Understanding Elderly Hoarding and How to Help

As our loved ones age, it can be hard for them to let go of items they’ve accumulated over the years. Sometimes, they keep things for sentimental reasons, or they might be fueled by a fear of change or loss of control. Other times, a loved one’s refusal to discard possessions can be an indication of a hoarding disorder. 

Research has found that hoarding symptoms are three times more likely to occur in older adults than in younger adults. Even if your loved one never showed signs of hoarding before, if you notice their living areas becoming cluttered and you’re concerned, read on to understand the signs of hoarding in seniors, why it happens, and what you can do to support them.

Key takeaways

• Senior hoarding disorders result in an unsafe home environment, with clutter creating fall hazards, and in extreme cases, sanitation issues.
• Hoarding behaviors can surface or worsen in older age and can be triggered by mental health issues, stressful life events, changes in daily life, or dementia.  
• Cognitive behavioral therapy (CBT), professional organization services, and telehealth support are options that can help older adults with a hoarding disorder. 

Does my older parent have a hoarding disorder?

Not all clutter points to a mental health condition, and saving items can be rooted in life experience, personality, or necessity. But in some cases, it may signal something more serious. Understanding the differences can help you decide how to respond.

The differences between resourcefulness, "pack rat" behavior, and hoarding disorder

Many older adults save items for sentimental reasons or out of a sense of utility and frugality. So, how do you know when a senior is exhibiting resourcefulness, “pack rat,” or hoarding behavior? 

Resourceful reuser

My grandfather grew up during the Great Depression and saved many items to reuse. I’ll never forget the large ball of tinfoil he kept inside the kitchen cupboard. Some family members found this to be frustrating and unnecessary, but the items he saved were always neatly stored and organized, and he used them often. My grandfather would be considered a resourceful reuser. 

Signs that your aging loved one is a resourceful reuser:

• Saves items that are practical and usable.
• Intends to use the items in the near future.
• Keeps items relatively organized.
• Usually not overly attached to items.

If the tinfoil ball had grown so large it blocked the doorway to the kitchen, and if other items were scattered on the countertops and floors, it could be an indication of “pack rat” tendencies or a hoarding disorder. 

Pack rat behavior

A pack rat habitually collects items and has a hard time discarding them, even when they might not have a real intention of using them in the future. Sometimes they feel a compulsion to keep things that are worthless or unusable out of fear that they might need them later, and they can have a hard time getting rid of items. 

Because they keep so many items, their living spaces can often become cluttered and disorganized. Depending on the severity, pack rat behavior may be an indication of OCD or other mental health concerns. It’s always a good idea to consult a medical professional if you’re worried that your aging loved one’s possessions are causing them physical and mental stress. 

Characteristics of a pack rat:

• Enjoys collecting items
• May collect items that are unusable or worthless
• Might have a hard time discarding items
• Living spaces can become cluttered and disorganized

Hoarding disorder

A hoarding disorder is defined as persistent difficulty getting rid of possessions due to a perceived need to save the items. Attempts to part with possessions creates extreme distress and often results in decisions to keep them. While a pack rat’s home might be disorganized, people who have a hoarding disorder cannot use or access vital areas of their homes due to messiness and clutter. 

In more extreme cases, known as Diogenes syndrome, seniors can experience severe hoarding, neglect to care for themselves and their homes, and social withdrawal. Diogenes syndrome has also been linked to dementia, personality disorders, and severe stress in seniors.

Symptoms of hoarding disorder:

• Obsessively collects items and feels emotionally attached, even when items are worthless.=
• Extreme difficulty and distress when faced with discarding items.=
• Desperation or bargaining to keep items.=
• Clutter prevents normal activities in living spaces and creates fall hazards
• Self-neglect and sanitation issues
• Severe stress and social isolation

Why hoarding behaviors can surface in older age

Although hoarding behaviors typically present in younger years, research investigating senior hoarding has found that the consequences of hoarding can become more prevalent with age due to the accumulation of objects over time and an impaired ability to discard or organize items following declines in physical and mental health. 

In one study, people aged 60 - 87 years old reported increasing severity of hoarding symptoms in each successive decade of their lives, with the most severe symptoms occurring in older age. 

If your loved one’s hoarding tendencies seem new or worse than before, there are several risk factors that can occur later in life that might be the reason. It’s important to keep in mind that hoarding disorder is often tied to depression, anxiety, and OCD, and these mental health issues can be triggered along with hoarding behaviors.

Risk factors, causes, and triggers of hoarding in older age include:

• Mental health issues: Depression, anxiety, OCD, and personality disorders are all linked to hoarding disorder.
• Dementia: Hoarding behaviors can emerge in older adults with dementia.
• Scarcity mindset: Prevalent in older generations who may save items out of fear.
• Mobility issues: Physical decline can contribute to hoarding, disorganization and clutter. 
• Stressful life events: The death of a family member or the aftermath of a natural disaster can increase the risk of developing hoarding disorder.
• Life changes: Changes that disrupt daily life like retirement or relocation. 
• Personality: Indecision and perfectionism are common traits among those who hoard.
• Family history: Hoarding tendencies can be behavioral or genetic and may run in families.

How to help a senior parent who’s hoarding

Many times people with hoarding tendencies are in denial or unaware that their hoarding has become an issue. When you want to help, it’s important to know that you may receive pushback from your loved one. 

Here are some tips you can use when attempting to help an older adult with a hoarding disorder: 

• Establish a common goal: Start with a mutual goal like having space for grandkids to visit.
• Lead with safety and wellbeing: Tell your loved one, “I’m worried you might fall and get hurt.” 
• Focus on hazards: Prioritize clearing main living areas and pathways over aesthetics. 
• Ask caring questions: “What thoughts or feelings come up when you think about getting rid of these items?” 
• Listen and validate: Show compassion and understanding related to hoarding struggles.
• Plan in advance: Agree in advance, don’t surprise a loved one with a forced clean up project. 
• Be respectful: Talk about discarding items, don’t get rid of them behind their back. 
• Avoid shame: Don’t launch personal attacks like, “How could you let this get so bad?” or “Your house is filthy.”
• Ask for help: You may need to consult a medical professional for help. 

Treating hoarding disorder in older adults

Treatment for hoarding disorder often involves a combination of therapeutic support and practical interventions tailored to the senior’s needs.

Cognitive behavioral therapy

Cognitive behavioral therapy (CBT) supports seniors in building practical skills that help them challenge their beliefs and habits around hoarding. CBT teaches seniors to:

• Identify and challenge thoughts and beliefs related to keeping items
• Resist the urge to acquire more items
• Decide which items to organize and which ones to get rid of
• Improve coping skills and stress reduction
• Reduce isolation and increase opportunities for social activities and support

Some sessions may be held within the senior’s home to assess the severity of hoarding and to come up with a plan of action. If your loved one feels uneasy or overly defensive about this, there are other options available like telehealth where seniors won’t feel their privacy is being invaded. Providers might recommend family therapy sessions to support family members or caregivers in carrying out solutions to hoarding. Learn more about when marriage and family counseling is covered under Medicare. 

And, a provider may prescribe medicine in addition to CBT, especially if anxiety or depression occur with hoarding disorder.

Professional organization services for hoarding

Professional organizers and cleanup services offer specialized, compassionate support to sort items and clear hazardous clutter from your aging loved one’s home. You can hire a national service or find a certified local hoarding specialist to assist with clean up and organization services. 

Professional organizational specialists can: 

• Assess the severity of hoarding and come up with a customized plan
• Remove clutter so the home environment is safe, accessible, and sanitary
• Create sustainable organizing solutions to prevent future clutter
• Act as an accountability partner and offer encouragement
• Coordinate with medical professionals and family to create a comprehensive approach

Why telehealth can be a safer way to seek help

Family members are typically the first to notice and seek help for older adults with a hoarding disorder. Even when clutter interferes with daily life and causes distress, many people with a hoarding disorder deny that it’s a problem. An unwillingness to accept the problem can sometimes lead to extreme defensiveness, making traditional therapy challenging, especially if the healthcare provider wants to assess the senior’s home. Telehealth offers an effective alternative by allowing a professional to assess the severity of the environment without the intrusion of someone entering the home.

Virtual mental healthcare can also be a benefit to seniors facing mobility challenges as it saves them from traveling to a clinic. And, if adult children or caregivers of an aging adult with a hoarding disorder are also Medicare recipients, they can receive affordable telehealth therapy to help with their own mental health without additional office visits or transportation needs.

Sailor Health works hard to address cost barriers for seniors on a fixed income, and most of our Medicare patients have a $0 copay. To learn more about how the older, experienced therapists at Sailor Health can help you or your loved one, book a consultation and get matched with a provider today.

References

1. Ayers, C. R., Najmi, S., Mayes, T. L., & Dozier, M. E. (2015). Hoarding disorder in older adulthood. American Journal of Geriatric Psychiatry, 23(4), 416–422. https://pmc.ncbi.nlm.nih.gov/articles/PMC7295124/ PMC
2. American Psychiatric Association. (n.d.). What is hoarding disorder? Retrieved from https://www.psychiatry.org/patients-families/hoarding-disorder/what-is-hoarding-disorder American Psychiatric Association
3. Bloch, M. H., et al. (2014). Meta-Analysis: Hoarding Symptoms Associated with Poorer Response to OCD Treatment. [Details from PubMed Central]. https://pmc.ncbi.nlm.nih.gov/articles/PMC4169729/ PMC
4. Diefenbach, G. J., et al. (2013). Characteristics of hoarding in older adults. International Journal of Geriatric Psychiatry. https://pubmed.ncbi.nlm.nih.gov/23567383/ PubMed
5. Harvard Health Publishing. (2024). Hoarding: What to know about this mental health disorder. Harvard Health. Retrieved from https://www.health.harvard.edu/mind-and-mood/hoarding-what-to-know-about-this-mental-health-disorder Harvard Health
6. Kassel, M. T., et al. (2023). Hoarding Symptoms in Late Life Depression. [PMC Article]. https://pmc.ncbi.nlm.nih.gov/articles/PMC10872841/ PMC
7. Mathews, C. A. (2014). Hoarding disorder: More than just a problem of too much stuff. Journal of Clinical Psychiatry. https://pmc.ncbi.nlm.nih.gov/articles/PMC4432907/ PMC
8. Nakao, T., & Kanba, S. (2019). Pathophysiology and treatment of hoarding disorder. Psychiatry and Clinical Neurosciences, 73(7), 370–375. https://pubmed.ncbi.nlm.nih.gov/31021515/ PubMed
9. PubMed. (2015). Diogenes syndrome in dementia: A case report. https://pubmed.ncbi.nlm.nih.gov/33526159/ PubMed‍
10. PubMed. (2015). Cognitive behavioral therapy for hoarding disorder: A meta-analysis. https://pubmed.ncbi.nlm.nih.gov/25639467/ PubMed