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Hoarding, a big problem among the elderly, starts in childhood

November 6, 2018

The Philadelphia Inquirer

Hoarding gets worse with age, which is why it’s often associated with older adults, but it usually starts in childhood.

That’s what Patrick Arbore, founder and director of the Center for Elderly Suicide Prevention and Grief Related Services in San Francisco, told a group of professionals who work with seniors recently. He was one of the speakers at the annual Regional Conference on Aging hosted by Philadelphia Corporation for Aging.

He said people whose homes later become overwhelmed with stuff often begin having dysfunctional relationships with things between ages 11 to 15. They may cling passionately to clothes that no longer fit or toys meant for much younger children. This is an opportunity for parents to teach them how to organize their possessions and discard items they no longer need, skills that are often deficient in adult hoarders.

Arbore thinks much hoarding also stems from trauma or emotional pain. Hoarders fill the emotional holes in their lives with things that seem more trustworthy and comforting to them than their fellow human beings. He said he has had success at reducing hoarding by helping people address their underlying pain and learn better ways to cope.

Overall, though, he presented a depressing picture of a condition that directly affects 6 percent of the population and causes much distress among families and friends. For the elderly, who are more likely to have dementia and physical problems, hoarding can also increase the risk of debilitating falls and isolation. The older population can be especially difficult to work with because their behavior is entrenched and they have a negative image of mental health treatment.

Hoarders can be pack rats, compulsive buyers or more organized collectors whose acquisitiveness has gotten out of hand. Eventually, they run out of room and wind up with narrow walkways and only a tiny place to sit amid what looks like trash to most people but is treasure to them.

Some hoarders grab good deals on furniture they plan to fix someday, but never do. “I am a rescuer of things,” one woman told Arbore. “I save them.” Some hoarders have a similar attitude toward animals.

“What do you see?” Arbore often asks hoarders. “I see Christmas time,” one woman told him as she surveyed the piles of debris in her room. “My cats are really flourishing,” another said, even though Arbore saw sickly animals along with some smelly, dead ones.

The cause of hoarding is unknown. Arbore sees elements of addiction and compulsion. The condition may also run in families. Many hoarders reject offers of treatment. “When you try to help guide them,” he said, “there is so much resistance.”

Arbore said hoarding needs more study. There is currently no evidence-based treatment. While hoarders may seem obsessive, they do not respond well to treatments for obsessive-compulsive disorder and anti-depressants have mixed results. Just clearing out their stuff for them doesn’t work. Most end up filling up the space again because they’re more comfortable amid clutter. He said one study found that about 70 percent of hoarders responded to cognitive behavioral therapy, a type of talk therapy that helps patients change their thinking patterns, when combined with skills training that strengthens decision-making and organization along with motivational interviewing.

Professionals, he said, should think of hoarding as a chronic, relapsing disease. “Just like when we work with alcoholics, it can be exceedingly painful, and we can’t save everybody.”

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