Maggie was well-known in her neighbourhood for her eccentricity. Her neighbours knew her as someone with a bad temper, whom they should not offend, or she would be hurling vulgarities at them.
She was 75 years old and single, living in an elderly studio apartment. She enjoyed going out to churches and attending English and art classes at Community Centres. She prided herself for knowing how to take care of herself after her retirement as a health attendant. Hence, when the hospital doctor referred her to see a counsellor to help her cope with her newly diagnosed dementia, she was very resistant. O’Joy counsellor finally gained her trust and was allowed into Maggie’s home. Only did she realised the extent to which Maggie was not coping well on her own.
Her medications were lost in a mess on the table, some were expired, from different doctors, and wrongly labelled. She could not tell which ones she needed to take when. She often missed taking her medications, especially those for diabetes, putting her at risk of developing diabetes-related complications. Some food she bought and supposed to be kept in the fridge, were left outside and had turned mouldy. The water in the kettle was brown and cloudy. Her pot was stained with leftovers from the previous meal. There were ants and cockroaches running about in the apartment.
Her sofa was so full of things she had to clear away before she could sit down. Likewise with her bed. There were many cookbooks she had previously collected, as well as pamphlets she picked up outside that she meant to read in her free time. Here and there were free gifts given by promoters, as well as clothes donated to her by her church friend. She had many individual socks without the other matching one, so she kept buying new pairs of socks. She also had many pens and stationery lying all over the flat, some with no ink which she was not prepared to throw away because she intended to buy refills for them. With her clothes strewn everywhere, she could not tell if they had been worn or washed.
Her clutter was a symptom of her dementia which resulted in impaired cognitive ability to remember, think, plan, organise and to interact with others properly. She was not able to organise her belongings or decide on what to keep and what to throw. She wanted to recycle or donate things that most people would consider as waste. Any suggestions by the counsellor to help her tidy up and re-organise was met with great resistance, fear and anxiety.
Even though some services were put in place initially to help her to continue living in the community, such as medication packing and monitoring by a home care nurse, medical escort and transport services to make sure she did not miss her doctor’s appointment and meals-on-wheels delivery to make sure she ate well, Maggie was eventually unable to take care of her basic needs. She was repeatedly admitted to the hospital for dehydration or stomach-aches for eating unclean food. Maggie was eventually persuaded to stay in a dementia nursing home. Her physical well-being improved and her anxiety reduced significantly after she was cared for in a structured way and led a routine life with activities she enjoyed, including making art, gardening and taking walks in the garden.
This case illustrated the need to take a holistic approach to caring for an elderly, especially since hoarding is only one of the many symptoms of dementia and it is not possible for an elderly with cognitive impairment to relearn how to keep her home tidy without a caregiver doing so for her.
(All names are not real, and details have been changed to protect the identity of these individuals)
Written by Chew Yat Peng, principal counsellor at O'Joy