Implementation and evaluation of a community-based treatment for late-life hoarding

Abstract

Objectives: The objective of this paper was to examine the implementation and effectiveness of a community-based intervention for hoarding disorder (HD) using Cognitive Rehabilitation and Exposure/Sorting Therapy (CREST). Design: This was a mixed-method, pre-post quasi-experimental study informed by the Practical, Robust Implementation and Sustainability Model for implementation science. Setting: Program activities took place in San Diego County, mainly within clients’ homes or community, with some activities in-office. Participants: Participants were aged 60 years or older, met eligibility for Medi-Cal or were uninsured, and met criteria for HD. Intervention: A manualized, mobile protocol that incorporated CREST was utilized. Measurements: The Clutter Image Rating and Hoarding Rating Scale were used as effectiveness outcomes. An investigator-created staff questionnaire was used to evaluate implementation. Results: Thirty-seven clients were reached and enrolled in treatment and 15 completed treatment during the initial 2 years of the program. There were significant changes in hoarding severity and clutter volume. Based on the initial 2 years of the program, funding was provided for expansion to cover additional San Diego County regions and hire more staff clinicians in year three. Conclusion: Preliminary data suggest that the CREST intervention can be successfully implemented in a community setting with positive results for older adults with HD.

Evidence to guide ethical decision‐making in the management of older people living in squalor: a narrative review

“…CBT on its own produces minimal improvement in older people, 44–48 but CBT with practical in‐home support can reduce depression and hoarding severity 49 . A more effective intervention is Cognitive Rehabilitation and Exposure/Sorting Therapy (CREST), which is a manualised treatment protocol that targets memory, executive functioning, exposure challenge and relapse prevention strategies 42,50–52 . CREST is more effective in reducing hoarding severity compared with case management immediately post‐intervention (78% vs 28% responder rate respectively), 50 yet showed little difference after 12 months 42 …”

“…49 A more effective intervention is Cognitive Rehabilitation and Exposure/Sorting Therapy (CREST), which is a manualised treatment protocol that targets memory, executive functioning, exposure challenge and relapse prevention strategies. 42,[50][51][52] CREST is more effective in reducing hoarding severity compared with case management immediately post-intervention (78% vs 28% responder rate respectively), 50 yet showed little difference after 12 months. 42 Alternatively, compassion-focussed therapy (CFT), which emphasises emotion regulation through mindfulness and compassion imagery, treats individuals by physiologically activating the parasympathetic nervous system to achieve settling and soothing states during decluttering efforts.…”

Randomized Controlled Trials and Quasi-Experimental Therapies for Hoarding Disorder: A Review of the Literature

“…The characteristics of all the research articles used in this literature study were published between 2011-2021. Three studies used quasiexperimental methods [14][15][16], one used mixedmethods and quasi-experimental [7], and one used an RCT [17]. Of the five articles reviewed, four therapies were conducted in the USA [7,[14][15]17) and one in Australia [16].…”

“…Symptoms are most likely to occur before the Therapies using Randomized … Nur Hidayati, Nazla Nida, Iwan Shalahuddin 127 age of 20 and continue to develop with age [6]. This can be seen from the prevalence in the elderly, which is three times higher than the prevalence in the general population [7]. Several factors that cause hoarding are genetics, beliefs, neurocognitive function, personality factors, attachment to possessions, avoidance behavior, and life events.…”

Assessment and treatment of hoarding disorder in rural-dwelling older adults.

“…For individuals with executive dysfunction, treatments that focus more on behavioral strategies may be effective. For example, Ayers and colleagues found promising results in older adults using a combination of cognitive rehabilitation and exposure therapy (CREST; Ayers et al, 2018), and this intervention was successfully implemented as a community-based intervention in San Diego County (Pittman et al, 2020).…”