In 2003, an interdisciplinary New York City Hoarding Task Force was convened to address the complex behavioral disorder of hoarding in older adults and to develop practical tools and resources for community service providers.

As our population ages, hoarding has been increasingly recognized as a complex mental health problem that threatens the health, safety, and dignity of older adults. Although compulsive hoarding usually starts in young adulthood, it becomes particularly problematic later in life due to increased fall and fire risk. Moreover, the majority of older adults have multiple chronic health conditions, but necessary home care services may be denied until hoarding is resolved. Medicines can be buried under mounds of paper or clutter, and asthmatic conditions are exacerbated by dust and mold. Further, if the spouse dies who has been responsible for maintaining the home or if a person with advanced dementia loses the ability to organize or make rational judgments, then hoarding can spiral out of control.

A recent poll of ten Manhattan community service agencies that serve older adults revealed that approximately 10% of their clients are afflicted with hoarding behavior. Social workers reported of clients who lived in environments with

• Beds and bathtubs so filled with belongings there was no room for sleeping or bathing
• Kitchens that were unsafe and unusable due to cluttered stoves, sinks, and tabletops
• Large amounts of combustible materials blocking walking paths, radiators and fire exits
• No working toilets, sinks, heating and cooling appliances - afraid of eviction, they failed to get needed repairs
• Mounds of trash, rotten food, human and animal waste
• Insect and rodent infestation
• Many unkempt pets in need of care

These life-safety, quality-of-life and health issues not only affect the occupants but their neighbors as well. What makes hoarding so challenging is that people who hoard are usually oblivious to the problem and resist intervention. Factors such as extreme emotional attachment to possessions (including what appears to outsiders as useless junk), fear of loss, and the inability to discriminate (trash mixed with valuables) makes discarding items almost impossible.

Without a proper understanding of the psychosocial issues and reasons for hoarding, forced clean-outs, which can be costly, are often unsuccessful: dwellings revert back to an uninhabitable level within a relatively short period of time. Additionally, older adults may experience catastrophic emotional responses during forced cleanouts requiring emergency psychiatric care.

Understanding the reasons people hoard can help promote more therapeutic interventions, including on-going support and maintenance. It is our goal that the information contained in this section will help community agencies have a better understanding of, and more compassionate treatment for, older adults with hoarding behavior.