Hoarding and the Holidays

During the holiday season, we have occasion to interact with friends, neighbors and family members that we may not see very often. These holiday visits may reveal problems that we were not previously aware of. A problem that often goes unnoticed or overlooked is hoarding. According to the medical staff at the Mayo Clinic, hoarding is the excessive collection of items, along with the inability to discard them. While it is not uncommon for older adults to hold on to items that we would usually discard, when this tendency becomes excessive, and interferes with their ability to function and threatens their health, it can no longer be ignored. The home of a hoarder is unmistakable – there are piles everywhere and often only a narrow path remains to get around the house. Hoarding animals is a commonly example and the person may have as many as a hundred pets that are kept in conditions that are unsanitary.

Hoarding is often associated with an anxiety disorder called Obsessive Compulsive Disorder (OCD); however, some individuals who hoard do not have OCD. Therefore it may make sense to understand hoarding as a separate condition that has its own characteristics and treatment. Hoarding behavior appears to occur on a continuum ranging from mild to severe. Mild hoarding does not usually interfere with a person’s ability to function and is not usually identified as a problem by those who know the individual. Severe hoarding can lead to life threatening situations because of the unsanitary and hazardous conditions that typically exist in a hoarding environment.

It is not clear what causes hoarding, but it tends to run in families and the characteristics are usually first manifest in the early teen years. The behavior gets worse over time and that is why hoarders are usually only brought to the attention of authorities and the medical community when they reach their latter years. Other risk factors for hoarding include having a stressful life situation and it is more common in individuals who are socially isolated. Another identifying characteristic of hoarders is that they tend to be perfectionists and are very rigid about how things are done.

Just as the symptoms become worse with age, so the treatment becomes more difficult as a person gets older. Treatment is further complicated by the perception, by the hoarder, that there is nothing wrong with their basic need to collect things. They may concede that a specific situation is problematic, but they will not accept that there is anything wrong with the underlying tendency. How the person is approached can be pivotal in the success or failure of an intervention. A person who hoards will need reassurance about how their belongings will be handled and that the treatment staff have his/her interests in mind. Treatment is most likely to succeed if the ostensible focus of the treatment is something that the hoarder wants to change (i.e., something they subjectively experience as a problem). The inclusion of a trusted other can aid treatment. Attempts to treat hoarding have met with mixed success, but the most successful interventions combine psychotherapy (counseling that is aimed at understanding behavior and changing thoughts and behaviors) and medications (usually medications that effect serotonin levels in the brain).

Hoarding presents real and increasing danger to those who are afflicted and, because it tends to get worse over time, the earlier the person gets help the better. As family and friends of those who hoard, we may be in the best position to help the person understand that there is a problem and that treatment is needed. In cases of severe hoarding it may be necessary to get the authorities involved and for those over age 65 years county aging services may be the best place to start.

Help Your Parents Enjoy the Holidays - 6 Tips for the Season

The holiday season is a great time to get together with family to rekindle warm feelings and recall fond experiences from the past. However, family gatherings can also be stressful if we are not prepared or if we have expectations that cannot be met. As you prepare to gather with family this year, the staff of Helpwithmyparents.com offers some suggestions that will help you and the older members of your group have the best possible experience.

1- Be considerate
Remember that the older members of your group may not be able to maintain the same level of activity as the younger members, so plan activities that are suitable for all of the group. If an older family member suffers from memory difficulties avoid embarrassing them by asking them to recall an event from the past.

2- Be Prepared
If you are hosting the family gathering make sure that your home is accessible to older family members who may have limited mobility. Older members of your family group may not be as able to tolerate the noise and the strain of an extended gathering and it may be necessary to prepare a quiet room where they can rest.

3- Be Aware
If an older family member needs transportation make sure that it is arranged well in advance and that a suitable vehicle is available. If the older family member needs to take medication during the event make sure they bring it with them. Some medications will interact poorly with alcohol and it may be necessary to monitor the alcohol consumption of an older family member particularly if there is some loss of cognitive functioning.

4- Be Understanding
As we age our abilities and interests may also change, if an older family member cannot or does not want to engage in activities they may have engaged in in the past avoid attempting to persuade them to do so.

5- Be Open
Going into a holiday family gathering with expectations that are too rigid or inflexible will likely lead to disappointment for all, so try to open to the experiences as they occur and allow those present to be themselves.

6- Be…
Most importantly if we can relax and be our most warm, open and accepting selves, the holiday gathering can be a wonderful experience for all who attend.

Companion Site Launched

This week we decided to launch a companion site of HelpWithMyParents.com called HelpWithMyKids.com. In many ways this decision feels premature to me - the site still needs a lot of work on the topic pages and we have just begun to list providers who serve children and their parents. Nevertheless, the need is there, and the decision to publish the site now will spur us to action. It will also provide the opportunity for others to contribute as they see fit. The site is very similar in structure to the HelpWithMyParents site - it is in a wiki format so that those with expertise can contribute and providers of services can list themselves on the site.

Those of you, like me, who have young children and aging parents will quickly see why both websites are necessary. This point was brought home to me recently as I spoke at a conference on Multiple Sclerosis. I was demonstrating the information on the HelpWithMyParents site and a woman in the audience said that she thought the information was helpful, but that she would not have found it on her own because it was her child she needed help with not her parents.

I look forward to working with those of you who share my commitment to provide comprehensive and easily accessible information to people who are in need of services throughout the life span.

My Committment

In late 2006 after a visit from my good friend and colleague John Bowling I decided to start Helpwithmyparents.com. John and I have both worked for many years in the senior care industry - at first together as psychologists and later separately. John went on the work as an administrator and corporate officer for Silverado Senior Living and I operated outpatient psychiatric programs for seniors. John is now at Southern Oregon University where he continues to advance the cause of senior services and I am running a small outpatient mental health clinic in Salt Lake City.

When John and I get together we spend a lot of time talking about ideas and solutions to problems that we perceive. During that visit in 2006, one of the things we discussed was the difficulty the children of aging parents have finding comprehensive and coordinated information. It was shortly after this that I started working on Helpwithmyparents.com. My goal was, and remains, to provide a single website that can provide comprehensive informative content and information about all of the providers of services to seniors across the whole country. I want a person who lives on one side of the country to know all of the options that available to them, as they search for help for their parent(s), who may live on the other side of the country. I also want them to be able to access information about any situation, circumstance or illness that their parent may be dealing with.

This is an enormous task and it was two years before I felt ready to publish the site to web. The thing that finally allowed me to feel comfortable doing so was the decision to make all of the content pages into wikis (pages that can be edited by users), and to allow service providers to submit their own information to the site. In the 10 months since we launched the site we have made steady progress, but there is much that still needs to be done. Brent Pace has contributed significantly to the design and function of the site and Jeremy Rasmussen has worked wonders on the technical side. We are also now fortunate enough to have Carolyn Hunter whose knowledge of senior issues is proving invaluable to our ongoing efforts.

I made a decision early on that a website like Helpwithmyparents.com is only useful if it can provide free comprehensive and unencumbered access to users. Therefore we do not require people to log in to use the site and we do not charge providers to be listed on the site. I feel strongly that having free unencumbered access is the strength of Helpwithmyparents.com. My commitment to those who use the site is that we will never charge people to use the site and we will never charge businesses and organizations to be listed on the site.

It is my hope, and expectation, that we will be able to generate enough revenue through the banner ads that are available on the site to continue to fund the ongoing development and maintenance of the site, and that users will contribute to the content and provider information available.

The Critical Incident – Are you Prepared?

Most of us who have aging parents go about our daily lives without much thought about what our parents might need if they suddenly became incapacitated or severely ill. Our parents are relatively healthy and self-sufficient, but as they continue to age the likelihood that a critical incident will create a sudden need for us to intervene increases. At HelpWithMyParents.com we think of a critical incident as any event that rapidly changes the circumstances of an older adult, or couple, requiring rapid intervention by family or other concerned persons. Some common critical incidents include: a fall that results in significant injury, a death that exposes significant vulnerabilities in the surviving spouse, the onset of an acute illness (especially if it leads to a delirium). The critical incident may also result from an unexpected reaction to an elective surgery.

When these critical incidents occur, the need for action on the part of the adult children, and other caregivers, is often immediate and significant. The time and resource demands placed on loved ones can be very disruptive to their daily lives leaving them feeling overwhelmed. HelpWithMyParents.com was started as a response to the unmet need for a place that the adult children of aging parents could go to get all of their needs met when they are called to action.


There are several things that can be done to mitigate the impact of these critical incidents before they occur. The first thing is to make sure that there is a current set of advance directives. Beyond advance directives, it is also helpful to have a plan for who in the family (and non-family support system) will take on specific responsibilities. This type of planning may seem like a low priority when everything is going well, but a plan can be put together fairly quickly and the benefits down the road are significant for all involved.


If you would like to put together a plan to prepare for a critical incident but feel like you need help to do so contact us at helpformyparents.com and we will assist you.

Could it be Delirium?

I can’t tell you how many unfortunate situations I have seen that could have been avoided if someone had asked “could it be delirium?” I have seen people committed to psychiatric facilities where they were treated for psychosis and I have seen people assigned long-term guardians because of what was a temporary alteration in consciousness caused by an episode of delirium. If you have ever seen people during a delirium it is not hard to understand how this can happen – they are often highly agitated, they may make outlandish statements with no basis in reality and they may even hallucinate. The symptoms may also fluctuate over a relatively short period of time which can add to the confusion. The problem is that a delirium is often a short-term situation resulting from a reversible condition like an infection, dehydration or an unintended response to a medication. There are three basic clues to look for if you think the person is suffering from delirium.

The first clue that it might be delirium is that the onset of the symptoms is fairly rapid. If a person over 55 years with no history of hallucinations starts talking about seeing bugs crawling on the wall it is appropriate to ask “could this be delirium?”

The second clue that it might be a delirium is that the person is not oriented to person, place and/or time – They can’t they tell you basic things about who they are, where they are or they can’t tell you the day, the month and/or the year? During a delirium a person will also have difficulty focusing their attention for sustained periods and will often have to have questions repeated for them – if they can respond at all.

The third clue that it might be delirium is the presence of significant changes in the person’s life. For example, recent onset of physical symptoms (especially those consistent with a Urinary Tract Infection), changes in medications, recent surgeries (deliriums are common after anesthesia), or changes in eating, drinking or sleeping patterns?

It is also important to understand that delirium is not mutually exclusive with any other condition – i.e. a person with any other condition (e.g., dementia, bipolar illness) can still experience delirium. A person with dementia who develops a delirium as the result of a Urinary Tract Infection (UTI) may be overlooked because the symptoms are assumed to be part of the progression of the dementia. The key is the timeframe for the onset of the worsening of symptoms. If there is any question, consult a physician – a test for a UTI is simple and it is usually treatable.

It is not wise, or helpful, to try to diagnose delirium and its primary cause on your own. The diagnosis of delirium is tricky, even for doctors, and that is why so many get overlooked. If the clues mentioned above are present, it is advisable to get the person to a doctor as soon as possible and to ask the doctor “could this be delirium?”

Combating Helplessness – One Weed at a Time

I recently read the chapter on weeds in Michael Pollan’s book Second Nature and it seemed to me that there are some parallels between weeds and hopelessness, especially for those who live in the country’s nursing homes. I have been counseling nursing home residents for the past 12 years and in that time I have worked with people who have had such a profound sense of hopelessness that it seemed almost tangible. When I first started working with people in this state I would often leave the room feeling exhausted and like some of my own hope had been drained from me.

These experiences got me thinking a lot about hope and about why it is important to keep the flame of hope lit – even if it is just the pilot light. It seems to me that hope is what keeps us going even when we can see no ostensible reason to do so. So we must be vigilant and combat threats as they arise.

This is where the analogy to weeds comes in – if we have one or two weeds in our garden they are easy to ignore and they may even blend in with the other plants so as to be unnoticeable. However, as more weeds appear, they can no longer be ignored and if not dealt with they can easily take control of the garden. So it is with hopelessness – with losses and disappointments comes threats to our hope for the future. For many of us this is a normal part of life - we experience some feelings of hopelessness which we may ignore expecting that they will resolve without much special effort from us. However, if the situational factors support the spread of hopelessness and we continue to do nothing the insidious effect of hopelessness can take over our lives.

The sooner you begin to tackle the weed problem the better the chances of success, so it is with hopelessness. Nevertheless, it is always possible to make progress in the fight, and even when all seems lost improvement can be made. Most gardeners have their preferred tools for tackling a job and psychologists are no different. The choice of tools has a lot to do with how they have worked in the past and how comfortable we using them.

One of the most effective tools I have found in combating hopelessness is to change the subject. How I go out doing this varies based on the person I am working with and my relationship with them. Sometimes I will explain what tool I am using and what I expect it to do, and at other times I will subtly introduce the tool with no mention of its presence.

In nursing homes it is common to hear complaints about everything from family not visiting to the food that is served. I find that these complaints, while usually justified, serve to nourish hopelessness, so I will work to refocus the person to more positive themes. One of my favorite positive themes is gratitude and I will ask the person to tell me about the things that they are grateful for. I have found most people responsive to this intervention, but I have had a few people say that they could not think of anything that they were grateful for. When this happens I encourage them to think about things from the past that they are grateful for and I have not yet come across a person who has failed to find something they are grateful for. The wonderful thing about gratitude is that it is incompatible with hopelessness. You cannot in the same moment feel gratitude and hopelessness, and so in that moment it provides a person with respite and nourishes the seeds of hope (the stuff we want growing in our garden).

There are other great tools to fight hopelessness and so if, like me, you encounter hopelessness in your interactions with those you care for weed assiduously and do not let hope die.

Is My Dad Depressed?

The question of depression comes up frequently in my conversations with the children of aging parents – especially when there has been a recent significant loss. In answering this question it is important that we understand what depression is, how it is manifested differently among seniors and what are the things that mimic, or look like depression.

I think of depression as an impairment of mood that usually results in subjective distress and interferes with social and/or occupational functioning. It can result from internal factors or a response to external situations. Depression is not a normal part of the aging process. It occurs in 5-9% of women and 2-3% of men in the population at large and in about 5% of healthy elderly people. The prevalence of depression increases dramatically among those who are chronically ill and those living in residential care settings.

The symptoms of depression include: depressed mood (feelings of sadness sometimes accompanied by tearfulness), anhedonia (loss of interest in things that used to be enjoyable), weight loss/gain, insomnia/hypersomnia, fatigue, feelings of worthlessness and/or hopelessness, excessive guilt, problems with attention and decision making, and when severe can include persistent thoughts about death and suicidal ideation and/or intent.

Among seniors anhedonia is usually the primary symptom and depressed mood (the subjective feeling of being depressed) may be denied. The older depressed person is more likely to present with somatic symptoms (physical complaints for which there is no identified illness, or that are in excess of what would be expected for an illness). Cognitive symptoms may also be prominent particularly short-term memory loss and mental slowing.

If you think that your aging loved one may be depressed ask yourself – has there been a notable change in their involvement in the things that used to be enjoyable to them? Are they sleeping and eating well? Does there appear to have been a significant change in their mental capacity or short-term memory? If you answered yes to any of these questions then there your loved one should be evaluated for depression. I recommend starting the evaluation process with a physician who specializes in the treatment of older adults because he/she will know the medical conditions to assess that may be responsible for the symptoms. There are many systemic, neurologic and iatrogenic (caused by treatments – for example medication side-effects) that can cause or exacerbate depressive symptoms.

If the physician believes the person is depressed she/he can prescribe various treatments including counseling and/or medications. Both counseling and the newer anti-depressant medications have been found to be effective in the treatment of depression in older adults.

To Blog or Not to Blog

To Blog or not to Blog – that was my question. At 47 (I know - where have the years gone – it seems like only yesterday I was 29) I am among the last of the boomers and, like many of my peers, have an uneasy relationship with advancing technologies. However, the convenience and the expediency of the web and mobile devices have largely won me over, and while I am not ready to tweet (still not sure what that means) I am finally ready to Blog.

To Blog then - allow me to introduce myself - I am Tony Morrison a psychologist who specializes in working with seniors and the founder of http://www.helpwithmyparents.com/ . While my interests are largely around issues of aging and caring for older adults, I will be Blogging about a wide range of topics and events. I plan to Blog on the areas where I have experience including: depression, anxiety, the effect of aging on other mental health conditions, neuropsychological assessment as a tool for the diagnosis of dementia, the management of difficult behaviors and improving the quality of life for older adults and their families. I will also Blog about my observations of the senior care industry – where I see strengths and where I see problems. I will plan to comment on what I read in the news and on other Blogs. If I can summon the nerve, I may even Blog about my own experience of aging and, with children in grade school and parents in their 70’s, about being a part of the Sandwich Generation. I hope that some of you will join me, for at least part of this journey, and that together we learn how to better care for our aging family members and friends.