1. Hoarding Abby Wagner, Marie Sartori, Adam Coleman, David Cotterman, Maryam Noorzad, Lindsey Gamrat, Morgan Lewis, Aaren Hampton, Katie York, Liz Farra

2. What the Research Says... "Compulsive hoarding is a progressive and chronic condition that begins early in life." "Left untreated, its severity increases with age." Most compulsive hoarding symptoms were reported as being in midlife, but results found most cases began in childhood or adolescence (Ayers et al, 2010).

3. What is Hoarding? Two behaviors associated w/ hoarding: o Excessive collection of items o Inability to discard or rid these items Common items hoarded: o clothes o newspapers o junk mail o books o craft items (International OCD Foundation, 2010)

4. What is Hoarding? YES..... EVEN ANIMALS!!!! (Mayo Clinic, 2011)

5. What is Hoarding? Debilitating, chronic disorder Disorganized clutter that creates chaos in homes leading to: o Cramped living conditions o Unsanitary conditions o Exits being blocked o Rooms unable to be used o Difficulty moving around (International OCD Foundation, 2010) (Mayo Clinic, 2011) (Ayers et al, 2010).

6. Who Hoards? Hoarding may be a symptom of OCD, but many people who hoard do not have other OCD-related symptoms Hoarding can affect anyone, regardless of age, sex or economic status. It's not clear, though, how common hoarding is. People who hoard do not see it as a problem so treatment is difficult Due to lack of understanding of cause there is no known prevention (Mayo Clinic, 2011)

7. Risk Factors Little is understood as to what causes hoarding but researchers have identified risk factors: o Age: usually starts in adolescence and gets worse with age o Stressful life events o Family history o Alcohol abuse o Social isolation Late onset hoarding may be idiopathic or secondary to other conditions (Mayo Clinic, 2011; Ayers et al, 2010).

8. Signs and Symptoms o Cluttered living spaces o Inability to discard items o Keeping stacks of newspapers, magazines or junk mail o Moving items from one pile to another, without discarding anything o Acquiring unneeded or seemingly useless items, including trash or napkins from a restaurant o Difficulty managing daily activities, including procrastination and trouble making decisions o Difficulty organizing items o Shame or embarrassment o Excessive attachment to possessions, including discomfort letting others touch or borrow possessions o Limited or no social interactions (Mayo Clinic, 2011)

9. Focus on age at onset: compulsive hoarding in elderly Elderly hoarding can be more difficult to diagnose and is not well understood Study conducted by Ayers et al (2010) interviewed 18 adults over age 60 o Asked patients about major life events and to rate their hoarding symptoms o Used a number of different tools to conduct structured interviews, including Mini International Neuropsychotic Interview (MINI) Findings: onset actually occurs most often in childhood and adolescence o Compulsive hoarding behaviors increased with each decade of life; it is a progressive, chronic condition o Only 16% of participants met criteria for OCD, but mood and anxiety comorbidities were common Should be considered a separate disorder from OCD

10. Implications Goal is to stick to treatment; sticking to your goals and treatment plan will ensure the most probable outcome. Examples -Keeping up on personal hygiene/bathing -Proper nutrition -Compliant with medications -Living a healthy, enjoyable life (Mayo Clinic, 2011)

11. Implications Reach out to others -Hoarding lifestyle can cause people to become isolated and have a sense of loneliness which in turn can lead to more hoarding. Nurses should encourage socialization -If people are feeling overwhelmed and don't want people in their house, they should be encouraged to socialize outside the house with friends and family. (Mayo Clinic, 2011)

12. Current Treatments Therapy o Psychotherapy Cognitive Behavior Therapy most commonly used. Medications o SSRIs Paxil Not everyone responds to medication (Mayo Clinic, 2011)

13. Prognosis Initially obtaining treatment may prove difficult in itself Barriers to treatment may include: o Hiding symptoms/denial o Less public awareness of hoarding and OCD o Lack of training of health professionals (may be misdiagnosed) o Difficulty finding a therapist o Not being able to afford therapy On average, it takes 14-17 years after the problem starts for someone with an OCD disorder to get the right treatment (International OCD Foundation, 2010)

14. Prognosis (cont.) Treatment is challenging and often results in mixed success Cognitive Behavior Therapy is often most successful Underlying disorders and potential causes of the hoarding need to be treated Ideally, a combination of treatment options tailored to the specific patient will help them learn to live a normal life and be a productive member of society (Mayo Clinic, 2011)

15. Videoclip CBS News interview with "Hoarding:Buried Alive" women and a psychologist https://www.youtube.com/watch?v=RvlHdx7-M6g

16. Resources International OCD Foundation (2010). About hoarding. Retrieved from http://www.ocfoundation.org/hoarding/about.aspx Mayo Clinic (2011). Hoarding. Retrieved from http://www.mayoclinic.com/health/hoarding/DS00966 Ayers, C., Saxena, S., Golshan, S., & Wetherell, J. (2010). Age at onset and clinical features of late life compulsive hoarding. International Journal Of Geriatric Psychiatry, 25(2), 142-149. doi:10.1002/gps.2310