Hoarding Behavior In Elderly People: A Comprehensive Literature Review

Literature Review

Discuss about the Hoarding Behavior in Elderly People.

Hoarding can be defined as the habit of acquisition of the valueless objects and the inability to discard such objects, which may appear to be valueless possessions for others. The prevalence of the hoarding behavior is seen in the elderly population of Singapore. Such behavior is mainly seen in the patients suffering with mental disorders. Hoarding behavior also result in stress, anxiety and many other physical and psychological problems. The aim of this paper is to provide the comprehensive literature review on the Hoarding behavior of the elderly people in Singapore. Hoarding is a very serious problem. Therefore, it is also important to analyze the motivations  for hoarding.  Paper will also discuss the data collected from the interview of two hoarders. Paper will use the particular scales (Clutter-Hoarding Scale and Conner Davidson Resilience Scale) to evaluate the hoarding severity and to compare the hoarders from non-hoarders. Paper will also make two psychosocial interventions and/or services for people with habitual hoarding behaviour in Singapore.

Hoarding is the habit of keeping the possession of the valueless things, which increases the excessive clutter, disability and also distress. According to American Psychiatric Association (2013), “Hoarding is defined as an excessive acquisition of objects and inability to discard or part with possessions that appear to have no value to others, leading to excessive clutter, distress and disability”. Earlier hoarding behavior was considered s pathology, but now the studies have shown that not all hoarding behavior is pathological. It is associated with many mental disorders like “depressive disorder, obsessive compulsive disorder, acquisition-related impulse control disorders (including compulsive buying, kleptomania and acquiring free things), generalised anxiety disorder, social phobia, inattentive-type attention deficit hyperactivity disorder, obsessive-compulsive personality disorder, schizophrenia or dementia” (Choo et al, 2015). The problem of hoarding can lead to various environmental and social problems. This problem affects the family members, neighbors, individual himself and also a threat to the wider community. Hoarding has also considered being the reason of isolation in elderly population (Holmes, Wolter & Harris, 2014).

There are many problems associated with clutter accumulation. Clutter prevents proper cleaning of the houses or premises, hinders the proper accessibility and also increases the risk of fire and many health hazards. The older people in Singapore are the most vulnerable population that also go through extremely complex aging process. Ayers et al (2010) states that hoarding is a chronic disorder and clinical features of this disorder are mainly seen in the late life of an individual. The study also states that late life hoarding is associated with psychiatric and medical co-morbidities. Hoarding behavior is also related to the concept of possessions. Older people, who suffer from hoarding behavior, are mainly those, who feel connected to their old possessions, which they have being there since many generations. Such people also believe that their material possessions of who and what they are.

Hoarder’s Interviews

Some of the people also believe that acquisition of possessions is associated with their social status. Possessions of different things, objects and brands are also associated with the memories of being associated with a social group. According to the study of Weatherhead (2015), “in older life, possessions take on an increased role as aide de memoires of the life that has been lived, as an aid to reflection, for nostalgia and also a source of comfort.” With the growing age, the attachment to the materialistic things also increases and deepens. Elderly people are more tend to surround themselves with such objects and possessions, which has followed them through good and bad times. It helps them to remember everything, which on the other hand also increases distress and anxiety. Ponner & Cherrier (2008) examined that overflowing clutter harm the residents and family members and neighbor also suffer from odor and pest infections. Different epidemiological studies have been carried out to reveal the problems associated with hoarding. The study of Subramaniam et al (2016), found that “Significant impairments brought about by hoarding behavior, such as relationship tension with those sharing the same living space, impairment in quality of life, and daily functioning, health, safety and hygiene concerns resulting from clutter”. 

For the purpose of this study, the data was collected from the interview of two extreme hoarders. The first hoarder is Mr. Lee, who lives in the populated residential area of Singapore. He is 68 years old and has accumulated the clutter of sports magazines. In his young age he was the captain of football team and an avid player. After an accident he lost the ability to play football. He has one room flat and he lives with his 21 years old son. Hi room is filled with old magazines that have also accumulated fungus due to moisture. He also suffers from chronic depressive disorder. He has persistent disability in discarding valueless possession, even after several requests made by his son. According to the Clutter Hoarding Scale Mr. Lee is found on the IV level. Structural damage is found in his house, which is more than 6 months old. Mold and mildew are also visible on the walls. Excessive spider webs can be found in the bed room and drawing room. Due to ineffective waterproofing on the roof, the walls have been damaged. Since there is not much space in bedroom, so Mr. Lee uses a sofa to sleep and his son sleeps on floor. No cleanliness was noticed in the kitchen area.

Motivations of Hoarding

Another participant is Mrs. Chang, she is 72 years old. She is an elderly widow and lives alone in her flat. Recently she started sleeping outside her one room flat because of the useless clutter that she has hoarded in the memory of her husband. She also suffers from generalized anxiety disorder (GAD) She had hoarded lot of bundles of newspaper, because it reminds her of her husband. Since two months she has been sleeping outside her home and cleaning dishes outside as well due to the clutter she has accumulated insider her house. According to Clutter hoarding scale, her house is found on level V. Structural damage and broken walls are visible in the house. There are no proper water and sewage connections in her house. The contaminants have exceeded the local ordinance level. Her house is filled with insects and mosquitoes. The chances of fire hazard are also very high.  The food in the kitchen is rotting and due to lack of space she sleeps outside her house.

The motivations for hoarding are associated with cognitive and behavioral problems. According to the cognitive behavior theory or the model of hoarding, “the behaviour is driven by information processing deficits, fear of losing important items that the person believes will be needed later, distorted beliefs about the nature of possessions, exaggerated emotional attachment to possessions and avoidance of the anxiety associated with discarding and decision-making” (Subramaniam et al, 2016). The behavior of Mr. Lee and Mrs Chang is also due to excessive emotional attachment and lack of proper decision making. According to the evidences provided in the study of Sagayadevan et al (2016), the functional hoarders have difficulty in disposing the useless clutter without any conscious motivation or control. According to the concept of semiotic analysis that main motivation found in the case of hoarder is the emotional connection with past.

According to the interview data collected it can be said that hoarders have reported significant impairment in mental health, physical functioning, family life, work life, relationships and also in academics in comparison to non-hoarders (Jarrett, 2013). People with problem of hoarding have les insight in comparison to non-hoarders (Subramaniam et al, 2016). When they are compared with the mental health patients in terms of stress and anxiety, hoarders are less likely to respond towards treatment. Tolin et al (2008) found that hoarders also suffer from many chronic mental health conditions and “have higher healthcare utilisation than non-hoarding family members”. It can also be said that they are less likely to fight with stress or depression.

Comparison of Hoarders and Non-Hoarders

Recommendations and Conclusion

Paper discussed the problem of hoarding behavior, which is a significant issue in Singapore. The elderly people suffer from the chronic hoarding conditions. Hoarding is the useless acquisition of materialistic things that are associated with good and bad memories. Paper discussed the hoarding behavior problem and provided the data collected from the interview of two hoarders. Hoarding is a serious medical condition, which has been well studied. Paper provides a comprehensive literature review of reliable resources. For the people with habitual hoarding  behavior in Singapore the two recommendations for psychological intervention are as follows. The first recommendation would be that individual who hoard should be immediately referred for medical evaluation. They should also be provided with social and community support. Second recommendation is that Hoarding Task Force in Singapore must take aggressive actions for addressing the issue of hoarding in the local community. They must encourage more people to inform immediately about such incidents.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub.

Ayers, C. R., Saxena, S., Golshan, S., & Wetherell, J. L. (2010). Age at onset and clinical features of late life compulsive hoarding. International Journal of Geriatric Psychiatry, 25(2), 142-149.

Choo, K. W. Q., Lee, W. L., How, C. H., & Ng, B. Y. (2015). Hoarding in Singapore. Singapore medical journal, 56(9), 484.

Frost, R. O., Steketee, G., & Tolin, D. F. (2011). Comorbidity in hoarding disorder. Depression and anxiety, 28(10), 876-884.

Jarrett, C. (2013). The psychology of stuff and things. PSYCHOLOGIST, 26(8), 560-564.

Ong, C., Sagayadevan, V., Lee, S. P., Ong, R., Chong, S. A., Frost, R. O., & Subramaniam, M.(2016). Hoarding among outpatients seeking treatment at a psychiatric hospital in Singapore. Journal of Obsessive-Compulsive and Related Disorders, 8, 56-63.

Ponner, T., & Cherrier, H. (2008). Hoarding Behavior & Attachment to Material Possessions (20: 00). NA-Advances in Consumer Research Volume 35.

Sagayadevan, V., Lau, Y. W., Ong, C., Lee, S. P., Chong, S. A., & Subramaniam, M. (2016).

Validation of the clutter image rating (CIR) scale among psychiatric outpatients in Singapore. BMC psychiatry, 16(1), 407.

Subramaniam, M., Abdin, E., Vaingankar, J. A., Picco, L., & Chong, S. A. (2016). Hoarding in an asian population: prevalence, correlates, disability and quality of life.

Tolin, D. F., Frost, R. O., Steketee, G., Gray, K. D., & Fitch, K. E. (2008). The economic and social burden of compulsive hoarding. Psychiatry research, 160(2), 200-211.

Weatherhead, S. (2015). A Psychological Perspective on Hoarding. Clinical Psychology, 276, 1.  

Whitfield, K. Y., Daniels, J. S., Flesaker, K., & Simmons, D. (2011). Older adults with hoarding behaviour aging in place: looking to a collaborative community-based planning approach for solutions. Journal of aging research, 2012.