MENTAL HEALTH MATTERS: HOARDING DISORDER AMONG SENIORS
FEATURE:
GERIATRICIANS: WHO THEY ARE AND THE ROLE THEY PLAY IN HEALTHY AGING
Last week, a neighbor of my mother’s said she was off to see her geriatrician. My mother, not wanting to be nosy, waved her neighbor off and said, “Have fun!” Then, she called me. She asked, “What is a geriatrician…and do I need one?” We spent the next hour exploring the world of geriatrics, identifying what exactly a geriatrician is, how one differs from other doctors in the field and when it’s time to consider reaching out for the specialized skills and training a geriatrician offers.
Creative Director: Sarah McElroy Coalfeather Art & Design
Office & Marketing Coordinator: Anna Wiedholz AnnaW@aosnc.com
Marketing & Ad Sales: Emma Campbell EmmaC@aosnc.com
LETTER FROM THE EDITOR
OCTOBER 2022 - 2
October is here, and for those of us who endure the summer, we give thanks. The leaves are literally changing color and falling delicately to our feet. The days are becoming crisp. I’ve dug out my sweaters and sorted my sock bin, preparing for boot season and sweater weather.
This month’s feature is an exploration into the world of geriatric medicine. We ask (and answer) the question: What is a geriatrician and what roles do they play in healthy aging? We get into definitions, roles, responsibilities and options for finding the best care possible as we age.
In this month’s Ask the Expert, we’re gearing up for another travel season. ONC has recently had a few reader questions related to travel with the upcoming holiday season. As readers and family members consider planes, trains and automobiles (now that COVID restrictions have eased), some of the questions and concerns about travel are coming up again. We dug back into our files and found a great Ask the Expert response from AOS Care Management Care Manager Kate Pomplun.
Well, it’s official: fall is here. I had my first pumpkin-spiced latte just ture dipped low enough to merit a fleece.
Don’t worry. It was decaf.
In Mental Health Matters, Amy Phariss, LCMHCA examines hoarding and how it shows up in the senior population. If you know someone who struggles with this disease, or if you’re wondering if your loved one is hoarding vs. dealing with clutter, this is a great article to examine what hoarding is, what it isn’t and how to help someone who struggles in this area.
October is a gentle month. There are constant reminders of change. we are lucky, toward each other. We have lingering conversations the flames flicker. Smoke dances around us in a circle. We zip our
In this month’s feature, we’re starting an important conversation: care community for ourselves or a loved one? Fox Hollow Senior Robin Hutchings offers inside perspective for making this decision.
Finally, because it’s October, we’re offering up some pumpkin and spice. If you’re craving a cozy fall snack, turn to page 10 for an easy pumpkin muffin recipe that will satisfy an afternoon hankering for something that tastes like fall.
In Ask the Expert, Amy Natt answers a reader’s question regarding away without any estate planning. Without a will or access to important
For anyone who is an Outlander fan, you’ll appreciate Diana Gabaldon’s words on fall:
Physical therapist Dr. Sara Morrison of Total Body Therapy and Wellness potential diagnostic tools used in physical therapy to help diagnose these tools differ from what other doctor’s offices may offer.
“It was a beautiful, bright autumn day, with air like cider and a sky so blue you could drown in it.”
I’m going to agree with Nathaniel Hawthorne this month, who wrote: I cannot endure to waste anything so precious as autumnal sunshine spent almost all the daylight hours in the open air.
Here’s to enjoying the October sunshine, falling leaves and daylight
Kate Pomplun, LMSW, CMC | kate@agingcaresolutionsnc.com
Q: Now that travel has begun again, my mom talks about driving to see us and the grandkids. A lot has changed with her health and mental status over the last year. She manages okay in familiar settings, but I worry about her traveling beyond her local circle. We have all missed each other so much in the last year and we want her to see people, but I’m concerned about her ability to manage traveling, even if she flies.
A: The discussion about when a person should stop driving is always among the toughest. People would rather discuss their funeral plans and what to do with the antiques when they die than the possibility of giving up the keys. Throw in a global pandemic, which kept people at home or within a small radius geographically, and the idea of getting back to traveling longer distances becomes even more complicated. Even if giving up the keys isn’t an issue, travel concerns include managing a flight or two as well.
It does not sound like your mom needs to give up driving entirely (lucky you, you all dodged that one – for now), but maybe she shouldn’t be taking a road trip or hopping on a plane without some extra help. So many people have been isolated from loved ones over the last year or more and are very anxious to finally meet that grandbaby, or make it to the wedding that had been put off or simply catch up with family and friends face to face. These social connections are so important to maintaining one’s health. In fact, the National Council on Aging reports in a recent article about the effects of mental health due to social isolation among older adults during COVID-19, that prolonged social isolation increases risk for depression, cognitive decline and dementia. It can also affect the ability of someone to conduct activities of daily living, including driving. (https://www.ncoa.org/article/covid-drivenisolation-can-be-dangerous-for-older-adults)
The problem becomes twofold. She and you want to prevent more social isolation and lack of positive face to face connections, thus improving her quality of life. However, your mom has likely declined in mental capacity and physical ability, whether due to isolation during COVID-19 or through the aging process.
Having an open discussion about your concerns, while still encouraging her to continue with her travel plans – with some added assistance as described below – may actually be a relief to her. With a bit of help, it could allow for her to see people she’s missed without shouldering all the work of planning and carrying out travel plans.
You and her other loved ones could suggest some of these ideas:
Manage the logistics: Offer to help book direct flights and set up transportation to and from the airport. Depending on her physical and mental abilities, she could utilize the airport escort service to safely and accurately get her to her gate. Booking tickets and setting up transportation to the station could also be done for train travel or bus. This could be successful if she can manage appropriately once she is on the plane/ train/bus.
Manage and provide a travel companion: You can still
help set things up logistically, but if she’s not able to manage even once she’s on the plane/train/bus, maybe a friend or family member can ride along with her. If traveling by car is most appropriate, someone could offer to drive her. Even if that family member or friend isn’t able to stay for the visit, maybe there is someone else who could drive or ride back with her. Bonus: She gets the added socialization of visiting with that person while traveling!
Manage and delegate the escort: Slightly different from above, you could still manage the logistics, but if a friend or family member isn’t able or it’s not practical to travel to her in order to travel with her, you could utilize a home care companion or an Aging Life Care™ Manager. Just as you would pay the hourly rate for someone to provide management, care or companionship in her home, you may be able to hire someone to do so while traveling with her.
Other things to consider:
Task of packing: With decreased cognitive abilities, plus not traveling for some time, your mom might struggle with what to pack, how to pack it, what’s permitted if flying, what form of identification she’s going to need to show and when. Someone may want to help her go over her needed items and ensure they’re packed in accessible places. This could be done in person or possibly over the phone or video call.
Environmental safety: Even if you can work out how to get her to her friends and family, depending on your mom’s abilities, you’ll want to consider how she will do once staying there. Will she easily be confused staying in a different house? Does the bathroom she’ll be using have safety measures if she needs a walk in shower, grab bars, or uncluttered flooring (think throw rugs) to prevent falls, etc.?
Alternate ideas: If getting your mom to see her loved ones and ensuring a safe place for her to stay just isn’t practical, maybe taking to those loved ones to see who can get to her would be most beneficial. Maybe short day trips that allow her to be returned to the familiarity of her home are best. Think a little outside the box before dismissing the possibilities. Maybe the grandchildren with the new baby don’t have the travel funds to get to her and pay for lodging, but your mom is able to use her travel funds to get them there.
It’s a good sign that your mom is actively seeking social connection with the loved ones she’s missed. It’s likely you can come up with a plan to help her do so and in return, as the study shows, her overall health is likely to benefit.
GERIATRICIANS:
WHO THEY ARE AND THE ROLE THEY PLAY IN HEALTHY AGING
by Amy Phariss
The conversation is important as my mom and I both age. She is now approaching 71, and I recently turned 49. We find ourselves commiserating about joint pains or comparing how many steps we got that day. We are both focused not only on our own health but the health of each other and how we can live our healthiest, happiest lives.
As we age, many of us begin spending more time focused on our health. We begin valuing regular check-ups and have more time to address sometimes long-standing health issues, such as chronic pain or issues we have ignored for years while working and raising children. The aches and pains of life can begin to sharpen their tone, demanding to be addressed.
As we continue aging, some health issues become more common or pronounced.
The top 10 health issues facing seniors 65+ include:
For many seniors, seeing specialists for these health conditions will be part of their overall care plan. We see our primary care doctor for a flu shot and checkups and are referred to a cardiologist for heart problems or a counselor or psychiatrist for mental health issues.
Along with other specialists, a geriatrician may be an important part of an overall care team for optimal health as we age.
What is a geriatrician?
A geriatrician is a medical doctor who specializes in the care of older adults, typically those aged 65 and older. Geriatricians are trained to manage the unique health issues and medical conditions that come with aging, such as those listed above. They focus on promoting healthy aging, diagnosing and treating age-related diseases, and providing holistic care for elderly patients, many of whom live with multiple chronic conditions.
Geriatricians are trained to attend to the unique needs of seniors and focus on promoting and supporting quality of life and independent living.
Geriatricians have several key responsibilities and areas of focus including:
• Providing a comprehensive geriatric assessment (evaluating the physical, social and mental health of patients and developing personalized care plans for treatment)
• Managing chronic conditions (such as diabetes, Alzheimer’s Disease or osteoporosis)
• Medication Management (monitoring and management of multiple medications to avoid harmful interactions and to ensure proper dosing and best health outcomes)
• Fall Prevention (both assessing fall risk and implementing strategies to avoid falls)
• Cognitive and mental health care (assessing for, diagnosing and managing dementia, Alzheimer’s Disease, depression and more)
• Palliative and End-of-Life care (providers are focusing on improving the quality of life for patients with serious or terminal illness)
• Coordination with other healthcare providers (such as medical specialists, nurses, social workers and caregivers, all of whom play key roles in a care team)
What is the difference between a geriatrician and a gerontologist?
The main difference between a gerontologist and a geriatrician is in their roles, training, and focus areas. While both work in fields related to aging, their approaches and responsibilities are distinct:
Gerontologist:
Gerontologists study aging in a broad sense, including its biological, psychological, and social aspects. They are not medical doctors and usually do not provide medical treatment.
Gerontologists usually have degrees in fields like social work, psychology, sociology, or public health, with a specialization in gerontology (the study of aging). Their training focuses on understanding the aging process and improving quality of life for older adults through research, advocacy, policy, and program development.
Gerontologists have many different roles or positions, including:
o Research and study the aging process.
o Advocate for policies that benefit older adults.
o Work in settings like universities, research institutions, social services, senior centers, or government agencies.
o Develop and manage programs for older adults, such as wellness programs, senior housing, or mental health services.
o Educate professionals and the public about aging and the needs of older populations.
Gerontologists’ work is typically non-medical, but they may work with healthcare providers and other professionals caring for seniors.
Geriatrician:
Geriatricians are medical doctors who specialize in diagnosing, treating, and managing health conditions in older adults. They focus on the physical and mental health challenges that come with aging.
Geriatricians are board-certified physicians who have completed medical school, a residency (usually in internal medicine or family medicine), and additional fellowship training in geriatrics.
Geriatricians offer hands-on, medical care and treatment, often working closely with other healthcare providers, caregivers, and social workers to provide comprehensive care.
The key differences between the two are:
• Gerontologists focus on studying and understanding aging, while geriatricians provide medical care for aging individuals.
• Gerontologists typically have non-medical backgrounds in social sciences or public health, while geriatricians are medical doctors with specialized training in geriatrics.
• Gerontologists may work in research, education, and program development, while geriatricians directly treat the health problems of older adults.
How is a geriatrician different from a primary care physician (PCP)?
Primary care physicians also offer holistic, comprehensive care for many patients. A geriatrician is a primary care doctor with additional specialized
training in geriatrics through a fellowship (1 or 2 years) in geriatric medicine and are board certified in geriatric medicine. This specialized training includes training in complex age-related conditions, polypharmacy management, cognitive and mental health, falls and mobility, palliative and end-of-life care, comprehensive geriatric assessment (CGA) and interdisciplinary collaboration.
When should I consider seeing a geriatrician?
You might consider seeing a geriatrician when you or a loved one begins experiencing health challenges common to aging or if managing multiple chronic conditions becomes complicated. Some situations that may need specialized attention are frequent hospitalizations or medical crises, concerns regarding medication management, decline in mobility or physical function, caregiver strain, incontinence or bladder control problems, or palliative or end-oflife care. Geriatricians are also excellent resources for helping seniors prevent age-related issues and promoting healthy aging.
Finally, many people simply don’t live near areas with a high concentration of geriatricians or may not feel comfortable switching doctors. In fact, a family doctor or internist may be the best fit for either yourself or your loved one, and seeing a geriatrician isn’t necessary at all. Speak with your loved one about options and consider speaking with your current primary care physician if you feel you or your loved one needs more specialized care or is facing a complicated health issue.
Some other options for pursuing geriatric-focused care include:
1. Find a medical practice or primary care doctor with experience in geriatric care
2. Work with a Nurse Practitioner or Physician Assistant Specializing in Geriatrics
3. Work with a Geriatric Care Manager
4. Consult with a Geriatrician Through Telemedicine
5. Ask for Referrals to Specialists
6. Utilize Community Resources for Seniors
By combining these resources, you can ensure highquality care for older adults, even without a geriatrician nearby.
Keeping these tips in mind and understanding the field of geriatrics overall means you are better prepared to seek out the care you need. With the right help and support, we can all thrive as we age and make our last decades our best decades.
MENTAL HEALTH MATTERS: HOARDING DISORDER AMONG SENIORS
Amy Phariss, LCMHCA, Clarity Counseling NC
As a mental health counselor, I’ve worked with several family members whose parents or loved ones have developed hoarding behaviors. Most of my clients were unaware hoarding had become a problem for the parent. They realize, upon reflection, that the hoarding went unnoticed over a period when they weren’t going into their loved one’s home. They typically live out of state, and their loved one would either visit them or often had excuses to host events or get-togethers outside of the home. So, for several years, a client wouldn’t have gone into an uncle’s or even a parent’s home. Then, when a crisis happens and the home is opened, the hoarding is revealed. This is challenging for both the person hoarding and for the loved one, who often feels shocked, saddened, guilty and overwhelmed. How could my aunt live like this? Why didn’t my father ask for help? Where did they get all this stuff ?
The first step in helping a loved one with a hoarding issue is understanding what hoarding is and how to differentiate it from clutter, collecting or messiness. Collecting refers to collections of possessions as a larger set of items. Collecting is organized and systematic. Display of these items does not impede active living areas of the home, such as blocking the entrance or exit of a room.
Clutter refers to a disorganized collection of items in a space that do not necessarily need to be there. Cluttered spaces can be untidy or filled with items that haven’t been put away or are no longer in use. The DSM-5 defines clutter as “a large group of usually unrelated or marginally related objects piled together in a disorganized fashion in spaces designed for other purposes (e.g. tabletops, floor, hallway).”
Messiness refers to a temporary state of disorder where items are out of place but not necessarily excessive. Messiness is often situational and reflects a lack of tidiness rather than a chronic issue.
Hoarding is a behavior characterized by the persistent difficulty in discarding or parting with possessions, regardless of their actual value. Hoarding becomes Hoarding Disorder when it severely impacts a person’s daily life and functioning. It is often linked to emotional connection to items, fear of needing them in the future and anxiety about letting items go.
Key differences between clutter, collecting, messiness and hoarding include:
• Hoarding is chronic in nature and often linked with mental health issues. It severely impacts the daily life of the person or persons. There are strong emotional links between a person and the accumulated stuff in a hoarding situation.
• Collecting is usually linked with the displaying of items, and items are typically well organized.
• Clutter is linked to disorganization and is less chronic, more manageable and impactful than hoarding. Clutter can often result from having a busy lifestyle, being disorganized or having difficulty making decisions (such as where to store paper documents) and procrastination (I’m going to make a photo album next month, when my schedule calms down).
• Messiness is typically temporary and usually reflects normal, everyday disarray. It is not usually tied to emotional connection with items or mental health issues; although anxiety, depression and ADHD (among other mental health issues) can contribute to messiness.
Why Do Seniors Hoard?
Hoarding often begins in early adulthood but can become more severe as people age. Several factors contribute to hoarding in seniors:
1. Emotional Attachment: Over the years, seniors accumulate items that hold sentimental value. Letting go of these items can feel like losing a part of their past.
2. Fear of Scarcity: Many seniors lived through difficult times, such as the Great Depression or World War II. These experiences can create a mindset of scarcity, making them reluctant to throw things away.
3. Cognitive Decline: As cognitive abilities decline with age, seniors may struggle to make decisions about what to keep and what to discard, leading to an accumulation of items. According to researchers exploring late life depression (LLD) and hoarding
disorder (HD), “We found 30.1% co-occurrence of HD in LLD, which was accompanied by greater executive dysfunction, disability, and poorer response to depression treatment.”
4. Loneliness and Isolation: For some seniors, hoarding can be a coping mechanism for loneliness. Their possessions may provide a sense of comfort and companionship.
The Impact of Hoarding Hoarding can have serious consequences on a senior’s health and safety:
1. Physical Hazards: A home filled with clutter increases the risk of falls, fires, and other accidents. It can also make it difficult for emergency responders to provide assistance in a crisis. According to Catherine Ayers, Associate Clinical Professor of Psychiatry at the University of California San Diego, “In particular, late-life hoarding poses a fall risk by creating trip-and-fall hazards throughout the home” (Getz, 2020).
2. Health Risks: Piles of clutter can harbor dust, mold, and pests, which can lead to respiratory problems and other health issues.
3. Social Isolation: Seniors who hoard may feel ashamed or embarrassed by their living conditions, leading them to withdraw from social activities and isolate themselves from friends and family.
4. Emotional Distress: Hoarding often causes significant stress and anxiety, both for the individual and their loved ones.
Statistics on Senior Hoarding Hoarding affects a significant portion of the senior population. Research suggests that:
• Approximately 2% to 5% of the general population exhibits hoarding behavior, but the prevalence is higher among older adults, particularly those over 60.
• A study from the International OCD Foundation estimates that 15% to 25% of hoarders are over 55 years old.
• Another study published in the American Journal of Geriatric Psychiatry found that 6% of older adults met the criteria for hoarding disorder, which is significantly higher than the general population. The highest prevalence of hoarding disorder is seen in patients over the age of 65.
How to Help a Senior Who Hoards
If you have a loved one who struggles with hoarding, it’s important to approach the situation with empathy and understanding:
1. Communicate Openly: Talk to your loved one about your concerns without judgment. Let them know that you want to help because you care about their well-being.
2. Seek Professional Help: Hoarding can be a complex issue that often requires the assistance of professionals, such as therapists who specialize in hoarding disorder or geriatric care managers.
3. Offer Practical Support: Helping with decluttering can be overwhelming, so start small. Focus on one area at a time and celebrate each success, no matter how small.
4. Be Patient: Change takes time, especially for seniors who have been hoarding for years. Patience and persistence are key to making progress.
Conclusion
Hoarding among seniors is a challenging issue that can significantly impact their quality of life. By understanding the causes and effects of hoarding, we can provide better support to our aging loved ones. Empathy is key, so calming ourselves down before we approach our loved one is important. Speaking to a counselor or other professional before approaching your loved one can help you process your own feelings before a delicate conversation. Understand the connections the hoarding behavior may have with depression, attachment and cognitive decline, and develop a plan to help your loved one live a healthier life for better overall wellness.
Sources:
International OCD Foundation: Hoarding Fact Sheet
Journal of Clinical Psychiatry : “Hoarding in Older Adults: Prevalence and Association with OCD”
Ayers, Najmi, Mayes & Dozier. 2015. Hoarding Disorder in Older Adulthood. American Journal of Geriatric Psychiatry. 23(4): 416-422. doi: 10.1016/j. jagp.2014.05.009
Psychiatry.org. “2021. What is hoarding disorder?” https://www.psychiatry. org/patients-families/hoarding-disorder/what-is-hoarding-disorder
Kassel et al. 2023. “Hoarding Symptoms in Late Life Depression are Associated With Greater Executive Dysfunction and Disability and Poorer Response to Depression Treatment.” American Journal of Geriatric Psychiatry 32(2): 137-147. DOI: 10.1016/j.jagp.2023.08.009
Getz, Lindsey. 2020. “Hoarding – a Hazard for Older Adults.” Today’s Geriatric Medicine. 13(1): 10.
Cath, Nizar, Boomsma & Matthews. 2017. “Age-specific prevalence of hoarding and obsessive compulsive disorder: a population-based study.” 24(3): 245-255. doi: 10.1016/j.jagp.2016.11.006
Easy Pumpkin Muffins
INGREDIENTS:
• 1 ⅔ cups all-purpose flour
• 1 teaspoon baking soda
• 1 ¼ teaspoons ground cinnamon
• ½ teaspoon ground ginger
• ¼ teaspoon ground nutmeg or freshly grated nutmeg
• ½ teaspoon salt
• 2 large eggs
• ¾ cup granulated sugar
• ½ cup dark brown sugar
• ½ cup vegetable or canola oil (avocado oil is our go-to choice)
• 1 ¼ cups pumpkin puree (canned or fresh)
• ¼ cup milk
DIRECTIONS:
1. Preheat oven to 375°F/190°C. Grease a muffin pan or line with muffin liners.
2. In a large bowl whisk together flour, baking soda, cinnamon, ginger, nutmeg, and salt.
3. In a medium bowl, whisk together eggs, granulated sugar and brown sugar until combined. Add oil and whisk to combine. Add pumpkin and milk and whisk until combined. (You can also use a standing mixer and let it do the work for you). Pour the pumpkin mixture into the flour mixture and mix gently just until combined. For the fluffiest and most tender muffins, don’t overmix.
4. Divide batter evenly in muffin tins. Bake for 16-22 minutes, until a toothpick inserted into the center of the muffin comes out clean. Allow to cool for 5 minutes in the pan. Transfer to a wire rack to cool completely.
5. Keep them in the fridge in an airtight container for up to 5 days. Slather with butter or cream cheese or eat them plain. The muffins can also be frozen for up to 2 months.
Location:
The Village Chapel 10 Azalea Rd, Pinehurst, NC 28374
Cost:
$25- For family caregivers, community members, students, clergy
$75 - For Professionals, includes 4 CEUs
For questions, email apiper@dementianc.org or call (919) 832-3732 ext. 103
Hosted By:
October 24, 2024 9:00 am - 3:30 pm
Whether you are new to caregiving for someone with dementia or have been doing it for years, this event is for you! Join us, in person for education sessions, resource exhibitors and time for networking with other caregivers.
Featured Speakers include: Dr Karen Sullivan, Pinehurst Neuropsychology
Jennifer Tyner, Aging Outreach Services
Emily Tobias, Gill & Tobias Law
Suzanne Lafolette-Black, AARP
More information to know
Check-in, visiting with exhibitors, and breakfast begin at 9 am, the symposium begins at 10 am
Local and state resource information will be on hand as well as experts in a variety of dementia-related fields. Lunch and snacks are also included
