Hoarding by Elderly People

Article excerpt

Although hoarding has been studied in adults, little is known about problems of hoarding by elderly people. This study used a structured telephone interview with elder services providers to investigate hoarding behaviors in relation to functional impairment, cognitive deficits, and physical and psychological conditions in 62 elderly clients. Most elderly hoarders were female, unmarried, and lived alone. Extensive clutter was associated with significant impairment, interfering with basic hygiene, and posing a serious physical threat for many elderly clients. Clients were rarely insightful about their collecting and often resisted change, rendering interventions generally ineffective. Never-married status was associated with more severe hoarding and greater impairment and possibly with worse outcomes of intervention efforts. Health and mental health implications of hoarding by elderly people and implications for treatment are discussed.

Key words

clutter

collecting

elderly

people

hoarding

obsessive-compulsive disorder

In recent years compulsive hoarding has gained increased public and research attention because of frequent and detailed media coverage of hoarding cases involving tragic circumstances (Frost, Steketee, & Williams, in press) Hoarding is a debilitating disorder characterized by the acquisition of a large volume of possessions that clutter living areas to such a degree that living spaces cannot be used for their intended purpose (Frost et al., in press; Frost & Hartl 1996). In addition, the disorder causes impairment in normal life functioning and often affects others in the environment (Frost, Steketee, Youngren, & Mallya, 1999; Frost et al., in press) Hoarding often is associated with significant distress, but the lack of insight in many people who hoard often prevents their seeking treatment until family or others insist (Frost & Steketee 1998). A cognitive-behavioral model of hoarding that suggests problems in acquisition, discarding, organization, and beliefs about possessions has been partly supported by e mpirical studies of student, community, and clinical samples (Frost & Steketee).

Hoarding symptoms occur in nearly one-third of obsessive-compulsive patients (Frost, Krause, & Steketee, 1996). However, virtually no formal epidemiological studies have systematically examined the prevalence rate of this problem outside of the context of obsessive-compulsive disorder (OCD). A survey of local health departments to study the frequency and characteristics of compulsive hoarding complaints in Massachusetts found that 26 cases of compulsive hoarding per 1,000 population were reported to authorities in a five-year period (Frost et al., in press). Undoubtedly, this is a low estimate because hoarding referred to public health enforcers likely represents only very severe cases.

Although empirical literature regarding compulsive hoarding in student, subclinical, and clinical adult populations is growing, only case reports and commentary have been published about this problem in the elderly population (Hogstel 1993; Thomas, 1997). The paucity of information, however should not be taken to imply that hoarding rarely occurs in this age group. In fact, a recent study showed that more than 40 percent of hoarding complaints to the local health departments involved elder services agencies (Frost et al., in press). Similarly, other studies have consistently found that hoarding individuals were significantly older than nonhoarding individuals (Frost et al., 1999; Frost et al., 1998), possibly because hoarding problems increase in severity with age.

Hoarding symptoms in older adults have been studied mainly in the context of Diogenes' syndrome, which is characterized by gross self-neglect, domestic squalor, and hoarding of trash; it occurs annually in 0.5 of 1,000 cases in people over age 60 (Clark, Mankikar, & Gray, 1975; Drummond, Turner, & Reid, 1997). …