We were asked to work with an aged person (let’s call her Doris), who was experiencing difficulties living at home. She had filled her house with so much paraphernalia she couldn’t move. In desperation, she bought a second house! Over time, she also filled this house to capacity with her belongings. She had two houses and could not move in either of them. Doris was in her nineties and was experiencing typical age-associated frailty, including difficulty walking without the aid of a walker. A carer visited her daily to help with bathing, grooming, cleaning, and personal care. But, the care giver was getting increasingly frustrated by the physical environment, which prevented her from giving Doris the best care she could.
Unfortunately, Doris is not the only one. Increasingly, we come into contact with aged people, struggling to let go of things they have accumulated throughout their lives. Over time, we recognise two things: (1) accumulated items are a symptom of hoarding, not a cause; and (2) several typical characteristics are associated with people who experience a problem with hoarding.
People who hoard are obsessive in the way they collect stuff. They have an exaggerated and, sometimes, compulsive need to collect things. We can speculate, sometimes, getting stuff may be associated with a positive mood or a way of improving a person’s mood. The reverse may also be true. If the person cannot obtain the item they feel strongly about, they may feel grief and distress at the lost opportunity.
We also recognise the hoarding condition is associated with the inability to discard possessions, even those that appear to be useless or of limited value. Possessions are associated with a feeling of safety and comfort and may be perceived as an extension of the person. When discarding possessions, hoarders are likely to experience severe anxiety and distress. They are also prone to social isolation, typically, unwilling to seek help and, often, becoming increasingly secretive and distancing themselves from friends or family.
The consequences of hoarding include living spaces that are cramped, full of papers and chaotic piles of stuff. The living area may have narrow pathways, winding through heaps of clutter. Often, parts of the home cannot be used for the activities for which they were designed, such as a stove that can’t be used for cooking, bathrooms that can’t be used for bathing, and beds piled so high with possessions, they can’t be slept in. The cleanliness of the home deteriorates, and the grubbier it gets, the more difficult it is to clean and maintain it. This can lead to pest infestation and a growing risk of fire. Elderly residents find such conditions challenging, as it’s often impossible to use necessary equipment, like walkers or wheelchairs, because there simply isn’t room. There are also disturbing statistics that suggest a direct relationship between hoarding and the incidence of house fires. The excessive accumulation of materials inside the homes of people, who are compulsive hoarders, makes it difficult for firefighters to combat fires and rescue trapped people.
Hoarding behaviour is thought to begin in childhood or adolescence, possibly because of some trauma or grief, but rarely becomes problematic until later in life. It seems to have a greater impact on older people.
Hoarding is often driven by an intense association between the person’s possessions and their identity and occurs in people with a predisposition to anxiety. Losing a possession produces extreme anxiety or a sense of loss and grief. Since ageing can also trigger anxiety, symptoms show as a person ages and anxiety increases.
Sometimes, hoarding is triggered in ageing people, who face the possibility of outliving their resources. To compensate, they collect and save compulsively to feel safe and over-prepared and as a response to feeling overwhelmed by what lies ahead.
Hoarding can also be associated with holding onto memories. As they get older, some people worry their memories will be lost if they don’t retain physical evidence of the past. For them, hoarding becomes a mechanism to remind them of past relationships and experiences.
Hoarding behaviour and the inability to discard are also symptomatic of cognitive deterioration and the inability to decide and remember things associated with dementia, rather than a true clinical diagnosis of hoarding.
Fortunately, there is a growing number of services, established to help seniors affected by hoarding. Most councils have social workers, who have a good understanding of hoarding and the dynamics associated with it. There are also several de-cluttering services and specialised Professional Organisers, who provide practical assistance to help the aged person resolve issues of squalor and hoarding.