Using Motivational Interviewing to Treat Hoarding Symptoms in a Rural-Dwelling Older Adult: A Case Study

There are few interventions adapted specifically for older adults with hoarding disorder (HD). Efficacy for cognitive-behavioral therapy (most commonly used in HD cases) is limited in older adults, potentially due to poor fit between the mechanism of change being activated (fear reduction) and the underlying etiology of late-life hoarding disorder, which is characterized by less distress with discarding. This study describes the use of in-home motivational interviewing for late-life hoarding disorder for an individual enrolled in an ongoing clinical trial. The intervention involves conversing with participants as they sort items in their own homes and using motivational interviewing techniques to reduce ambivalence towards behavioral change. This participant’s presentation seemed to fit well within the expectations of late-life hoarding disorder (lower distress with discarding), and motivational interviewing techniques successfully elicited change-related statements during treatment sessions. Over the course of 16 sessions, the participant demonstrated an increased level of readiness for change and lower levels of object attachment. At a three-month follow-up meeting, he indicated that he had continued to pursue his goals of decluttering at home and within his workspace. This study demonstrates the utility of motivational interviewing in cases where cognitive behavioral therapy may be ineffective or contraindicated to influence symptom change in late-life hoarding disorder. Clinicaltrials.gov ID: NCT05237466; Motivational Interviewing to Enhance Behavioral Change in Older Adults with Hoarding Disorder; https://clinicaltrials.gov/study/NCT05237466 .