We all like collecting knick knacks. Small things that adorn our cabinets. What are sideboards for if not to store such mementos?

We have a lifetime of collecting things that make us feel comfortable and secure. Perhaps they remind us of past happiness. However, when these collections grow to such an extent that they start interfering with our daily routine, then that behaviour becomes more than just collecting, it becomes hoarding.

Hoarding is a disorder with which individuals have a tendency to acquire items, regardless of whether these items have value, and fail to discard a large number of these items.

Although hoarding can be found in people of any age, it is more common among older adults because they have had more opportunities to collect. In some cases, they are unaware that their living circumstances pose a danger to themselves and to others. The behaviour starts simple enough and accumulates slowly. They do not throw stuff out, ever. Even when they become aware of the problem, they are unable to change their behaviour on their own.

In most long-term cases, hoarding results in a dangerous home environment. I have personally gone into the home of a retired lawyer, where stacks of newspapers covered all the walls six feet high with only a narrow passageway from one room to another. These were all the newspapers she received in the last 20 years. She never threw any out. Other than the unhygienic conditions, older adults are killed as a result of hoarding either when there is a fire, or the clutter falls on them and entombs them alive.

Compulsive hoarding is not only a health and safety issue, it is also an expression of psychological trauma

As many as one in 25 older adults are thought to hoard, and it gets worse with age. In 2016 in Malta this statistic would indicate that there are 3,165 older Maltese (65 years and older) who hoard. But they remain hidden. Because people who hoard often don’t see it as a problem, the only way to identify them is through someone referring them to authorities.

Maltese psychiatrist Peter Ferry reports a case where a nephew of an 83-year-old woman came to see him. Eventually Ferry diagnosed this older woman with mild dementia and Diogenes Syndrome – extreme self-neglect.

Hoarding disorder has recently been reclassified as a separate disorder in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

Prior to this new classification, hoarding was listed as obsessive-compulsive disorder (OCD) but it was not well described there. The new designation identifies hoarding as a separate disease but the only help today is still by treating it as OCD.

Initially, families or caregivers might approach the problem as simply an issue of cleaning up the house or apartment. But compulsive hoarding is not only a health and safety issue, it is also an expression of psychological trauma. If we don’t address the underlying problem – the reasons for hoarding – the behaviour will come back within a few months. If you suspect a hoarding situation in your neighbourhood or with a family member, you need to seek professional help.

Hoarding by itself might be a nuisance but it is an indication of more serious psychological trauma. There are many reasons for this trauma; some that might be from childhood, others might be due to emerging problems with thinking and behaviour.

Addressing the root of the problem of hoarding might resolve long-standing issues, and make lives safer and more meaningful. But there is a problem

in Malta.

A 2012 report compiled by Dorianne Farrugia and Deborah Stoner on 6,000 older Maltese (75 years and older) living in the community found surprising high occurrence of isolation. One in six older adults live alone. These are mainly women – because they live longer – and they tend not to seek help, even if that help existed.

In addition, hoarding is a difficult topic to bring up. Older Maltese are likely to have experienced great deprivation in the past and storing things is part of our siege mentality. Because we live on an island, stuff is expensive and therefore we tend to store things as a matter of being frugal.

Because hoarding is an indication of broader problems, there might be reluctance by the family to seek help. We might not want to expose past problems.

We also have a lack of mental health services. There is no Hoarding Task Force or support group. All of these factors make addressing hoarding that much more difficult but not impossible.

By identifying hoarding among loved ones, and then seeking social or medical help, we can start the process of healing.

Because older adults are more likely to have other health problems as well as hoarding, it is going to be difficult to address them all. But if nothing is done, hoarding will continue to grow.

Mario Garrett was born in Malta and is currently a professor of gerontology at San Diego State University in California, US.

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