***Elderly Hoarding: Threat to Aging in Place

A house is just a place to keep your stuff while you go out and get more stuff.
– George Carlin

Dante’s Inferno
The 14th-century epic poem The Divine Comedy by Dante Alighieri is 14,000 lines of allegory describing the author’s philosophical journey through hell, Purgatory and beyond. In the story Dante one night dreams of a beautiful hillside and at the top is a paradise in waiting. All he has to do is climb to the peak to reach it.

As he embarks on the journey, it’s interrupted by a monster who tells him that before he climbs to the top of the hill, he first has to descend through nine circles of hell, down to the pit, and back again. Only then can he ascend to the top.

The ancient poet Virgil is his guide and, when the two enter the 4th circle of hell, they encounter dueling armies at war with each other; each rolling huge stones with their chests and crashing about.

One army shouts “Why do you hoard?” and the other army shouts back “Why do you Waste?”

Virgil describes them as the hoarders and the wasters in life. They’ve spent so much time worrying about their wealth and possessions “that they lost light of God and were forever doomed to this joint punishment”.

These heavy stones represent the material objects they clung to so tightly in life and the metaphor for “hell” is the opportunity cost of possession obsession.

Hoarding and Clutter
Recently a colleague at work called me about an elderly gentleman who he was helping. The older fellow had a number of issues threatening his ability to remain home independently.

My friend asked me if I had any resources that may be able to assist the man in maintaining his aging in place status. After listening to the scenario, I wanted to assess the situation and see how I could help.

As it turns out, the elderly man is a compulsive hoarder. Living alone as a bachelor in one of Portland’s most desirable neighborhoods, he was literally a prisoner buried in his own treasures.

Definition of Compulsive Hoarding
Hoarding is defined as the acquisition of and inability to discard items, even though they appear to others to have no value. People with Compulsive Hoarding syndrome (CHS) have immense difficultly throwing things away, even items of little or no value such as old newspapers, bits of string, worn-out clothes, and junk mail.

Most people with compulsive hoarding disorder are thought to have obsessive-compulsive disorder (OCD). In fact, a third of people diagnosed with OCD have hoarding behaviors. So the challenge with people who hoard is they are usually oblivious to the problem and resist any kind of intervention.

Randy Frost, PhD, one of the country’s leading authorities on compulsive hoarding, describes the definition of Compulsive Hoarding as a three-fold process:

1. The acquisition and failure to discard, possessions that appear to be useless or of limited value.
2. Living spaces so cluttered that using the room as intended is impossible.
3. Significant distress or impairment in the ability to function

Frost says: “Our research indicates that they save things for exactly the same reasons we all save things. The difference seems to be that people who suffer from compulsive hoarding apply these reasons to a wider variety of things.”

That wider variety of things presents a wider variety of dangers including:

• Beds and bathtubs so filled with belongings there was no room for sleeping or bathing
• Kitchens that were unsafe and unusable due to cluttered stoves, sinks, and tabletops
• Large amounts of combustible materials blocking walking paths, radiators and fire exits
• No working toilets, sinks, heating and cooling appliances – fearing eviction, they don’t get repairs
• Mounds of trash, rotten food, human and animal waste
• Insect and rodent infestation
• Many unkempt pets in need of care

With the aging of the population, hoarding is increasingly being recognized as a mental health problem that threatens the health, safety, and dignity of older adults. Compulsive hoarding (which often begins in young adulthood) becomes more challenging for older people with multiple chronic health conditions.

According to Frost, mobility is an issue in homes filled with clutter. The elderly often form “goat-paths” amongst the clutter in order to move from room-to-room. This amount of clutter increases the risks of tripping and falling; as well as hazardous to emergency personnel should a rescue be needed.

These unsafe conditions in the dwelling affect not only the health of the occupant, but also put the community and neighborhood at risk.

Psychological Costs
The irony is that CHS suffers are actually perfectionist in constant fear of making a mistake. In order to avoid mistakes, they take longer to make decisions—in fact they spent time “churning”; moving one pile to another instead of getting rid of anything for fear of making a “bad choice”.

They are also in need of control and to throw something out is to surrender control of the items over to others.

Family members are often collateral damage as feelings of embarrassment, frustration, or resentment towards the hoarding behavior leads to stress. The clutter also causes social isolation and few social contacts due to lack of visitors to the home. Ashamed of the clutter, family members may attempt to clean up and organize which leads to further chaos and fights.

I read a disturbing story by elder law attorney, Geoff Bernhardt about a couple married for over 50 years. The wife was a compulsive hoarder and the husband was meticulously clean. The difference was so pronounced they had separate rooms in their home; one jam-packed with stuff, the other neatly organized.

When the wife’s health began to decline over time, the husband took on the caretaker role. At the end of her life as she lay dying, her last message to her life-long mate wasn’t “I love you”, it was “please don’t touch my stuff”. This heart-breaking story is evidence of a compulsive hoarder.

Threat to Aging in Place
Compulsive Hoarding Syndrome is a threat to aging in place. Home health services will be denied unless the hoarding is addressed and resolved. As I witnessed in this case, medicines were buried under mounds of paper and clutter, and lung conditions were exacerbated by dust and mold (to mention only a few health hazards). The home is not livable in its current condition and the hoarding had spiraled out of control.

The importance of understanding of the psychosocial issues and reasons for hoarding are essential for successful interventions. Forced clean-outs, which can be costly, are reported to often be unsuccessful as homes revert back to an uninhabitable level within a relatively short period of time. Further, older adults may suffer acute emotional responses during forced cleanouts requiring emergency psychiatric care. Insights into the reasons older people hoard can help facilitate effective and compassionate interventions, including on-going support and maintenance. The goal is to support successful aging in place, and in turn quality of life.

With numerous loads to the dumpster and runs to the Goodwill, he pleaded his case to keep various items. As gut wrenching as that was to watch, my colleague reminded him gently that the overall goal was to keep him safely in his dwelling…we all hope on some level the message hit home.

(Note: Care was taken to keep him from seeing the items being removed from the home-eventually he was taken to a family member’s house to stay during the clean up.)

“Have nothing in your homes that you do not know to be useful, or believe to be beautiful.”
-William Morris (1834-1896)

See:
‘Collyer brothers syndrome’
Help for children of hoarders
Best Practices
Gerontological Environmental Modifications
Studio Apartment Assessmet
Randy Frost, PhD: Radio interview on hoarding

Understanding OCD: web site by an individual with obsessive-compulsive disorder
Center for Animals and Public Policy at Tufts University
An excellent website on animal hoarding, with extensive articles, bibliographies, interventions, and resources.
NYC Task Force on Hoarding: Randy O. Frost, PhD
Digital hoarding: Cluttered hard drives
George Carlin “Stuff” (Censored)
Thanks to R. Frost for The Divine Comedy story