With the population aging globally, the number of older adults with OCD is expected to double within the next 30 years. We currently lack important information about the best possible ways to treat this growing number of older adults, and how to modify approaches that work with children and adults to best serve this population.

Dr. Johnco’s project focused on family accommodation (when a family member of a person with OCD helps that person with their rituals). Accommodation in childhood and adult OCD is well understood, and treatment approaches now commonly involve family members in order to reduce accommodation from family and help their loved one recover from OCD. Older adults have an increased need for support from a variety of people, including their adult children, health care workers in the home or in a residential setting, neighbors, and others, all of whom are not the typical sources of accommodation for younger people with OCD.

This study found that accommodation was very common in late-life OCD, and increased with OCD severity, sensory and mobility problems, cognitive impairment, and assistance with tasks. The most common accommodation behaviors were tolerating or not stopping a loved one’s OCD behaviors, reassurance, and waiting for one to complete a compulsion. Adult children of older adults with OCD were less likely to participate in compulsions than spouses, but were more likely to help avoid OCD triggers. Finally, accommodation was higher when loved ones could tolerate emotional distress less, and a relationship between accommodation and supporter mental health was found. Most older adults with OCD believed it would helpful for their supporters to be involved in their treatment, but challenges included not having a close supporter, shaming by supporters, possible relationship conflict, and supporters not knowing the extent of symptoms. Both older people with OCD and their supporters marked a preference for being involved in the first treatment sessions to have more knowledge and guidance about OCD, as well as later involvement to address concerns that could come up.