Seniors And Hoarding

Seniors And Hoarding:
How to Cope with Diogenes Syndrome

 

Obsessively collecting things, also called hoarding, has recently entered the public conscious through TV shows about the subject on channels such as The Learning Channel, A&E, and Lifetime. It’s a real condition and it can afflict seniors as well as people of all ages.

Hoarders are people who lose the desire to throw away unneeded items because of a feeling of attachment to these items. Compulsive hoarders will equate certain, usually mundane, objects to their own personal identity or even give them certain human characteristics. Hoarding is different from obsessive–compulsive disorder (OCD) because the thoughts about hoarding are in the person’s natural stream of thought, not unwanted or distressed thoughts that people with OCD feel.

In severe cases, houses belonging to such people may become a fire hazard (due to blocked exits and stacked papers) or a health hazard (due to vermin infestation, excreta and detritus from excessive pets, hoarded food and garbage or the risk of stacks of items collapsing on the occupants and blocking exit routes).

According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition,
the symptoms for hoarding disorder include:

• Persistent difficulty discarding or parting with possessions, regardless of their actual value.
• This difficulty is due to a perceived need to save the items and to distress associated with discarding them.
• The difficulty discarding possessions results in the accumulation of possessions that congest and clutter active living areas and substantially compromises their intended use. If living areas are uncluttered, it’s only because of the interventions of third parties (e.g., family members, cleaners, authorities).
• The hoarding causes clinically significant distress or impairment in social, occupational, or other important areas of functioning (including maintaining a safe environment for self and others).
• The hoarding is not attributable to another medical condition (e.g., brain injury, cerebrovascular disease, or Prader-Willi syndrome).
• The hoarding is not better explained by the symptoms of another mental disorder (e.g., obsessions in obsessive-compulsive disorder, decreased energy in major depressive disorder, delusions in schizophrenia or another psychotic disorder, cognitive deficits in major neurocognitive disorder, restricted interests in autism spectrum disorder).

When it comes to seniors, hoarding can often be associated with Diogenes syndrome, also known as senile squalor syndrome, a disorder characterized by extreme self-neglect, domestic squalor, social withdrawal, apathy, compulsive hoarding of garbage, and lack of shame. Sufferers may also display symptoms of catatonia.

It has been shown that the syndrome is caused as a reaction to stress. The time span in which the syndrome develops is undefined, though it is most accurately distinguished as a reaction to stress that occurs late in life.

In most instances, those afflicted were observed to have an abnormal possessiveness and patterns of compilation in a disordered manner. These symptoms suggest damages on the prefrontal areas of the brain, due to its relation to decision making. Although in contrast, there have been some cases where the hoarded objects were arranged in a methodical manner, which may suggest a cause other than brain damage.

Although most who suffer from Diogenes Syndrome have been observed to come from homes with poor conditions, and many had been faced with poverty for a long period of time, these similarities are not considered as a definite cause to the syndrome. Research showed that some of the participants with the condition had solid family backgrounds as well successful professional lives. Half of the patients were of higher intelligence level. This indicates the Diogenes syndrome does not exclusively affect those experiencing poverty or those who had traumatic childhood experiences.

The severe neglect that a hoarder brings on themselves usually results in physical collapse or mental breakdown. Most individuals who suffer from the syndrome do not get identified until they face this stage of collapse, due to their predilection to refuse help from others.

The patients are generally highly intelligent, and the personality traits that can be seen frequently in patients diagnosed with Diogenes Syndrome are aggressiveness, stubbornness, suspicion of others, unpredictable mood swings, emotional instability and deformed perception of reality. Secondary DS is related to mental disorders.

Helping a senior hoarder or one with Diogenes Syndrome goes beyond simply sorting through their clutter and tossing away unnecessary items. Clearing out the clutter doesn’t address the underlying psychological problem, and too often the behavior simply resumes and continues until it reaches another crisis point.

The correct intervention depends on the type of hoarding behavior. Although there isn’t yet much research to confirm it, there appear to be two subtypes among people with hoarding behaviors. Some evidence suggests that one group has difficulty with executive functioning: decision making, planning and following through with plans. For these individuals, cognitive behavioral therapy can be beneficial. One area of ongoing research that has shown promise is the use of an intervention based on cognitive rehabilitation of brain-injured patients, aimed at re-teaching them executive functioning skills.

For the other subtype — those with impulse control problems and addiction-like behavior — cognitive therapy seems less effective. But as with substance abuse, support groups of peers who can provide a nonjudgmental and safe environment of support and encouragement can help.

Improving organizational skills can also help. The Institute for Challenging Disorganization provides education and resources to professionals and individuals dealing with hoarding, including access to professional organizers who offer services targeted at helping people with hoarding issues get better control of their environment.

Ongoing, targeted case management is essential and should be focused on keeping clients independent and safe at home while helping them make progress at their own pace to improve safety and address their medical needs.

If you feel that a senior loved one is no longer capable of living on their own due to issues of hoarding, it may be time to find them an assisted living facility where they can receive 24-hour care. To locate a facility in your area, visit the Alternatives for Seniors website or call a Senior Specialists at (888) WE-ASSIST (888-932-7747) for personalized assistance.

 

BLOG Date: Thursday, October 15, 2015
Writer: Ryan Allen