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Best Practices

Working With Individuals With Dementia Who Rummage and Hoard

People with dementia experience memory loss, mental confusion, disorientation, impaired judgment and behavioral changes, which may include rummaging and hoarding. The following information may be helpful to you when working with individuals who are experiencing these symptoms.

People with dementia may spend excessive amounts of time rummaging through their possessions. This may happen because they are searching for items they have misplaced or hidden. Oftentimes, people with dementia hide their possessions, forget where they have hidden them, and then blame others for stealing them.

Rummaging behavior may also result from boredom as people with dementia find it difficult to initiate activities and rely on others to keep them active. Quite often, redirecting individuals to activities that they enjoy, such as music, gardening, and/or meal preparation, can help distract them from engaging in distressing behaviors. For individuals in the later stages of dementia, certain repetitious activities, such as folding napkins or sorting colored socks, can satisfy the need to be active and engaged.

Some people will hoard or save numerous items, including dirty clothes, food, and papers. Keep in mind that individuals with dementia are continuously losing parts of their lives. Losing a meaningful role in life, an income, friends, family, and a good memory can have an impact on a person's need to hoard and or to "keep things safe". Hoarding in this population is oftentimes triggered by the fear of being robbed.

When working with persons who have dementia, it is essential that you keep their safety in mind as they become increasingly unable to protect themselves. Order, routine and simplicity are most helpful and a house or apartment that is relatively uncluttered is the ideal environment.

Tips to Consider
  1. Building trust – Any changes you make in the home of a person with dementia could cause the person to become very anxious and agitated. It is essential, therefore, that you build a sense of trust between yourself and your client before you attempt to make any changes at all.

  2. Focus on fire prevention – Check for papers stored on top of or inside a stove or microwave, and near working radiators. Make certain your client has a working smoke alarm and arrange for someone to test it monthly.

  3. Focus on preventing poisonous ingestion – Be aware that people with dementia may not recognize that some things are not good to eat. Keep potentially dangerous materials such as cleaning fluids, plant soil, lotions, and medicines out of reach. Check the refrigerator on a regular basis to make sure that rotten food is thrown away.

  4. Focus on fall prevention – Make certain that pathways are clear and that there are no slippery rugs that could cause falls. Keep in mind that some frail adults hold onto furniture while moving through the home. Observe how your client gets around and make sure that these supports are stable.

  5. Minimize the number of hiding places by locking unused closets or doors Put signs that say "NO" or "STOP" on places that you want the person to stay out of. Note: This may not work for people who are advanced in the illness.

  6. Limit the amount of valuables or cash that are within reach of the person with

  7. Keep the amount of junk mail to a minimum so the person has less to manage. If possible, arrange for bills to be sent to some one else for payment.

  8. Remove non-essentials such as out of season clothing to lessen the amount of clutter. Remember, however, that a person with dementia will experience increased anxiety if she/he believes that these possessions have been stolen.

  9. Understand coping mechanisms – For example, some people with dementia keep their belongings, including clothing, out in the open otherwise they forget where they have placed them. This coping mechanism, with oversight by a caregiver, may help a person continue to function in the beginning or middle stages of the disease. Other individuals may be willing to put their belongings away if large signs or labels, such as "Socks" or "Blouses" help them identify the location of their possessions.

  10. Fill a drawer full of "odds and ends" for the person to enjoy rummaging through.

  11. Check wastebaskets for "lost" items before they are emptied.

  12. Provide support such as home care for on-going maintenance.

  13. Learn their hiding places – If a person hides things, learning where their favorite hiding places are will help you locate their important items. Items are often put in the same places, such as under carpets or mattresses and in shoes, handbags, coat pockets, or drawers.

  14. Keep duplicates of important items such as glasses, hearing aids, keys, etc. as back-up. Have the client's doctor's name on hand if duplicate prescriptions need to be filled.

  15. Remove discarded items immediately – If you are removing items from your client's home, it is best to remove them immediately from the premises or your client may rummage through the garbage and bring them back into the house.

Rosemary Bakker, MS, ASID
Weill Medical College of Cornell University

Paulette Michaud, LMSW
Manager, Education & Training
Alzheimer's Association, NYC Chapter
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New York-Presbyterian. The University Hospitals of Columbia and Cornell