International Psychogeriatrics

Research Article

A study of severe domestic squalor: 173 cases referred to an old age psychiatry service

John Snowdona1 c1 and Graeme Hallidaya2

a1 Discipline of Psychological Medicine, University of Sydney, Concord Hospital, Sydney, Australia

a2 Sydney South West Area Health Service, Concord Hospital, Sydney, Australia


Background: Although community psychiatric services commonly encounter cases where intervention is needed due to persons’ unclean or cluttered living conditions, evidence concerning the referral rate and prevalence of severe domestic squalor is sparse.

Methods: Between 2000 and 2009, ratings of cleanliness and clutter have been made in all cases of people living in squalor who have been referred to an old age psychiatry service in Central Sydney. Where possible, one-year follow-up was arranged.

Results: 173 persons aged 65 years or more were referred to the service during the ten years and assessed as living in squalor (120 moderate or severe, two thirds of whom showed a moderate or severe degree of hoarding/clutter). Of 157 followed up after one year, 47% were still at home, 32% were in long-term care homes, 12% had moved elsewhere, and 9% had died. The annual new referral rate was close to 1 per 1000 elderly people in the catchment area, and of moderate or severe squalor was 0.66 per 1000. Limiting follow-up to those in moderate or severe squalor, 41% were still at home one year later. Current findings suggest that the minimum prevalence in the community of older people living in moderate or severe squalor in Sydney is 1 per 1000.

Conclusions: The costs of intervening in cases of severe domestic squalor are considerable. Increased attention and funding are warranted, as the incidence and prevalence are higher than had previously been estimated.

(Received February 28 2010)

(Revised March 16 2010)

(Revised April 12 2010)

(Accepted April 12 2010)

(Online publication August 03 2010)


c1 Correspondence should be addressed to: Professor John Snowdon, Discipline of Psychological Medicine, University of Sydney, Concord Hospital, N.S.W. 2139, Australia. Phone: +61-2-97675000; Fax: +61-2-97678951. Email: