Assessment of Critical Health and Safety Risks in Homes where Hoarding is Prevalent.

Hoarding behaviour sometimes requires intervention from community agencies to reduce risks to residents and the nearby community. Human services professionals from a wide range of disciplines are called upon to address hoarding concerns, often in collaboration with each other. No guidelines currently exist to guide staff from those community agencies in a shared understanding of common health and safety risks that occur with severe hoarding behaviour. Using a modified Delphi method, we aimed to generate consensus among a panel of 34 service-provider experts from a range of disciplines on essential risks in the home that would require intervention for health or safety reasons. This process identified 31 environmental risk factors that experts agreed are critical to assess in cases of hoarding. Panelist comments outlined the debates that commonly occur in the field, the complexity of hoarding, and the difficulty with conceptualizing risks in the home. The multi-disciplinary consensus achieved on these risks will facilitate better collaboration between agencies by providing a minimum standard of what to evaluate in hoarded homes to ensure health and safety standards are being met. This can improve communication between agencies, specify the core hazards that should be incorporated into training for professionals who work with hoarding, and facilitate more standardized assessment of health and safety risks in hoarded homes.

Adult safeguarding managers' understandings of self-neglect and hoarding.

Self-neglect and hoarding are behaviours that are hard to define, measure and address. They are more prevalent among older people because of bio-psycho-social factors, which may be exacerbated by advancing age. This paper aims to further understandings of self-neglect and hoarding in England's Care Act 2014 context, drawing on a study involving qualitative interviews with local authority adult safeguarding managers who play an important role in determining interventions with individuals who self-neglect and/or hoard. Online interviews were conducted with adult safeguarding leads and managers from 31 English local authorities in 2021. Interview data were subject to thematic analysis. This paper explores the commonalities and differences in adult safeguarding managers' understandings of the causes and consequences of self-neglect and/or hoarding among older people, which are likely to have tangible impacts on service provision in their local authority, and influencing of wider changes to policies and procedures. Most participants understood these phenomena as caused by a range of bio-psycho-social factors, including chronic physical conditions, bereavement, isolation. A minority took a more clinical or psycho-medical perspective, focusing on mental ill-health, or referred to the social construction of norms of cleanliness and tidiness. Whatever their understanding, by the time such behaviours are brought to the attention of safeguarding professionals a crisis response may be all that is offered. The implications of the findings are that other agencies should be encouraged to provide more early help to older people at risk of self-neglect and/or of developing harmful hoarding behaviours, and that sustained engagement with those affected may help to understand some of the causes of these behaviours to enable effective support or practice interventions.

Health-related quality of life in hoarding: A comparison to chronic conditions with high disease burden.

Hoarding disorder often results in debilitating functional impairment and may also compromise health-related quality of life (QoL). This study investigated the association between hoarding behavior and QoL relative to six highly impairing medical and psychiatric disorders in a sample of 20,722 participants enrolled in the internet-based Brain Health Registry. Nearly 1 in 8 participants (12.2%) endorsed clinically relevant hoarding symptoms (CHS). In separate multivariable linear regression models, hoarding was more strongly associated with mental QoL than diabetes (Standardizedß = -0.21, 95% CI: [-0.22, -0.20] vs. -0.01 [-0.02, 0.0]), heart disease (-0.22 [-0.23, -0.20] vs. 0.00 [-0.02, 0.01]), chronic pain (-0.18 [-0.19, -0.16] vs. -0.12 [-0.13, -0.10]), post-traumatic stress disorder (PTSD; -0.20 [-0.22, -0.19] vs. -0.07 [-0.09, -0.06]), and substance use disorder (SUD; -0.21 [-0.23, -0.20] vs. -0.04 [-0.05, -0.03]). Similarly, CHS was more strongly negatively associated with physical QoL than diabetes (-0.11 [-0.10, -0.12] vs. -0.08 [-0.06, -0.09]), major depressive disorder (-0.09 [-0.10, -0.08] vs. -0.05 [-0.06, 0.03]), PTSD (-0.11 [-0.12, -0.10] vs. -0.08 [-0.09, -0.07]), and SUD (-0.12 [-0.13, -0.09] vs. -0.01 [-0.02, 0.00]). Higher hoarding severity was associated with reductions in both mental (Standardizedß = -0.28, ΔR2 = 0.08, p < 0.0001) and physical (ß = -0.12, ΔR2 = 0.02, p < 0.0001) QoL, though the strength of the relationship between hoarding symptoms and QoL varied with depression severity. Efforts to improve the overall QoL and well-being of those with CHS are needed.

Pandemic buying: Testing a psychological model of over-purchasing and panic buying using data from the United Kingdom and the Republic of Ireland during the early phase of the COVID-19 pandemic.

The over-purchasing and hoarding of necessities is a common response to crises, especially in developed economies where there is normally an expectation of plentiful supply. This behaviour was observed internationally during the early stages of the Covid-19 pandemic. In the absence of actual scarcity, this behaviour can be described as 'panic buying' and can lead to temporary shortages. However, there have been few psychological studies of this phenomenon. Here we propose a psychological model of over-purchasing informed by animal foraging theory and make predictions about variables that predict over-purchasing by either exacerbating or mitigating the anticipation of future scarcity. These variables include additional scarcity cues (e.g. loss of income), distress (e.g. depression), psychological factors that draw attention to these cues (e.g. neuroticism) or to reassuring messages (eg. analytical reasoning) or which facilitate over-purchasing (e.g. income). We tested our model in parallel nationally representative internet surveys of the adult general population conducted in the United Kingdom (UK: N = 2025) and the Republic of Ireland (RoI: N = 1041) 52 and 31 days after the first confirmed cases of COVID-19 were detected in the UK and RoI, respectively. About three quarters of participants reported minimal over-purchasing. There was more over-purchasing in RoI vs UK and in urban vs rural areas. When over-purchasing occurred, in both countries it was observed across a wide range of product categories and was accounted for by a single latent factor. It was positively predicted by household income, the presence of children at home, psychological distress (depression, death anxiety), threat sensitivity (right wing authoritarianism) and mistrust of others (paranoia). Analytic reasoning ability had an inhibitory effect. Predictor variables accounted for 36% and 34% of the variance in over-purchasing in the UK and RoI respectively. With some caveats, the data supported our model and points to strategies to mitigate over-purchasing in future crises.

An Ecological Momentary Assessment Study Investigating the Function of Hoarding.

This study examined the function of hoarding behaviors and the relations between hoarding and a series of cognitive and affective processes in the moment using ecological momentary assessment. A matched-groups design was used to compare college students with higher hoarding symptoms (n = 31) and matched controls (n = 29). The two groups did not differ in what function they reported acquiring served, and positive automatic reinforcement was the most commonly reported function in both groups. Engaging in hoarding-relevant behaviors did not predict change in positive or negative affect when controlling for previous affect. Emotional reactivity and experiential avoidance in the moment were both elevated in the higher hoarding group compared to controls, while momentary mindfulness and negative affect differentiation were lower. Overall, these findings support the importance of emotion regulation processes in hoarding. They also suggest individuals may not be successfully regulating affect in the moment with hoarding behaviors, despite efforts to do so. It may be useful to evaluate processes such as striving for positive affect in hoarding disorder in the future.

The Role of Public Health in the Development of a Collaborative Agreement with Rural and Semi-urban Partners in Cases of Severe Domestic Squalor and Hoarding.

When confronted with complex situations of hoarding and severe domestic squalor, small municipal communities and their partners frequently feel overwhelmed due to limited resources at their disposal. Stakeholders often report these situations to Public Health Service and seek their support. In order to facilitate more effective and coordinated actions, the main stakeholders involved (municipal, fire, police, public health and the regional health center) must agree on the most appropriate intervention strategies. An agreement providing services for the management of severe cases of domestic squalor in rural and semi-urban areas located in Quebec, Canada was produced by the Laurentians regional public health, and signed with fourteen local municipalities.

Medication Saving Behaviors of Older Adults: Scale Developed to Assess Family Caregiver Perspectives.

OBJECTIVES: This study developed and explored the preliminary reliability and validity of a 6-item Medication Saving Behaviors (MSB) scale when completed by family care partners of older adults. METHODS: Women (N = 119) helping an aging relative with healthcare appointments and medication management completed an online survey including items related to generalized hoarding and medication saving behaviors. RESULTS: The MSB was psychometrically sound and correlated significantly with hoarding scales and reported number of expired and leftover medications. Compared with those reporting low levels of general hoarding concerns, group means on the MSB were higher for caregivers reporting clinically significant levels of hoarding by their elderly family member. The MSB was unrelated to total prescription or over-the-counter medications for the older adult, lending support for the discriminant validity of the scale. CONCLUSIONS: This study provides initial support for the convergent and discriminant validity of the MSB when administered to intergenerational care partners of older adults. CLINICAL IMPLICATIONS: The MSB may function to identify higher risk patients via their family members and target families for interventions.

Sociodemographic and socioeconomic characteristics of elder self-neglect in an US Chinese aging population.

This study aimed to examine the socio-demographic and socioeconomic characteristics associated with prevalence and severity of elder self-neglect in an U.S. Chinese older population. The PINE study is a population-based epidemiological study in the greater Chicago area. In total, 3159 Chinese older adults were interviewed from 2011 to 2013. Elder self-neglect was assessed with systematic observations of a participant's personal and home environment across five domains: hoarding, personal hygiene, house in need of repair, unsanitary conditions, and inadequate utility. Elder self-neglect was prevalent among older adults aged 80 years or over (mild self-neglect: 34.6% 95% CI 30.9-38.4; moderate/severe: 15.6% 95% CI 12.8-18.6), men (mild: 28.6% 95% CI 26.1-31.3; moderate/severe: 13.1% 95% CI 11.2-15.1), those with 0-6 years of education (mild: 32.2% 95% CI 29.7-34.9; moderate/severe: 12.6% 95% CI 10.8-14.5), and those with an annual personal income between $5000 and $10,000 (mild: 30.8% 95% CI 28.4-33.2; moderate/severe: 11.8% 95% CI 10.2-13.5). Older age (mild self-neglect: OR 1.02, 95% CI 1.01-1.03; moderate/severe self-neglect: OR 1.02, 95% CI 1.00-1.03) and lower education levels (mild self-neglect: OR 1.06, 95% CI 1.03-1.08; moderate/severe self-neglect: OR 1.07, 95% CI 1.04-1.09) were associated with significantly increased odds of elder self-neglect. Women (moderate/severe self-neglect: OR 0.73, 95% CI 0.58-0.93) had significantly decreased odds of moderate/severe elder self-neglect. No significant association was found between levels of income and overall elder-self-neglect of all severities. Future research is needed to examine risk/protective factors associated with elder self-neglect in U.S. Chinese older populations.

The investigation and comparison of the underlying needs of common disruptive behaviours in patients with Alzheimer's disease.

BACKGROUND: Management of the disruptive behaviours is one of the most challenging aspects of caring for patients with Alzheimer's dementia (PwAD). The underlying needs of disruptive behaviours in PwAD had rarely been studied, especially the comparison of the underlying needs of disruptive behaviours in PwAD have never been mentioned. AIMS AND OBJECTIVES: The purpose of this study was to investigate and compare the underlying needs of five common disruptive behaviours including hoarding, aggressive behaviour, repetitive behaviour, altered eating behaviour and delusion in PwAD, as perceived by family caregivers, and to relate these needs from the perspective of Maslow's hierarchy. METHODS: An exploratory research design with qualitative data collection techniques was employed. Informed consent was obtained from each participant prior to the data collection. A total of 65 pairs of caregiver-patient with Alzheimer's disease participated in the study. A semi-structured interview guide was used during the interview, and the directed content analysis method was conducted to analyse data. RESULTS: Four themes related to the underlying needs of the five selected disruptive behaviours emerged from the data, and these included a desire for comfort (physical and psychological), a desire for security (psychological and economic), a need for a sense of belonging (including a need to connect with the outside world and a need for attention) and a need for self-control. These behaviour features were found closely related to Maslow's hierarchy model of human needs. CONCLUSION: Although the data were gathered from the caregivers, and the views of the patients were thus not included in the analysis, the findings provide information for health providers that can enable them to better understand the underlying needs of common disruptive behaviours in patients with Alzheimer's disease and thus help develop better patient-centred care plans.

Self-neglect in an elderly community-dwelling U.S. Chinese population: findings from the Population Study of Chinese Elderly in Chicago study.

This study aimed to examine the prevalence of self-neglect and its specific behaviors in an elderly community-dwelling U.S. Chinese population through a population-based cohort study (PINE Study) in the greater Chicago area. Community-dwelling population of older Chinese adults were interviewed from 2011 to 2013 (n = 3,159). The personal and home environment of participants was rated based on prevalence of hoarding behavior, personal hygiene, repairs needed on the home, sanitary condition of the home, and adequacy of utilities. Prevalence estimates were presented according to self-reported quality of life (QOL). It was found that the prevalence of self-neglect was 18.2% for mild self-neglect and 10.9% for moderate to severe self-neglect. Unsanitary conditions (17.0%) was the most prevalent, followed by need for home repair (16.3%), hoarding behavior (14.9%), poor personal hygiene (11.3%), and inadequate utilities (4.2%). The prevalence of elder self-neglect of all severities and of all types was higher in older adults with fair or poor QOL than in those with good or very good QOL. Poorer QOL was significantly associated with greater risk of self-neglect of all severities (mild self-neglect: odds ratio (OR) = 1.93, 95% confidence interval (CI) = 1.26-2.96, P < .001; moderate to severe self-neglect: OR = 3.58, 95% CI = 1.79-7.13, P < .001) and specific personal and environmental hazards. The study's authors conclude that elder self-neglect is prevalent, especially in elderly adults with poorer QOL. Future research is needed to examine risk and protective factors associated with elder self-neglect.

A multifaceted assessment of emotional tolerance and intensity in hoarding.

Hoarding is characterized by emotionally reinforced saving behaviors, which often combine with excessive acquisition to give rise to clutter, distress, and impairment. Despite the central role emotional processes are thought to play in hoarding, very little research has directly examined this topic. There is suggestive evidence linking hoarding with several facets of emotional intolerance and avoidance, though one key limitation of this past research has been the exclusive reliance on self-report questionnaires. The aim of the current study was to conduct a multimethod investigation of the relationship between hoarding and perceptions of, and cognitions about, negative emotional states. A large unselected sample of nonclinical young adults (N=213) completed questionnaires, behavioral tasks, and a series of negative mood inductions to assess distress tolerance (DT), appraisals of negative emotions, and emotional intensity and tolerance. Hoarding symptoms were associated with lowered tolerance of negative emotions, as well as perceiving negative emotions as more threatening. Individuals high in hoarding symptoms also experienced more intense emotions during the mood inductions than individuals low in hoarding symptoms, though there was no association with poorer performance on a behavioral index of DT. Across measures, hoarding was consistently associated with experiencing negative emotions more intensely and reporting lower tolerance of them. This relationship was particularly pronounced for the difficulty discarding and acquiring facets of hoarding. Our results offer initial support for the important role of emotional processes in the cognitive-behavioral model of hoarding. A better understanding of emotional dysfunction may play a crucial role in developing more effective treatments for hoarding.

Community hoarding task forces: a comparative case study of five task forces in the United States.

During the past decade, many community task forces have formed to address hoarding problems that come to public attention. Such task forces provide a societal-level intervention to assist people with the most severe cases of hoarding, who do not voluntarily seek or want help for their hoarding behaviour. This qualitative study of five U.S. hoarding task forces included sites selected for their diversity of purpose, approaches to hoarding intervention and community geography, composition and resources. Data were collected during the period of September 2007-March 2008. The case study methodology used multiple forms of data, including semi-structured interviews, analysis of documents, small group interviews and investigator observation. This study captured the perspectives of public and private sector service providers such as mental health, housing, social service, public health agencies and community enforcement organisations (fire, police, legal, animal control) to examine how task forces organise and operate and the emerging practice and policy changes. Study findings suggest that structural factors (e.g. leadership, purpose, funding and membership) impact hoarding task force viability, that participation on a task force influences practice and policy decisions about hoarding, and that social work can expand its role in task force leadership. Task forces may be a mechanism for improving community policies about hoarding and mechanisms for addressing other social problems across multiple sectors.

Medication management: a case of brown bag-identified medication hoarding.

A 91-year-old woman living independently in the community presented along with her son for a medication therapy management (MTM) appointment with the clinical pharmacist at the University of Colorado Hospital Seniors Clinic. The purpose of the visit was to review the patient's medications, perform medication reconciliation, and identify ways to increase proper medication management. As requested for the MTM appointment, the patient and her son brought in several large bags of her over-the-counter (OTC) and prescription medications from her home, including those that she was not currently taking. The clinical pharmacist reviewed the medications and found multiple instances of duplicate therapies, nonadherence, discrepancies in her medication regimen, cost concerns, and other drug-therapy problems. In addition, the pharmacist's evaluation showed that the patient had been hoarding more than 100 medications, which increased her risk for drug-related problems. Most of the OTC and some prescription medications were voluntarily removed from the patient's possession to reduce the likelihood of potential overuse of medications.The pharmacist educated the patient and her son regarding her updated medication list and how to properly manage her medications. Finally, the patient's son volunteered to help his mother with medication management or hire someone to assist her. This case demonstrates the usefulness of requesting all medications-including OTC and prescription, active and inactive medications-be brought to the MTM appointment.The case also supports the need for family support for older adults struggling with managing polypharmacy.