Hoarding disorder (HD), recognized as a formal disorder in 2013 by DSM-5 (2013) ,1 is characterized by persistent difficulty in discarding objects. This leads to significantly cluttered living spaces, causing distress, impairment, and often negative consequences for the individual and their loved ones.2 The disorder affects approximately 1.5 % to 5.0 % of the general population, with higher rates observed in individuals over 60 and those with coexisting mental health conditions, particularly anxiety, OCD, and depression.2 Notably, one study found a significantly higher prevalence, 18.5 %, among residents in supported housing compared to the general population.3 Hoarding behavior can pose significant challenges for individuals in housing and healthcare settings. The prevalence of HD among older adults in Egypt is not explicitly stated in the available literature. However, it is essential to note that the population of older adults in Egypt is growing rapidly. The national census 2017 revealed a 2.56 % increase in the older adult population from the 2006 census, which is expected to double by 2031.4

Hoarding in long-term care (LTC) facilities is a substantial problem that warrants attention. Research has shown that such symptoms are widespread among older adults, usually beginning before age 40 and intensifying after middle age. The limited space in geriatric homes can exacerbate hoarding tendencies. These can result in problems in LTC facilities, including difficulties meeting regulatory standards, safety risks for residents and staff, and effects on residents' overall quality of life and well-being. Furthermore, clutter can increase the risk of fires in a person's room or cause a fire to spread more rapidly. This is particularly alarming in a geriatric home where many residents live nearby.5

Hoarding disorder presents a unique and complex challenge among geriatric home residents. While their possessions may offer a comforting sense of reassurance, productivity, and self-control 6 they can also become a source of isolation and alienation from peers. This paradox lies at the heart of this condition, where items that provide emotional connection and a link to personal history can inadvertently build walls between individuals.7 This can significantly impact the quality of life and overall well-being, further fueling the cycle of isolation and loneliness 0.8

The social functioning of older adults is recognized as an integral component of their overall life experience. The social network of these individuals plays a pivotal role in promoting their health and well-being.8 However, there is a paucity of research investigating the correlation between hoarding symptoms in older adults and their social functioning.9 When social functioning was examined in the context of hoarding symptoms among the geriatric population, it was discovered that clutter significantly impedes the continuity of these functions and relationships.6 It has been documented that older adults exhibiting hoarding symptoms often harbor various beliefs, memories, emotional attachments, control mechanisms, and responsibilities about their possessions, which can precipitate interpersonal conflicts.6 Interestingly, even older adults who maintain satisfactory interpersonal relationships often avoid inviting others into their cluttered homes due to feelings of shame and embarrassment.10

However, hoarding symptoms and social functioning are complex and intertwined. It was found that supportive social networks may act as a protective factor against hoarding tendencies, potentially via several mechanisms. The presence of close others can mitigate feelings of isolation and loneliness, contributing to a stronger sense of belonging and security, thus dampening the urge to hoard as a coping mechanism.6,11 Social support can facilitate organized decluttering efforts through practical assistance with sorting, disposal, and even gentle negotiation.11 Sometimes, family or friends may even intervene to mandate clutter removal, though this requires careful consideration to avoid exacerbating conflict.6

Compounding this challenge is the unfortunate reality that hoarding disorder in geriatric settings often goes unrecognized and untreated. This may be due to a lack of awareness among staff, the inherent sensitivity of intervening in personal living spaces, or the stigma associated with mental health conditions in older adults. Additionally, individuals with hoarding symptoms frequently exhibit an intolerance of uncertainty and a tendency to avoid unfamiliar situations or experiences.12 This can make engaging in activities or socializing difficult, further contributing to their social isolation.

Nurses and caregivers working with older adults in long-term care institutions often face challenges when addressing the consequences of residents displaying compulsive hoarding behavior. It is essential for these healthcare professionals, who may be more familiar with handling prevalent behavioral symptoms in nursing homes, to understand compulsive hoarding behavior comprehensively. They must be equipped with the knowledge to assess and intervene in these situations effectively. This study underscores the pressing need for additional research. Given the limited literature in Egypt and the MENA region, they acknowledged hoarding tendencies and their correlation with social functioning among older adults. Therefore, this study investigated the association between hoarding symptoms and social functioning among long-term care older adult residents.

This study hypothesized that long-term care older adult residents with high hoarding symptoms would have impaired social functioning.