Treatment Recruitment and Retention of Geriatric Participants With Hoarding Disorder

Abstract

This study describes the initial contact of 255 potential participants, recruitment of 63 participants, and retention of 57 participants from three geriatric Hoarding Disorder (HD) studies. Patients with HD were easily recruited from the community, primarily through the use of clinician referrals and posted flyers, as evidenced by steady patient flow despite lack of compensation for participation. Contrary to treatment outcomes of late life mood and anxiety disorders, geriatric HD patients are largely retained in clinical research treatment studies. Results demonstrate that older adults with HD can be engaged in treatment. Participants often needed the study staff to provide substantial support, including informal motivational interviewing and problem solving, in scheduling and attending the initial visit.Keywords hoarding disorder; older adults; recruitment and retention Address correspondence to Catherine R. Ayers, PhD, ABPP, Anxiety Disorders Clinic, VA San Diego Healthcare System, 3350 La Jolla Village Drive 116B, San Diego, CA 92161, USA. cayers@ucsd.edu. U.S. Department of Veterans AffairsPublic Access Author manuscript Clin Gerontol. Author manuscript; available in PMC 2018 January 29. VA Author ManuscriptVA Author Manuscript VA Author ManuscriptHoarding Disorder (HD) is characterized by an inability to discard possessions regardless of the objects' value due to a desire to keep the items as well as to avoid the distress accompanying the act of discarding. This prevents the use of active living spaces due to excessive clutter and causes clinically significant distress or functional impairment (American Psychiatric Association, 2013). Hoarding has been associated with an increased risk for fire or falling in the home as well as increased medical problems in older adults (Ayers, Iqbal, & Strickland, 2014;Dong, Simon, Mosqueda, & Evans, 2011;Kim, Steketee, & Frost, 2001). Further, geriatric HD patients exhibit lower global functioning and increased impairment in activities of daily living than non-HD peers (Ayers, Schiehser, Liu, & Wetherell, 2012). Epidemiological research has suggested that the prevalence of DSM-5 hoarding disorder is approximately 1.5% of the general population (Nordsletten et al., 2013), and there is some evidence to suggest that clinically significant compulsive hoarding may increase with age (Samuels et al., 2008). However, there has been no large-scale investigation of the prevalence of HD in older adults. The course of HD appears chronic for 73.0% of adult with compulsive hoarding symptoms and increasing for another 21.2% (Tolin, Meunier, Frost, & Steketee, 2010). When left untreated older adults with HD can experience moderate to severe symptomatology (Ayers, Saxena, Golshan, & Wetherell, 2010).Individuals with HD often resist treatment or seek intervention only as a result of family or community pressure (Frost, Steketee, & Williams, 2000). In a clinical case series examining mid-life and older adults with clinically significant hoarding symptoms, Christensen & Greist (200...

Cognitive Rehabilitation and Exposure/Sorting Therapy (CREST) for Hoarding Disorder in Older Adults

“…The high retention rate of patients in both conditions throughout treatment and follow-up procedures demonstrates the motivation of HD patients in the community to engage in evidence-based treatment. The details of the techniques used to recruit and retain participants have been previously published 21 ; in brief, study staff utilized motivational interviewing and problem solving when scheduling participants in order to minimize potential barriers to treatment engagement.…”

“…Details of the recruitment methods and a discussion of the factors related to participant retention have been published elsewhere. 21…”

Predictors of treatment outcome and attrition in adults with hoarding disorder

“…Furthermore, hoarding severity is often associated with premature dropout and poor treatment prognosis (Christensen & Greist, 2001;Mataix-Cols, Marks, Greist, Kobak, & Baer, 2002). Dropout rates for HD are at or above what is found in CBT trials for OCD (Ayers et al, 2015;Ong, Clyde, Bluett, Levin, & Twohig, 2016), yet research into what predicts treatment drop is scarce. In addition to attrition, more research is needed to understand the rates, correlates, and predictors of other types of treatment noncompliance in HD.…”

“…These factors may keep many individuals with HD from seeking treatment altogether. Individuals with HD often only enter treatment because of external forces, such as a family member's insistence or civic pressure (Ayers et al, 2015;Frost, Steketee, & Williams, 2000). One HD study reported that only 3% of the older adults enrolled were self-referred for treatment services (Kim, Steketee, & Frost, 2001).…”

“…Low motivation can impede successful treatment by leading to early dropout, inconsistent attendance, and poor treatment compliance, particularly with regards to homework adherence (Tolin, 2011). Even when individuals are self-referred, substantial support including repeated scheduling attempts, informal motivational interviewing, and problem solving by staff are often necessary to help participants engage (Ayers et al, 2015).…”