Novel Treatment for Geriatric Hoarding Disorder: An Open Trial of Cognitive Rehabilitation Paired with Behavior Therapy

Abstract

Objectives To investigate the feasibility of an age-adapted, manualized behavioral treatment for geriatric hoarding. Methods Participants were 11 older adults (mean age: 66 years) with hoarding disorder. Treatment encompassed 24 individual sessions of psychotherapy that included both cognitive rehabilitation targeting executive functioning and exposure to discarding/not acquiring. Hoarding severity was assessed at baseline, mid-treatment, and posttreatment. Results Results demonstrated clinically and statistically significant changes in hoarding severity at posttreatment. No participants dropped out of treatment. Eight participants were classified as treatment responders, and three as partial responders. Partial responders reported severe/extreme hoarding and psychiatric comorbidities at baseline. Conclusions The combination of cognitive rehabilitation and exposure therapy is a promising approach in the treatment of geriatric hoarding. Targeting neurocognitive deficits in behavioral therapy for these geriatric patients with hoarding disorder doubled response rates relative to our previous trial of cognitive behavior therapy alone.

Predictors of hoarding severity in older adults with hoarding disorder

“…that the more the psychiatric co-morbidities, the more difficult it is to treat HD (Ayers et al, 2014).…”

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“…Some variations of CBT have been also developed, including CBT with bibliotherapy [29], CBT with cognitive rehabilitation [30] CBT with motivational interviewing [31], CBT with internet supported group [32] and isolated bibliotherapy [33][34][35]. In conclusion, these studies reveal that there are a percentage of hoarders who do not benefit the current CBT approaches.…”

Identificação e cuidados no transtorno de acumulação

“…To date, standard cognitive behavioral treatments, for late-age accumulation have not been shown to be effective. 21 Accumulation in old age is a serious psychiatric condition, with significant health implications, since elderly individuals with accumulation demonstrate a greater impairment in daily and high-activity activities number of medical complications. 13 In moderate accumulators, difficulties have been reported in finding important items in the home and absence of habits such as eating at the table, using the kitchen sink or even sleeping in the house.…”

“…CCR and disposal reorganization is a viable, acceptable and promising treatment with a significant reduction in the severity of accumulation. 21 Therefore, it is pointed out the importance of professionals to carry out home visits and clinical interviews to assess the severity of the disorder, since the criterion of disorder and agglomeration should only work when one has access to the home of the individual accumulator. 14 The approaches to be used should include relapse prevention to achieve promising results.…”