Hoarding concerns rise as America ages
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The rise in hoarding disorder as America ages requires a national response, a new Senate report shared first with Axios says.
Why it matters: The prevalence and severity of hoarding disorder increases with age — and the U.S. population is growing older, making this a crucial moment for policymakers to address the condition.
- The federal government has taken little action so far, according to the report released by Sen. Bob Casey (D-Penn.), who chairs the Senate Special Committee on Aging.
- "My report is a first step to raising awareness of hoarding disorder — and the first time Congress has brought attention to the condition," he told Axios in an email.
The big picture: Hoarding disorder — a mental health condition associated with an inability to part with possessions that can create dangerous living conditions — affects about 2% of the general U.S. population and 6% of adults over 70 years old.
- The complex condition isn't solved by forcing people to declutter, the report notes.
- Hoarding disorder is treated through different types of psychotherapies. Harm reduction approaches to help people limit potential dangerous effects of cluttered spaces can also be helpful.
Zoom in: Living in extremely cluttered spaces can lead to health problems, including falls, social isolation and malnutrition as the space to prepare food shrinks. People living in these environments are more likely to misplace medications or bills.
- First responders also have a harder time getting to people in emergency situations if there are excessive possessions in their home, the report says.
- Hoarding also affects public health: Severe clutter can lead to mold or infestation problems that seep into neighbors' living spaces.
Hoarding disorder can be compounded by physical disabilities, said Gia Alexander, a resident of rural Texas who has hoarding disorder and contributed a written testimony to the report.
- Alexander is legally blind and has multiple sclerosis. Counseling has eased her hoarding behaviors, but she's still struggling to clear out her possessions because of the physical difficulties of doing so.
- Her insurance doesn't cover occupational therapy as a treatment for hoarding disorder, and even if it did, there aren't any services in her rural community she could call to help her declutter, she told Axios.
Where it stands: Federal offices charged with aiding mental and community health aren't sufficiently addressing hoarding disorder, the Aging Committee staff found.
- The Substance Abuse and Mental Health Services Administration and the Administration for Community Living don't run programs specifically centered on the condition. The Centers for Disease Control and Prevention doesn't have recent resources on hoarding available online.
- Some local communities run task forces on hoarding to provide education, support and links to helpful services. But these groups often lack funding and structure.
- State-run adult protective services offices often encounter hoarding cases, but they have limited ability to intervene, especially when a person doesn't want help, the report says.
To prepare the country for a probable increase in hoarding, the report suggests agencies improve data collection on how hoarding behaviors affect older adults and first responders, and launch awareness campaigns to help people understand hoarding.
- SAMHSA and other federal regulators working on health, housing and emergency response should provide training and assistance for local service providers on how to respond to hoarding disorder, the report recommends.
- The National Institutes of Health could convene researchers interested in studying hoarding disorder in older adults, the report states.
- It also suggests Congress work with the Centers for Medicare and Medicaid Services to expand coverage for hoarding treatments.
- Policymakers should also engage directly with people who have hoarding disorder and their families, it says.
Between the lines: When a hoarding case is identified, it can be difficult to figure out which organization or agency is responsible for responding and treating someone, said Randy Frost, a psychologist who studies hoarding and published the first systemic study on the disorder in 1993.
- "That's an issue — this question of who's got jurisdiction," said Frost, a professor emeritus at Smith College. Policymakers should help different agencies integrate services that could assist older adults with hoarding disorder, he added.
The bottom line: America's aging boom "will require the federal government to address issues that it has not previously prioritized," the report says. Hoarding disorder is one of them.
