Hoarding Disorder and Older Adults

Transcription

1 Hoarding Disorder and Older Adults Christina Nairn, LCSW, Supervisor G.E.N.E.S.I.S. & F.A.C.T.S. Programs Haydeh Fakhrabadi, Psy.D., CPII Los Angeles County Department of Mental Health 5/21/2018

2 What is Hoarding? The excessive and compulsive collection of items/animals (at times with little or no value) and having difficulties discarding them when no longer needed. Also, this behavior significantly impacts individuals day to day functioning and aspects of life: Home Work Family Health Social Life Emotions Financial legal.

3 Hoarding Rooms are no longer used for the intended purpose Exits are blocked Difficulty moving through the home/place.

4 Definition of Hoarding Persistent difficulty discarding possessions regardless of their actual value Perceived need to save items & distress associated with discarding them Difficulty discarding possessions results in the accumulation of possessions that congest and clutter active living areas & substantially compromises their intended use Hoarding causes clinically significant distress or impairment Hoarding is not attributable to another medical condition or mental condition Diagnostic and Statistical Manual of Mental Disorders, 5 th edition. DSM5

5 Definition of Hoarding Disorder (cont d) Specifier Excessive acquisition-acquiring possessions which are not needed or there is insufficient space Insight Good-person recognizes that hoarding behaviors are problematic Poor-person is mostly convinced that hoarding behaviors are NOT problematic despite evidence to the contrary No insight or delusional-person is completely convinced that hoarding behaviors are not problematic despite evidence to the contrary Diagnostic and Statistical Manual of Mental Disorders, 5 th edition. DSM5

6 Core Features of Hoarding Characteristics of hoarders Limited insight into their difficulties Reluctance to seek help intelligent Core features of hoarding Indecisiveness Perfectionism Procrastination Central coherence

7 Hoarding Disorder 2%-6% prevalence of hoarding disorder in the general population 75% of individuals suffering from hoarding disorder have a cooccurring mental disorder Age of onset of hoarding disorder is generally younger, starting around 10-15y/o, less likely to have primary hoarding disorder if onset is after 40y/o

8 Possible Causes of Hoarding No clear cause; however, genetic and environmental factors play significant roles. 85% of hoarders have a family member who hoards. Abnormal brain development. Brain damage: Stroke Surgery Infection injuries

9 Diagnostic Instruments Hoarding Rating Scale-Self Report (HRS-SR) The Structured Interview for Hoarding Disorder (SIHD) UCLA Hoarding Severity Scale(UHSS) HOMES (Multi-disciplinary Hoarding Risk Assessment) (Health, obstacles, mental health, endangerment, structure and safety) Saving Inventory (Frost, R.O., Steketee, G., & Grisham, J. (in press).. Behaviour Research and Therapy. Tolin et al. Psychiatry research 2008.

10 National Study Group on Chronic Disorganization (NSGCD) The NSGCD scale is an assessment tool with 5 levels: Level I Level II Level III Level IV Level V

11 NSGCD Level I All doors and stairways are accessible Normal pet activities No significant clutter No odors Normal housekeeping

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14 NSGCD Level II One exit is blocked; one major appliance (heating, cooling,..) not functioning for more than 6 months Some pet waste Light to moderate household rodents/insects Clutter inhibits use of more than 2 rooms Unclear function of rooms Small narrowing of the pathways Odors Over flowing garbage cans Mildew

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16 NSGCD Level III Visible clutter outdoors 2 or more appliances are broken or not functioning Light structural damage for less than 6 months Pets and animals exceed the local society limits (1-3) Flea, rodents, bird droppings, spider webs Narrowed hallway One bedroom or bathroom not functioning Items stored in shower Excessive dust Obvious and irritating odor

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18 NSGCD Level IV Structural damage for longer than 6 months Mold and mildew on walls or floors Inappropriate use of appliances Pets exceed local humane society limits by 4 Obvious signs of animal wastes Bat, squirrels, raccoons in attic or room Flea infestation Hazardous materials stored inside of home Rotting food on counters Lice on bedding No clean dishes or utensils locatable in kitchen

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21 NSGCD Level V Structural damage in the home Broken walls No electrical power No water connection No sewer Fire hazard Pets dangerous to occupants or guests Rodents in sight Mosquito Insect infestation Kitchen or bathroom unusable due to clutter Client sleeping elsewhere as house is not livable Human defecation Rotting food

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27 What are the Effects of Financial Social Hoarding? Physical & Mental Health Not only the hoarder but also, the community!

28 Why Hoard? Items are seen as valuable Items provide sense of security Constant need to collect Fears that others will find their personal information Physical limitation Not able to organize Self-neglect Stressful life events

29 Animal Hoarding Failure to provide adequate care Usually starts 30y/o Recently unemployed Professional Rescuing animals from euthanasia Special ability to communicate with animals Pathological altruism Early childhood experience of neglect Inadequate human relationships Animals provide unconditional love

30 Feelings Associated with Shame Guilt Embarrassment Feeling out of control Anxiety Sadness Grief Fatigue Anger Rage Hostility Fear Hoarding

31 Safety Issues No Working toilets and sinks No safe walkway Insects and rodents Excessive accumulation of garbage Fire hazards No working and accessible phone and/or utilities

32 Who Gets Involve? APS DCFS Mental Health Providers Law Enforcement Fire Dept. Family Friends Neighbors Vector Control Animal Control Public Health Code Enforcement Lawyers Physicians Other Professionals

33 GERIATRIC EVALUATION NETWORK ENCOMPASSING SERVICES, INTERVENTION, SUPPORT PROGRAMS (G.E.N.E.S.I.S.) Inter-disciplinary Team Field-based Services In-home) Assessment Medication Support Therapy (Individual & Group) Case Management Linkage & Referral Consultation Evidence-based Practices (EBP) & Promising Practices EB Screening Tools 33

34 G.E.N.E.S.I.S. Older Adult Program Serving the County of Los Angeles older adult population, providing a holistic assessment approach. Our nurses and social workers act as a team to provide a bio-psychosocial assessment to the clients we serve. 34

35 The Multidisciplinary Social Workers, Social Work Interns Registered Nurses Case Managers Psychiatrist, Psychiatric Residents & Geriatric Psychiatry Fellows Geriatrician, Geriatric Medicine Fellow Team

36 GENESIS Home-based program, 100% services are provided in the home Older adults ages 60 years + Suffering from serious and persistent mental illness Cannot or will not participate in traditional mental health services Sources of referral include APS, code enforcement, fire, self-referral, family members/friends, PCP, other physicians Outcomes of consultation individual psychotherapy linkage to community resources consultation-liaison work with PCP s medication management medical declaration of capacity MHSA (Mental heath services act) proposition 63 passed in 11/2004 to improve the delivery of mental health services and treatment across California

37 Fire Standards (G.E.N.E.S.I.S. Hoarding Task Force) 1. Front Door must open fully to allow firefighters in full gear and a stretcher to every room. 2. Three foot aisles to all rooms- measure with yardstick. 3. No more than three foot high stacked boxes, clutter, etc. on the floor. 4. Nothing within two feet of the ceiling, preferably three feet of open space. 5. All bookcases, tall furniture, armoires, etc should be bolted to the wall. If tall, nothing stashed on top. (GENESIS Hoarding Task Force)

38 Fire Standards (G.E.N.E.S.I.S. Hoarding Task Force) 6. No windows covered with stacked boxes. Need ventilation to rooms. 7. In multi-story buildings, no more than 45 lbs per square foot of weight if boxes or bookcases are heavy and full. 8. No storage of flammable liquids. 9. No open flames. (GENESIS Hoarding Task Force)

39 Needs and Issues Facing Older Adults Bio-Psychosocial Aspects of Aging Health Emotional /Mental Health Support System Resources Advocacy

40 Warning Signs in Older Adults Unexplained aches and pains Hopelessness Helplessness Anxiety and excessive worries Issues related to Memory Loss of interest Slowed movement Irritability Issues with self care such as, meals, medications, and personal hygiene Social Withdrawal Increase use of alcohol or other substances

41 Tips Hoarders often refuse help Collaborate with the hoarder to discard the items Be non-judgmental Be respectful Establish boundary Establish positive relationship Offer and provide referral for social, physical and mental health services

42 Treatment On-going Psychotherapy Medication Groups Psycho-education Behavioral Modification Skills Training

43 Treatment of Hoarding Harm Reduction Code violations Disorder Cognitive Behavioral Therapy (CBT) Group Therapy Clutter s Anonymous, Buried in Treasures

44 PEI Outreach and Engagement Programs Anti-Stigma & Discrimination (ASD) Partners in Suicide Prevention (PSP) 44

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46 Q&A Thank you! 46

47 Resources & Helpful Contacts 211 ACCESS (Department of Mental Health) 1(800) (24/7) Adult Protective Services (APS) 1(888) (877) After Hours G.E.N.E.S.I.S. 1(213)

48 Clutterers Anonymous (310)

49 Legal Assistance for Owners Facing Eviction The eviction defense network 1930 Wilshire Blvd. #208 Los Angeles, CA, (213)

50 National Website for Hoarding Disorder rces

51 Resources HELPGUIDE.org