Preliminary data on barriers to treatment engagement in older adults with hoarding disorder in rural mississippi

Introduction Neurocognitive functions are associated with specific pathways or loci within the brain. Neurocognitive testing can be used to deduce which areas of the brain are involved when cognitive problems are suspected (Watson, 2014). Hoarding disorder refers to a compulsion that involves the persistent collection of items others may perceive to be useless or trivial (e.g., old newspapers). Hoarding is marked by three major characteristics: difficulty letting go of material possessions, compulsive acquisition of new items, and excessive clutter (American Psychiatric Association, 2013). Deficits across multiple aspects of cognitive functioning, including categorization, set shifting, working memory, concentration, and mental control, have been associated with hoarding across the lifespan (Ayers et al., 2013). Some older adults who suffer from hoarding disorder fear that they will not remember events unless objects are out in the open to serve as reminders and give the individual an increased sense of self (Belk, 1991). The impulsive acquisition of possessions indicates difficulties with inhibitory control (Woody, 2021). The purpose of this study was to provide descriptive statistics for several treatment-relevant domains in older adults with hoarding disorder, including neurocognitive functioning, level of household clutter, and perceived barriers to sorting/discarding. Clutter tends to increase with age (Dozier et al., 2016). Older adults with cognitive impairment may be especially suspectable to issues with clutter and treatment engagement. Methods Thirteen older adults enrolled in a pilot treatment study for hoarding disorder completed the NIH Cognition Battery during their baseline assessment. The average age of participants was 62 (range 50-81) and the majority identified as female (n = 11). The majority of participants identified their race as White (n = 9); three participants identified as Black and one participant identified as American Indian. All assessment procedures took place in participants’ homes. The NIH Cognition Battery was administered using an iPad and includes measures of executive function, attention, episodic memory, language, processing speed, and working memory. Raw scores were transformed into T-scores correcting for age and education. Clutter was assessed at baseline using the Clutter Image Rating scale (CIR; Frost et al., 2008). At the second treatment session, participants reported on any barriers that kept them from sorting and discarding clutter in between sessions. Results Participants’ average scores on the NIH Cognition Battery domains were all within one standard deviation of the mean, with the exception of participants’ scores on a task of Attention (average T score = 39; standard deviation = 7.9, range 26-55). However, a notable percentage of participants scored less than one standard deviation below the mean on several tests (54% on Attention; 23% on Executive Functioning; 38% on Episodic Memory; 54% on Processing Speed; 8% on Language; 23% on Working Memory). On the CIR, participants reported a lower level of clutter than has been reported in more urban areas (mean = 2.6, SD = 1.05). At the second treatment session, participants reported an average of 1.5 barriers to discarding (range: 0 – 3). The barriers that were most frequently reported included distress due to discarding or sorting (n = 6) and feeling overwhelmed (n = 3). Conclusions Attention and processing speed were the two domains where participants demonstrated the most impairment. This may impact participants’ ability to engage in treatment by hindering their engagement within session. Participants with low levels of attention may need additional assistance to focus in session and for scheduling. Older adults in treatment for hoarding disorder may benefit from repeated instructions and a slower pace of intervention. Our research team is made up of a diverse group of individuals committed to fostering the self-actualization and well-being of older adults. Through our person-centered interventions we provide older adults with the opportunity to take control of their treatment pace. We believe this will encourage a more calm and satisfactory process of therapy and sorting practices that will, in the long term, lead to better treatment outcomes. It is a part of our mission to destigmatize geriatric care and the desire for treatment amongst ageing individuals. This research was funded by Research reported in this publication was supported by the American Psychological Foundation and the National Institute of Mental Health of the National Institutes of Health under Award Number R15MH127565. The content is solely the responsibility of the authors and does not necessarily represent the official views of the American Psychological Foundation or the National Institutes of Health.