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Justin RG. Letter to the editor: things. Annals of Long-Term Care: Clinical Care and Aging. 2013;21(2):10.

“I own a house, small but comfortable. In it is a bed, a desk, a kitchen, a closet, a telephone. And so forth—you know how it is: things collect.” This poem by Mary Oliver resonated with me when I read the article by Ernst and Henry, “Hoarding in Elderly Long-Term Care Residents” in the January issue of Annals of Long-Term Care (2013;21[1]:22-26). The article reminded me of a house call I made decades ago. I found my patient at the end of a narrow path between ceiling-high walls of old newspapers—clearly an example of hoarding. There are, however, problems with drawing a sharp line between hoarding and being too attached to things. I once visited a patient in her home; it was not a particularly neat place, but I saw no evidence of hoarding. When she moved into the two rooms of her retirement home, she stuffed those rooms so full that she could hardly move from the living room to the bedroom. She was too attached to her things to give them away. She even kept her queen bed comforter, which she and her husband had shared, to use on her single bed. She told me, “With that comforter it feels as if David is in bed with me.” The process of finding new places for her heirlooms was difficult for her, as it is for most of us.

The Ernst and Henry article made me reflect on what place things have in our lives, especially for those whose lives are drawing to a close. Owning things follows a bell curve. As children we hang onto a favorite possession—a “blankie,” a stuffed animal—with tenacity and compassion. As we get older we accumulate more things: books, furniture, a car, a house. Things take on a life of their own. They become important stabilizers of our existence. If we sit, every evening, in our favorite chair to read the paper, we feel bereft if that chair is suddenly missing. We move beds and tables across the country in big vans so we can feel more at home in our surroundings when we arrive at the place of our new job. As we age we dispose of things, but keep some objects we treasure that remind us of those who have died—our mother’s dish, our father’s watch. As we move into smaller quarters the number of things we can keep approaches the downward sloping line of the bell curve. 

Some retirement homes and senior citizen apartments have space for a modest number of pieces of furniture. An assisted living home or nursing home has even less space, maybe enough for a chair, pictures, and a pillow. Federal regulations encourage long-term care (LTC) facilities to permit some belongings to come with new inhabitants of the home, but often space limitations, monetary value, or fragility of the object prohibit the nursing home from fulfilling this admonition. There is little doubt that having even one or two mementos of another lifetime nearby is desirable, but residents are not always given that option.

If residents are allowed to bring something they value, such as a photo or wood carving, it would be a good idea to have the staff engage in conversation with residents about the objects. To have someone listen to the story that goes with the cherished piece would enable the older person to share a sad or joyous memory. In summary, within the limits of available space and household cleanliness, it would enhance the life of the members of the LTC community if they had a few personal belongings in their room. 

When we think about dying we also think about what we leave for those we love. What we leave may not be particularly welcome. Old photos of unknown friends and relatives represent an item found in attics and garage storage units. Tossing them creates a feeling of discomfort and seems to be accompanied by a certain lack of respect for the people in the pictures. We may inherit items we never use—a tea cup, a pitcher—yet feel reluctant and slightly guilty if we discard them. Sometimes families fight bitterly over a thing that was not assigned to a particular person. The family of a patient of mine broke apart because three of the sons coveted an old trunk that had resided for years in their father’s basement. 

To take care of things requires energy and work. If we are overwhelmed with belongings, as hoarders may be, we have little time left for other endeavors. It is important throughout life, but especially as we get older, to reach a balance between too many and not enough things. Being on the low arm of the bell curve decreases the energy we have to expend on cleaning, repairing, and moving what we own. We need to aim at keeping just enough to stabilize our life, making it possible to sit in our favorite arm chair after supper and read the paper.

Renate G. Justin, MD 

Dr. Justin is a retired family physician formerly on the faculty of Indiana University School of Medicine, Terre Haute campus. She lives in Colorado and pursues her interests of biomedical ethics and writing. She reports no relevant financial relationships.

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