Working psychologically with older adults with hoarding disorder: A scoping review of psychological assessment, formulation and intervention

Abstract

IntroductionHoarding disorder (HD) is characterised by excessive acquisition and difficulty discarding possessions, resulting in heightened distress and significant clutter. Associated social isolation, reports of heightened shame, mistrust of professionals, and risk of falls or problems with hygiene make it difficult for professionals to successfully assess and intervene. The progression of hoarding symptoms is chronic in nature, with older adult (OA) services seeing an increasing number of individuals with HD.MethodA systematic search of several databases was conducted. Following title, abstract and full text screening, and the exclusion of research focussing on an OCD sample or hoarding within the context of dementia or psychosis, 12 primary research papers were identified for inclusion in this review. These described the assessment, formulation and intervention of OA’s with hoarding.ResultsDespite there being several psychometric measures of hoarding severity, symptoms and beliefs, only two are validated for use with older adults. Moreover, there is little evidence of the efficacy of formulation and CBT interventions for HD in an OA population. There is however, useful documented adaptations to psychological work with OAs.DiscussionMore research is required documenting the efficacy of psychological intervention with OA’s with HD, as well as adaptations for assessment tools and formulation models for HD. These should account for the transitional life stage of OAs, possible physical health and cognitive functioning barriers, time constraints, increased need for motivational interviewing, relational approaches and emphasis on social activity.