Hoarding Older Adults
26 giugno 2018 aggiornato da: VA Office of Research and Development
Treatment of Late Life Compulsive Hoarding
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.
Panoramica dello studio
Stato
Completato
Condizioni
Descrizione dettagliata
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.
Tipo di studio
Interventistico
Iscrizione (Effettivo)
58
Fase
- Non applicabile
Contatti e Sedi
Questa sezione fornisce i recapiti di coloro che conducono lo studio e informazioni su dove viene condotto lo studio.
Luoghi di studio
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California
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San Diego, California, Stati Uniti, 92161
- VA San Diego Healthcare System, San Diego, CA
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Criteri di partecipazione
I ricercatori cercano persone che corrispondano a una certa descrizione, chiamata criteri di ammissibilità. Alcuni esempi di questi criteri sono le condizioni generali di salute di una persona o trattamenti precedenti.
Criteri di ammissibilità
Età idonea allo studio
Da 60 anni a 85 anni (Adulto, Adulto più anziano)
Accetta volontari sani
No
Sessi ammissibili allo studio
Tutto
Descrizione
Inclusion Criteria:
Participants must be between the ages of 60 - 85 years old and meet clinical criteria for Compulsive Hoarding (CH) developed by the Steketee and Frost (2000) research group. These criteria include:
- significant amount of clutter in active living spaces
- the urge to collect, buy, or acquire things
- an extreme reluctance to part with items
- clutter accumulation that causes distress or interferes with functioning
- symptom duration of at least 6 months
- the reluctance to part with items is not accounted for by other psychiatric conditions.
To be enrolled, patients must have:
- a score of 20 or greater on the University of California, Los Angeles Hoarding Severity Scale (UHSS)
- 40 or greater on the Savings Inventory-Revised (SI-R)
- severity rating of 4 or higher on the Anxiety Disorders Interview Schedule (ADIS-IV) rating scales for clutter and difficulty discarding
- and diagnosis confirmed at a consensus conference including at least two licensed professionals with expertise in CH (myself and at least one mentor).
Exclusion Criteria:
- Individuals with moderate to severe cognitive deficits (scores below 23 on the MMSE) will be excluded.
- Prospective participants must not have active substance abuse problems.
- Participants will also be excluded if they are currently in other forms of psychotherapy.
- Participants must have no change in any psychotropic medications for at least three months prior to the initial assessment.
- Patients with current psychosis or mania will be excluded.
- Mood and anxiety disorders are permitted as long as compulsive hoarding is the primary diagnosis.
- Participants will are not eligible if they have active suicidal ideation, those participants will be given immediate medical or mental health attention.
Piano di studio
Questa sezione fornisce i dettagli del piano di studio, compreso il modo in cui lo studio è progettato e ciò che lo studio sta misurando.
Come è strutturato lo studio?
Dettagli di progettazione
- Scopo principale: Trattamento
- Assegnazione: Randomizzato
- Modello interventistico: Assegnazione parallela
- Mascheramento: Separare
Armi e interventi
Gruppo di partecipanti / Arm |
Intervento / Trattamento |
|---|---|
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Sperimentale: Arm 1: Cognitive Rehabilitation
Cognitive rehabilitation and exposure therapy for hoarding
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The intervention includes cognitive remediation for deficits in executive functioning and exposure therapy for discarding/acquiring.
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Comparatore attivo: Arm 2: Case Management
Case management
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Case management
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Cosa sta misurando lo studio?
Misure di risultato primarie
Misura del risultato |
Misura Descrizione |
Lasso di tempo |
|---|---|---|
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Hoarding Symptom Severity as Measured by the Saving Inventory-Revised (SI-R) at 6 Months
Lasso di tempo: 6 months
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Hoarding symptom severity (primary outcome) will be measured using the Savings Inventory-Revised (SI-R), a 23-item self-report measure used to assess common hoarding symptoms.
Subtests include excessive clutter, compulsive acquisition, and difficulty discarding.
The SI-R has demonstrated good internal consistency, divergent validity, concurrent validity, divergent validity, test-retest reliability in clinical samples with hoarding.
The total score will be used for analyses.
The range of the total score is 0-92, with higher scores indicating worse hoarding severity.
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6 months
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Misure di risultato secondarie
Misura del risultato |
Misura Descrizione |
Lasso di tempo |
|---|---|---|
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The Activities of Daily Living in Hoarding (ADL-H)
Lasso di tempo: 6 months
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The Activities of Daily Living in Hoarding (ADL-H) was used to assess functional impairment.
Higher scores represent increased impairment.
Mean score is 1-75, with higher scores indicating worse impairment due to hoarding.
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6 months
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Executive Functioning as Measured by the Delis Kaplan Executive Functioning System (D-KEFS) at 6 Months
Lasso di tempo: 6 months
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The D-KEFS Trail Making Test Condition 4: Number-Letter Switching Scaled Score was used to assess executive functioning.
Scaled scores range from 1-19.
Higher scores represent less impairment.
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6 months
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Collaboratori e investigatori
Qui è dove troverai le persone e le organizzazioni coinvolte in questo studio.
Investigatori
- Investigatore principale: Catherine R Ayers, PhD, VA San Diego Healthcare System, San Diego, CA
Pubblicazioni e link utili
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Studiare le date dei record
Queste date tengono traccia dell'avanzamento della registrazione dello studio e dell'invio dei risultati di sintesi a ClinicalTrials.gov. I record degli studi e i risultati riportati vengono esaminati dalla National Library of Medicine (NLM) per assicurarsi che soddisfino specifici standard di controllo della qualità prima di essere pubblicati sul sito Web pubblico.
Studia le date principali
Inizio studio
1 novembre 2010
Completamento primario (Effettivo)
1 aprile 2015
Completamento dello studio (Effettivo)
1 aprile 2015
Date di iscrizione allo studio
Primo inviato
20 ottobre 2010
Primo inviato che soddisfa i criteri di controllo qualità
20 ottobre 2010
Primo Inserito (Stima)
22 ottobre 2010
Aggiornamenti dei record di studio
Ultimo aggiornamento pubblicato (Effettivo)
24 luglio 2018
Ultimo aggiornamento inviato che soddisfa i criteri QC
26 giugno 2018
Ultimo verificato
1 giugno 2018
Maggiori informazioni
Termini relativi a questo studio
Altri numeri di identificazione dello studio
- CSRD-068-10S
Queste informazioni sono state recuperate direttamente dal sito web clinicaltrials.gov senza alcuna modifica. In caso di richieste di modifica, rimozione o aggiornamento dei dettagli dello studio, contattare register@clinicaltrials.gov. Non appena verrà implementata una modifica su clinicaltrials.gov, questa verrà aggiornata automaticamente anche sul nostro sito web .