Our 2010 Annual Report, “A Day in the Life of an Academic Geriatric Nurse,” includes photographic profiles of 18 nurses who have received BAGNC awards or who play key roles in the program. To supplement the profiles, we will be posting interviews with several of these outstanding nurses over the next month. Today we feature Monika Eckfield, RN, PhD. She received a BAGNC predoctoral scholarship award in 2004 to 2006 to study the effects of hoarding behaviors in older adults.

JAHF: What inspired you to pursue a doctorate in geriatric nursing?

Monika: I had a master’s degree in geriatric nursing, and I was working as a geriatric care manager. Dr. Jeanie Kayser-Jones, who was the director of the Hartford Center of Geriatric Nursing Excellence at UCSF, encouraged me to get a PhD and introduced me to Dr. Meg Wallhagen, who became my mentor. Dr. Kayser-Jones was the biggest cheerleader for anyone thinking about going for a doctorate in geriatric nursing. Dr. Wallhagen told me about the opportunities offered by the BAGNC scholarship and encouraged me to apply.

JAHF: You’ve become one of the foremost experts on hoarding behaviors. How did you become interested in studying this area?

Monika: When I was working as a geriatric care manager, I had a few clients with hoarding and cluttering behaviors. They were reluctant to get rid of things and it complicated their ability to receive health care services in their home. One woman had fallen and gone to the hospital. She wanted to return home, but she was at risk for another fall. We wanted to clean up her apartment and install hand rails. She refused. We struggled with the issue of balancing an older adult’s autonomy with the need to provide a safe environment. At the time, there was very little information about hoarding behaviors in general, and even less on older adults with hoarding behaviors.

In 2004, I was accepted into the doctoral program at UCSF and also received a BAGNC predoctoral scholarship. My earlier experiences planted the seed for my dissertation research.

JAHF: What was your initial approach to this challenging problem?

Monika: I decided to perform a qualitative study to better understand older adults and hoarding behaviors, and to determine what type of help is most appropriate. I started by interviewing eight older adults for a pilot study. This helped me to refine my questions and to see if I could find people willing to talk to me. This behavior is generally kept behind closed doors. I wasn’t sure how much access I would get. What I discovered is that there are a lot of people who are struggling with this who would like to get help. They don’t know who to talk to. When they’ve sought help from a therapist, family member, or social worker, they’ve often been met with such negative reactions to their home environment that it completely puts them off. They’re afraid of losing control over their home if they allow anyone to help.

JAHF: Tell us about your dissertation study.

Monika: My intention was to recruit participants locally. So I gave flyers to social workers and case managers, and I put the information on the Web site of the Mental Health Association of San Francisco and on a local website called hoarders.org. Something that was eye-opening was that I got calls from all over the country from family members and from people with hoarding behaviors who were thrilled that someone was focused on older adults with these behaviors.

I interviewed 22 adults age 65 and older, six men and 16 women. My oldest participant was 91. Most of them lived alone. Most had hoarding behaviors to varying degrees all their lives. When you’re living with someone there tend to be checks and balances, and the home doesn’t get overwhelmingly cluttered. When a person gets divorced or becomes widowed they no longer have the checks and balances. Other life changes can also exacerbate hoarding behavior, such as health changes, social status changes, or retiring from work. These changes, which often are related to aging, can turn a situation that was manageable into a situation where it is more challenging to live at home safely. (See also “Massive Clean Up Is No Cure for Hoarding.”)

Just a few weeks ago, I successfully defended my dissertation. In my dissertation report I describe two patterns of hoarding behaviors—an impulsive type and an anxious type. By identifying these types, public health and home health nurses will be better able to determine the kind of interventions that will be most effective for that individual. A body of rich information emerged from this study, and I’m developing manuscripts for publication in journals. I am excited to share these findings with nurses and others who can use it to guide their practice.

This is the second in a series of blogs celebrating the release of our 2010 Annual Report, “A Day in the Life of an Academic Geriatric Nurse.” Links to the series are below: