Geriatric Care Manager ‘s have many areas of expertise- one of them is hoarding.

Who is hoarder? According to geriatric care manager and hoarding expert Emily Saltz it’s a person who acquires then fails to discard things—say, 30 years of National Geographic—that seem to be useless or of limited value. It is also someone who lives in a home that is so cluttered that it stops activities that those spaces were designed for (a bedroom with a bed where clothes are piled mattress to ceiling, resulting in the hoarder sleeping on the couch). A hoarder is a person who either is significantly distressed or functions poorly as a result of the hoarding (a person who can’t have the plumber or anyone come to the house to fix things because the house is too filled with “stuff,” and worse, their hoarding would be revealed).

Hoarding is also collecting gone mad. Instead of acquiring and discarding, a hoarder just acquires and rarely discards. An example is a person who loves those collector plates that you put on the wall. She orders them over the years but never discards them or puts them on the wall, so every room in the house is stacked with boxes of collector plates.

This is a serious problem in our culture, yet it is so underreported that only 5 percent of hoarding is reported to the authorities such as Adult Protective Services. Only 40 percent of hoarders are mentally ill. The rest appear to have personality disorders, with a cluster of symptoms including reclusiveness, suspiciousness, and obstinacy and isolating tendencies. About 20–30 percent of hoarders have obsessive-compulsive tendencies, and 20 percent have dementia. It usually begins in childhood or adolescence, and 80 percent of hoarders had someone in their family who hoarded, like a sibling.

The typical hoarder is a woman, lives alone, is socially isolated, has symptoms of anxiety and depression, and has poor insight, so she denies the problems. Hoarding has nothing to do with income; and in fact, Jacqueline Kennedy’s cousins, the famous mother and daughter in Grey Gardens are hoarders.

It has nothing to do with IQ, as the average hoarder has an IQ of 115 or above. Excessive buying or acquiring possessions almost always accompanies hoarding. Acquisitions can be anything from those collector plates, clothes, cats, parts of computers, to TVs. Hoarders don’t just buy them on eBay or the shopping channel but also purchase at Goodwill or tag sales and are even dumpster divers. Hoarding is the bane of the aging family. Fifty percent of the referrals made to Adult Protective Services are for self-neglect and hoarding. As we age we move into our last decades with sometimes thousand of pounds of unnecessary possessions. Older people may have been collecting their “hoard” for 70 or 80 years with no one telling them that this is a problem. Family and sometimes neighbors, who “smell” the hoard, confront them in old age.

Or the traumas of widowhood or any of the severe losses of old age may trigger the need to hoard. There is actually a dearth of research and training in hoarding.

Emily Saltz, edited an excellent issue of The Journal of Geriatric Care Management Hoarding and Elders: Current Trends, Dilemmas and Solutions in Journal of Geriatric Care Management, Volume 20, Issue 2, Fall 2010.

For those of you who have read Dickens’s Great Expectations, think of poor Miss Havisham, sitting in the “airless room that was oppressive and hidden.” Pip, the main character, looks at her dust-covered, spider web–encased table from her long aborted wedding feast. In the center is a nightmarish centerpiece “overhung with cobwebs, speckled legged spiders with blotchy bodies running in and out of it, mice running in the walls in the background, revealed to be her long ago wedding cake.” Like any hoarder,

Miss Havisham has an aching story to tell. She has kept this moldy, dirt-encased, bug-infested wedding feast for decades after being abandoned at the altar. Her beloved fled, and she became an isolationist who was full of despair. She was a mean secret hoarder. (Hoarding is sometimes called Havisham syndrome.) But at the heart of her “hoard” was her long ago abandonment, a step away from her wedding, where her long-lost husband-to-be fled. It wasn’t about her “stuff,” it was about her heart.

If you have a Miss Havisham in your family, call a geriatric care manager