Happy New Year!

I hope you all enjoyed the Holiday Season.

A new year gives an opportunity for a new look, so I hope you like our newly designed newsletter.

With the New Year upon us, I think of all the clutter in my home from the holiday gifts and parties and it reminds me of the cleaning and organizing that needs to be done. But for some people, a cluttered home is the norm.

Do you have patients or clients that have a hard time throwing things away? I've worked with people that save magazines, newspapers, old clothes, trinkets, and other 'treasures'... because they "might need them one day." Nobody wants to throw things out that have value, but when piles accumulate in the house and it becomes difficult to find anything or move around, this indicates a larger issue.

People often keep things for sentimental reasons. As we age, the items we gather mean more than just the object alone. They represent memories, travels, friends, or love. We may hold on to our child's amazing "works of art" or newspapers from decades past to relive certain moments in time. But when does it become a concern? And when or should this behavior be considered "hoarding?"

We delve more into this issue with Dr. Alexis Freedberg, a psychiatrist at CHA. Here's what she had to say about hoarding and how this is a growing problem among older adults. 

Can't let go

Alexis Freedberg, MD

CHA Psychiatrist

Instructor in Psychiatry, Harvard Medical School

How is hoarding defined?

Hoarding is the excessive acquisition of belongings, often things that don't seem necessary or meaningful to others. The person who hoards has difficulty getting rid of belongings, to the point that he or she cannot use spaces for their original intent. This, in turn, can impact physical and mental health, relationships and even physical safety.  For example, an older woman's home may have accumulated so many books and newspapers that she is unable to use her walker and is falling more frequently.

How common is hoarding, and what do people hoard?

Hoarding probably occurs in 2-5% of the population. It may begin earlier in life, but often becomes problematic as people get older and develop more cognitive and physical limitations. People often save possessions for sentimental reasons, most often hoarding newspapers, paper, containers, clothing, food, books, trash, and even animals.

What problem does hoarding present for older adults who hoard, and to their communities?

For the person who hoards, social isolation is very common, and can increase over time. This can contribute to depression, cognitive decline, and poor health outcomes in general. Extreme clutter may impede access to furniture and entryways, and may make it more difficult for home-based services (personal and health aides, meal delivery, etc.) to enter the home. We have seen sanitation issues, like food spoilage, plumbing issues, and infestations. Fire hazards and trip hazards may increase, and it may be more difficult for emergency personnel to enter. Older adults may be more vulnerable to respiratory problems (from mold, dust, and other allergens), misplaced or disorganized medications, and tripping hazards.

Are there effective treatments for hoarding behaviors in older adults?

Though not yet widely available, cognitive-behavioral therapy specific to older adults who hoard has been shown to be effective. Given the high comorbidity between hoarding and other physical and mental health issues, it is important for providers to conduct a thorough assessment of an older adult's level of functioning, and a careful screening for depression, anxiety, and dementia. Treatment of comorbid diagnosis can sometimes alleviate some problems associated with hoarding.

If I suspect my older patient is suffering from hoarding disorder, what can I do?

Unless there is a clear and acute safety issue, don't panic! Often people who hoard experience considerable shame, social stigma, and fear of discovery. The best approach is one that prioritizes the patient's own goals and preserves autonomy and dignity.

Maybe a patient can agree, for example, that he would prefer to have a usable bathtub or that he would like to have family over to visit without getting criticized. As with any other behavioral change such as weight loss or smoking cessation, a motivational interviewing approach has the greatest chance of success. Using normalizing words like "packrat" or "clutter" may be less stigmatizing than "hoarding."  Also, keep in mind that "harm reduction" and not necessarily "stuff reduction" should be the ultimate goal. The safety, health and wellbeing of older adults can temporarily improve with help rearranging and sorting and not discarding.

What resources are available?

Many cities and towns in Massachusetts, including Cambridge and Somerville, have a Hoarding Task Force. A great place to get more information about local resources is www.masshousing.com, which lists individuals, organizations, and groups that specifically address hoarding and offer resources and advice on what to do about hoarding and the kind of help they need.

HouseWorks, a home care industry leader, is another resource for hoarding in adults. Bob Severino, Director of Home Modification at HouseWorks specializes in working with older adults who hoard and his team can assist in clearing/cleaning out their homes. For more information, call 617-928-1010.

Lastly, if the family is interested in staging an intervention to help the hoarder, information is available through the Anxiety and Depression Association of America at: http://www.adaa.org/understanding-anxiety/obsessive-compulsive-disorder-ocd/hoarding-basics/staging-intervention