“Severe domestic squalor exists across cultures and has existed across time”, say the authors of this impressive and informative book. They estimate that around one in a thousand people aged over 65 lives in severe domestic squalor, which makes it sufficiently prevalent for them to come to the attention of old age psychiatry services on a fairly regular basis. It occurs in the homes of younger individuals too, but seems to be less common in younger than older age groups, perhaps because it takes a finite amount of time for stuff to accumulate, and perhaps because dementia, one of a number of health conditions that is a risk factor for severe domestic squalor, is seen most often in people of advanced age.

The authors, supported by four other specialists who have contributed to four of the book's ten chapters, have done a great service to health professionals, environmental health workers, community services providers, emergency services and a host of other staff who encounter people living in domestic squalor from time to time, by publishing this concise and well written text. It provides the ideal place to find out what we know about squalor situations, how to assess them, what to do about them, and what more we need to learn (quite a bit). Their typology for communicating about squalor divides it into six categories: dry, neglectful squalor; rubbishy, neglectful squalor; wet, neglectful squalor; dry clutter; dry extensive clutter or hoarding; and dry semi-organised hoarding (my study!). Squalor also can be rated from first degree (“. . . little piles are starting to emerge and disorganisation is starting to cause inconvenience. . .” – does this sound familiar?) to fourth degree (“. . .all of the above, plus. . . .human faeces and/or urine . . . that is not in the toilet”). Just in case you struggle to visualise the scenarios described, there are 37 color plates, that probably should come in a specially sealed section of the book complete with a health warning. I was grateful that no ‘scratch and sniff’ card was provided.

Anyone working in old age psychiatry or geriatric medicine will encounter people who live in squalor and must have access to this excellent text. But a host of other professionals from police to nurses on general medical units will meet people who live in squalor, so this publication should be in strong demand worldwide. As the authors indicate that we still have a lot to learn about severe domestic squalor and how to help those affected by it, it is to be hoped that a second edition, incorporating new knowledge, will come along in just a few years from now.