Conquering the 'Collected Treasures' of Older Adults With Dementia: A Qualitative Study on Caregiver Strategies and Challenges

Aim: To explore hoarding scenarios in older adults with dementia, document management strategies and assess caregiver challenges in these scenarios.

Design: This study employed interpretative phenomenological analysis to guide data collection and analysis.

Methods: Purposive sampling recruited 20 caregivers of older adults with dementia from long-term care facilities and community elderly centres in Taiwan. Semi-structured interviews, lasting for about 1 h, were conducted with caregivers of older adults with dementia. The study's quality was assessed using five techniques: peer debriefing, member checking, inter-coder agreement, audit trail, and thick description.

Results: Key themes included hoarding scenarios, checkpoints of pre-decluttering, attitudes towards hoarding, language used for communication, management approaches for decluttering and caregivers' challenges. Caregivers highlighted the importance of assessing the emotions, cognitive function and backgrounds of older adults with dementia before decluttering for effective management. The onion skin peeling method for gradual decluttering was recommended. Success was more likely when caregivers maintained a positive attitude and adapted communication to the speech patterns of older adults with dementia. Challenges arose from ineffective communication, extreme resistance to decluttering and the need to work in highly unpleasant environments.

Conclusion: Caregivers face a range of complex challenges when managing hoarding behaviours in older adults with dementia. Pre-decluttering assessments, a positive caregiving attitude, effective communication and stepwise decluttering strategies can enhance the care experience and support caregivers and individuals with hoarding tendencies.

Impact: Managing hoarding behaviours in older adults with dementia requires comprehensive cognitive and emotional assessments, collaborative decluttering and tailored communication. The CALM guideline from this study provides an evidence-based framework for advanced nursing practice in this area. Through interdisciplinary leadership, refining guideline use and developing training programmes, nurses can standardise and enhance care quality, fostering adaptive, supportive environments for individuals with dementia and hoarding behaviours.

Patient or public contribution: Not applicable.