Determinants of Gambling Disorders in Elderly People

A total of 51 studies met the inclusion criteria for this literature review geared towards exploring the determinants influencing gambling disorder in older people.

Quantitative Data

• 80% of older gamblers are looking for entertainment and enjoyment.
• 38% of older gamblers are looking to distract themselves from everyday problems, and combat boredom and loneliness.
• 39%–45% of all casino users are over age 65.

Risk Factors

Social Factors

• Living alone or socially isolated.
• Using bus tours to access gambling venues.
• Search for excitement.

Loss Factors

• Separated or divorced.
• Loss of personal/ professional role.
• Loss of friends and loved ones.

Financial Fafctors

• Lower, declining, or fixed income.
• Money-making motivation.

Medical Factors

• Chronic medical illness.
• Cognitive impairment.

Co-Occurring Factors

• Substance use disorders.
• Mood disorders, anxiety disorders or avoidant personality disorder.

Protective Factors

• Increased awareness.
• Reduction in gambling cognitive distortions.
• Family support.

Qualitative Data

• 55 year olds struggling with problem gambling tend to play continuous or limitless games such as slot machines, online games or even scratch games.
  • (Those without a gambling problem tend to play discontinuous, inexpensive and time-limited games such as lotteries)
• Lack of resources to cover the damaging level of gambling expenditure appears to be specific to older adults.

Gambling Motivations

• Older people frequently visit gambling locations, such as casinos, to make social connections.
• Gamblers may wish to make up for a loss of income through winnings from gambling by increasing their participation.

Gender

• Women over the age of 60 have a risk of problem gambling that is equivalent to, or even higher than, that of men in the same age group.
• The prevalence of at-risk or problem gamblers is high among women over 65 years of age.
• Retired women over the age of 75 are targeted gamblers most susceptible to gambling marketing (particularly to electronic games machines).

Co-occurring Disorders

• Older adults with alcohol use disorder or tobacco use disorder, whose general health is impaired, may seek relaxation or excitement from readily available gambling opportunities (though the practice of gambling is in itself a stress factor).
• Individuals over 65 years of age struggling with problem gambling have significantly increased risk of alcohol use disorder and were more frequently tobacco dependent.
• Life-long problem gambling was associated with:
  • Substance use disorders (alcohol, illicit substances),
  • Psychiatric disorders: mood disorders (depression, dysthymia, mania, hypomania), and
  • Anxiety disorders or avoidant personality disorder.

Medical Comorbidities

• Gambling is a sedentary activity, which can lead to medical problems or, conversely, it can attract people who already have difficulty moving around for medical reasons.
• “Problem gambler” status is significantly associated with a lower quality of life (in medical, social, and emotional terms) compared with social gamblers or non-gamblers.
• Older adults with a life-long history of problem gambling had experienced significantly more medical problems in the previous year.
• In older adults, cognitive impairment may reduce the ability to decide to stop gambling.

Asian

• Themes in Asians’ incorrect perception of gambling include skill, near miss, concept of luck, superstitious beliefs, entrapment, gambler’s fallacy, chasing wins, chasing losses, and the belief that wins exceeded losses.
  • These gambling-related cognitions played a role in the maintenance and escalation of gambling in the Asian older adults.

Marketing

• Casinos aggressively direct marketing towards older adults offering discounts on meals, free drinks, guarantees to win and, sometimes, medication discount coupons.
• Gambling offers and availability reinforce gambling motivation and cognitive distortions in older people.
• Older women seem to be more vulnerable to gambling marketing strategies.

Identified Tools

• Implement the acronym “CASINO” to help everyone to remember the impact and factors linked to disordered gambling in older adults:
  • Chronic health problems,
  • Affective disorders,
  • Serious risk of suicide,
  • Incarceration, and
  • NO money (credit card debts, and financial problems).

Identified Challenges

• The identification of gambling problems or disorder is not typically initially concerned with medical care

Identified Conclusions

• Gambling fills a void in the lives of older people and may be a substitution for social support.
• Older adults are an especially desirable demographic for the gambling industry because they fill the floors during off-peak hours.
• Public Health
• Caregivers and public health authorities should be aware of specific points concerning gambling practices in older adults.
• Public authorities and institutions taking care of older people should consider that to delegate the provision of social activities for older people to gambling locations, as defined in literature, may not be an ideal solution and may not demonstrate a responsible or fair attitude towards older people.
• Public health authorities could learn a great deal from tobacco control, in terms of how to respond to gambling marketing, accessibility and “gamblers fallacy”.

Identified Recommendations

• Raise awareness of intrusive marketing campaigns that target vulnerable, elderly people.

Further Research

• It could be interesting to analyze older problem gamblers’ cognition to identify strategic prevention targets.
• Specific attention should be paid to the complex and varied relationship between gambling and Parkinson’s disease (PD) and dopaminergic medication.
  • Impulse control disorders, such as compulsive gambling, and also buying, sexual, and eating behaviors, are a serious, recognized complication in PD which occurs in up to 20% of PD patients over the course of their illness and especially in those with the highest risk profile.

Policy

• The legislative framework for gambling can have a direct impact on gambling practices.
• Identify and require action, beyond medical care, to help gamblers to control or to stop their problem gambling.