Hoarding Older Adults
Condition: Compulsive Hoarding
Study type: Interventional

Summary: 
      The purpose of this investigation is to examine treatment outcome of a new intervention for
      hoarding in older adults compared to standard case management for hoarding. The new
      intervention combines exposure therapy and cognitive remediation.
    

Detailed description: 
      Research has shown that hoarding disorder (HD) is debilitating chronic and progressive
      condition that has significant public health implications. Older adults represent the largest
      group of HD suffers due to increasing severity with age. Often, Veterans with HD are seen in
      the VA system and the status of their hoarding is never assessed. Providers are treating
      patients for other health and social service issues yet missing an important source of
      disability and distress. This insidious, often undetected condition leads to greater medical
      and social disability and is costly to the VA system as patients continue to decompensate.
      When HD is even detected, patients in the VA receive indefinite case management and
      inadequate treatment. The cases the investigators know about have caused significant
      financial burden to the investigators' system. Most importantly, HD causes significant
      impairment and poor quality of life for the Veterans, particularly older Veterans.
      Unfortunately, the investigators know nothing about how to treat late life HD. Nor do the
      investigators know how neurocognitive features impact treatment response, which the
      investigators strongly suspect influence treatment outcome. HD is a potentially treatable
      source of disability in the VA system - one that the VA must research and treat. This study
      represents the first randomized controlled trial of a novel intervention for the treatment of
      HD in older Veterans. The main objective of this proposal is to further refine and test a new
      treatment for hoarding in older Veterans (age 60-85) which will be accomplished through a
      series of treatment development phases (case series, open labeled trial) and a randomized
      controlled trial. The new treatment (Cognitive Remediation and Exposure Therapy for hoarding;
      CogRET) is hypothesis driven and based on late life anxiety literature, consultation with
      mentors, results of the pilot study using a standard cognitive-behavioral intervention, and
      several case series that will be completed prior to the start of the Career Development Award
      (CDA). The first draft of CogRET is complete and is currently being used with several case
      studies. The research and training plan is divided into 5 phases; 1) training and preparation
      2) training, further case studies using CogRET, further modification of CogRET 3)training,
      open label trial of CogRET, further modification of CogRET 4) randomized controlled trial and
      5) presenting, publishing, dissemination of results and submission of a VA Merit grant.
      Primary hypotheses include 1) when randomized to CogRET, older Veterans with HD will show
      significant decreases in acquisition, difficulty discarding, and excessive clutter compared
      to those randomized to case management and 2) executive functioning (EF) is a significant
      moderator of treatment response. Other mediators and moderates of treatment response
      (psychiatric, medical, demographic, etc.) will be explored.
    

Intervention name(s): Cognitive Rehabilitation and Exposure Therapy for Compulsive Hoarding; Case Management
Intervention type(s): Behavioral; Behavioral
Intervention description(s): The intervention includes cognitive remediation for deficits in executive functioning and exposure therapy for discarding/acquiring.; Case management
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: exposure therapy; case management; older adults; cognitive rehabilitation