Hoarding among older people: an evaluative review

Abstract

While there is considerable evidence that the factors involved in hoarding typically begin to manifest early in life (mostly in adolescence), the majority of those sampled in research studies are in their later years. As so much of our understanding of the psychological factors involved in hoarding is derived from those who are older and more chronically affected, the core hoarding psychopathology may have been masked, overlaid or even disregarded in previous research and in our approaches to clinical intervention. That is, factors relating primarily to chronicity of the problem and feelings of demoralization, hopelessness, loss and the extent of the damage caused to the person's life may swamp the processes which led to and maintain the problem. The present review examines the extent to which this is so and considers theoretical and clinical implications. The literature relevant to hoarding in later life was reviewed evaluatively in relation to a number of questions placing hoarding in a lifespan developmental context. Many studies relied on purely descriptive methodologies, meaning that typical case presentations and case histories are well documented, with less attention paid to underlying causal and maintaining mechanisms. Efforts to identify and control for factors relating to age or problem chronicity were minimal. A key future direction is the identification of younger samples of people who hoard in order to identify more clearly the processes which drive acquisition and retention of excessive amounts of material.

Working together when the problem is multi-faceted: understanding inter-agency working for the benefit of people with hoarding problems

“…People with personal experience of hoarding highlighted improvements to be made in three domains: developing an improved understanding of hoarding, the need for improved resources, and improved inter-agency working, echoing some commonly cited improvements from professionals. It is particularly important for those with personal experience to feel understood, be provided with appropriate resources, and have the belief that professionals are working together to support them, as there appears to be a longer treatment-onset gap in hoarding than is seen in other anxiety disorders, which may account for why people with hoarding problems are typically seen in later life (Thew and Salkovskis, 2016).…”

“…Hoarding problems commonly arise in adolescence, with a median age of onset between 11 and 15 years (Tolin et al, 2010). However, although hoarding has an early age of onset, people with hoarding problems are typically seen by community service providers in later life, which may suggest a longer treatment-onset gap than other anxiety disorders (Thew and Salkovskis, 2016).…”

Adult safeguarding managers' understandings of self‐neglect and hoarding

“…Genetic models consider hereditary factors in hoarding behaviour (Iervolino et al, 2009). Neurological explanations consider neural impairment and neurodegenerative conditions as a cause for self-neglect and hoarding (Hombali et al, 2019;Thew & Salkovskis, 2016;Wheaton, 2016).…”

“…Genetic models consider hereditary factors in hoarding behaviour (Iervolino et al, 2009 ). Neurological explanations consider neural impairment and neurodegenerative conditions as a cause for self‐neglect and hoarding (Hombali et al, 2019 ; Thew & Salkovskis, 2016 ; Wheaton, 2016 ). A social constructionist view argues that self‐neglect should be understood in relation to cultural and historical norms of hygiene and cleanliness (see also Cox, 2011 ; Lauder, 2001 ).…”

Do they really care? Specificity of social support issues in hoarding disorder and obsessive–compulsive disorder

“…Symptoms of HD typically develop before the age of 20 (Tolin et al, 2010). Difficulties commonly increase in severity over time, with clinically significant levels most likely to manifest in middle to late adulthood (Dozier et al, 2016) and with clinical presentation often occurring in later life (Thew & Salkovskis, 2016). Whilst previously categorized under the umbrella of obsessive-compulsive disorder (OCD) or obsessive-compulsive personality disorder (OCPD), HD is now classified as a distinct psychiatric diagnosis (American Psychiatric Association, 2013).…”