Hoarding is not usually one of the issues caregivers often think about when dealing with the elderly. Yet hoarding poses significant risks to the elderly as well as to the community, and it may very well impede the work of the caregiver unnecessarily.
Hoarding is defined as the keeping of possessions that do not pose a use or benefit to the person and that interfere with daily living. Studies, such as one reported in the International Journal of Geriatric Psychiatry, have found that compulsive hoarding is not something that begins during the elderly years; it is something that starts early on in life and simply progresses with each decade that a person ages. This is why by the time hoarders are in their elderly years, the hoarding may be severe and even compulsive, yet the hoarding tendencies have been there all along.
Health Risks of Hoarding
Hoarding can put the health of the elderly as well as their neighbors and relatives at risk. The presence of a plethora of items can pose the risk of physical injuries as well as serious health conditions, including:
These risks are also abundant for visitors and neighbors, especially if mold, bacterial growth, or animal fecal matter are present. In addition, serious house fires can spread as a result of hoarding, which put the neighbor's homes at risk as well.
According to a study published in Health and Social Work, most hoarders are women. However, authors Steketkee, Frost, and Kim note that since women outlive men and thus enter into the higher decades of life in greater numbers, the hoarding behavior just may be more evident among women, not more prevalent. What is more, the authors theorize, women are often more open to participating in studies or discussions, revealing their hoarding tendencies. Therefore, there may be no gender-specific element to hoarding. The researchers did find that never having been married was a definite key characteristic of hoarders. Perhaps hoarders' attachments to things are so strong because of lack of attachment to a partner in life. Although hoarding often accompanies some mental and emotional disorders, like Obsessive Compulsive Disorder, hoarding was not found to correlate with dementia. Hoarders also tended to be unkempt personally themselves, some severely so. Although about 30% of hoarders studied did appear to be personally clean, about 30% of those who were unclean were extremely so, to the point of being filthy and odiferous. Similarly, in about 30% of the hoarders, the neglected home exuded no offensive odors, but in two-thirds of the homes, there was at least some mild to moderate odor, and in one-third of them overpowering stenches of decomposing food, other garbage, and feces were present.
The hoarders frequently had filled their beds, sinks, refrigerators, stoves, bathtubs, showers, and other places with items, and these areas became non-functional for their normal uses. Many hoarders had a hard time getting around their homes or apartments at all, due to the clutter.
Ways to Help a Hoarder
A caregiver who services a hoarder can help in many ways. This will not only aid the hoarder, it will make the caregiver's job easier too, as access to areas and facilities improves. Here are a few ways to cope:
However, caregivers should be prepared for the fact that a hoarder will not necessarily change habits because of a one-time cleaning intervention or even steady interventions. The study by Steketee, Frost, and Kim showed that the results of full and partial decluttering were decidedly mixed; in a complete clear-out of seven hoarders' houses, the results were unclear, as several of the residents relocated to nursing homes, and others either relapsed or showed little change. However, partial cleanings of the homes showed better results: when 29 elderly person's homes were partially cleared out, 17% of them were able to keep their homes more clutter free from then on, either by themselves or with aid. Seven percent improved for a time, then went back to old habits. 21% got worse after the intervention and 38% showed little change; however, they were willing to have their excess items stored rather than kept in their homes. Out of six clients who received ongoing support and encouragement, only one changed for the long term; four remained the same, and one of the outcomes was uncertain.
With such mixed results for cleaning interventions, caregivers may simply have to keep working on keeping a hoarder's home clean and clutter free. Expectations that the hoarder will change with a little assistance must be kept realistic.
It is important to have an elderly person in one's care evaluated for psychological disturbances such as Obsessive Compulsive Disorder that may have been overlooked in the person's childhood and young adulthood. Because the conditions can worsen with every year a person ages, it is important to get to the root of the problem rather than deal with frequent interventions and relapses.
Hoarding is a very serious issue that may affect the health and even the life of a senior. A medical/psychological intervention could save time in the long run; however, home cleaning services and even the local Board of Health can intervene on a physical basis to make sure a hoarding elderly person's environment is safe for him or her and also for others in the neighborhood.
Ayers, C. R., Saxena, S., Golshan, S., Wetherell, J. L. (June 22, 2009). Age at onset and clinical features of late life compulsive hoarding. International Journal of Geriatric Psychiatry, 25(2). Abstract. Retrieved from http://onlinelibrary.wiley.com/doi/10.1002/gps.2310/abstract. Accessed on August 22, 2016.
Mass.gov. Risks Caused by Hoarding. The Official Website of the Executive Office of Health and Human Services (EOHHS).
Chuang Ti Di Duan
Retrieved from http://www.mass.gov/eohhs/consumer/behavioral-health/hoarding/risks-caused-by-hoarding.html. Accessed on August 22, 2016.
Steketee, G., Frost, R. O., Kim, H-J. (8/1/2001). Hoarding by Elderly People. Health and Social Work, 26(30). National Association of Social Workers. Retrieved from http://www.biomedsearch.com/article/Hoarding-by-elderly-people/78400913.html. Accessed on August 22, 2016.