationship with your loved one is already built on love and trust. After all, your concern for their well-being is why you’re trying to help them clean and organize their home in the first place. However, this trust does not always extend to family and close friends when one’s hoard is at stake. This is especially true if you have “helped” this person in the past by disposing of their possessions without asking permission or heeding their objections. Start slow and be patient. Verbalize your commitment to respecting your loved one’s decisions regarding the cleaning process and demonstrate this in your actions. Underhanded tactics may rid you of some hoarded items, but it will likely damage your relationship and hinder any long-term progress that might have been made.
Seek a Medical EvaluationAlthough hoarding was once classified as part of the diagnostic criteria for obsessive compulsive disorder, it is now recognized as a distinct issue with unknown causation. Many factors may play a role, including personality traits and stressful life events. It is important to rule out dementia, depression and other mental health conditions that may be contributing to their hoarding behaviors.
Set Realistic GoalsA hoarder’s collection often overtakes a substantial amount of their house and may even overflow outside as well. Helping an extreme hoarder clean and organize their home is a herculean task and efforts to take on the whole project will be overwhelming. One AgingCare member who was left with the job of cleaning out her parents’ home lamented in the Caregiver Forum that it took her a year to finish the house and 3 years to sort out the garage! Be sure to set realistic goals that factor in the pace at which your loved one is able to work through their hoard. Breaking the project into small, attainable objectives will keep a hoarder from feeling rushed or pressured and hopefully give them a sense of accomplishment as they are completed.
Celebrate SuccessEven a small milestone like recycling stacks of old newspapers should be celebrated! Once a hoarder sets a comfortable goal and achieves it, they are more likely to realize that the parting process isn’t as distressing as they once thought. Positive reinforcement will build your loved one’s confidence and encourage them to continue strengthening their decision-making and organizing skills. Although it will be a long process, it is possible to help an elderly hoarder reclaim their home and make it a safe and healthy place to live.
Sources: Prevalence and Correlates of Hoarding Behavior in a Community-Based Sample (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2483957/); Cognitive functioning in individuals with severe compulsive hoarding behaviors and late life depression (https://doi.org/10.1002/gps.2531); Hoarding: A Hazard for Older Adults (https://www.todaysgeriatricmedicine.com/archive/JF20p10.shtml); Boston University School of Social Work Hoarding Project (http://www.bu.edu/ssw/research/projects/hoarding/)