Resources for the Comprehensive Geriatric Assessment based
Proactive and Personalised Primary Care of the Elderly
Gambling in Late Life
GAMBLING ACTIVITIES AND MOTIVATIONS
RISKS AND VULNERABILITY FACTORS
TOOLS
The 4-As Approach for a structured Screening or Brief Intervention comprises the following – Ask, Assess, Assist, and Arrange
Step 1 - ASK (Brief Screen)
Many older adults enjoy gambling without problems. However, for a minority of older adults the consequences from
problem gambling can be severe. It has been argued that older adults are an especially vulnerable population of
gamblers; yet they are also frequently targeted by gambling enterprises.
Family physicians can assess the gambling behavior of their patients in a few minutes, using carefully chosen screening questions designed to determine if a problem exists and if it warrants intervention.
The CAGE questionnaire for smoking (modified from the familiar CAGE questionnaire for alcoholism), the “four Cs” test and the Fagerström Test for Nicotine Dependence help assess tobacco use and make the diagnosis of nicotine dependence based on standard criteria.
NODS-Clip
Brief 3 question screen for problem and pathological gambling
1-3 min.
NODS-PERC
Brief 4 question screen for problem and pathological gambling
1-3 min.
BBGS
Brief Biosocial Gambling Screen - Brief 3 question screen for problem and pathological gambling
BBGS - online
Online self-scoring Brief Biosocial Gambling Screen
BPGS ( 3 item )
from SBRIT toolkit
BPGS ( 5 item )
from SBRIT toolkit
Step 2 - ASSESS (Full Screen)
Additional assessment questions can be used to determine and document the individual patient's reasons and patterns of gambling, readiness to change (gambler's profile), and to determine whether this is an appropriate moment to initiate a quit gambling program (Stages of Change - gamblers).
NODS
NODS + NODS-Clip
PGSI
from SBRIT toolkit
PPGM
from SBRIT toolkit
Steps 3 – ASSIST (Brief Intervention)
If a person’s behaviours are identified as risky or problematic, a brief intervention follows. The goal of the brief intervention is to increase the person’s awareness of their risk level and to identify steps towards behavioural change.
Brief interventions consist of a limited conversation between the client and their healthcare provider, to increase the client’s awareness of the consequences related to their behaviours and to enhance their motivation to change their behaviours to be within healthy limits.
A brief intervention is usually indicated for 10 to 20 per cent of people screened.
Steps 4 – ARRANGE (Refer)
There are likely to be several national organisations, programs and counsellors/facilitators who assist individuals with a gambling problem. Utilising the insights gained from the preceding brief screening tools, choose the referral best suited to the elderly person in your care.
GAMBLING ACTIVITIES AND MOTIVATIONS (Tanner J, 2018 )
The most frequently gambling activities of the elderly include (2) :
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playing the lottery
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purchasing raffle tickets
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playing electronic machines in casinos
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buying scratch tickets
Several studies have examined older adults’ motivations to gamble, which can include: (Clarke D, 2008) (Subramaniam M, et al, 2015) (Williams RJ et al, 2013) :
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Excitement or stimulation
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Relieving boredom
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Socializing with friends
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Coping with stress, guilt, or emotional difficulties
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Winning money
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Giving to charities
When gambling starts to become a problem, motivations may change. So while older adults may start to gamble for the excitement, social aspects, or winning money, after gambling becomes a problem, motivations shift to helping cope with stress, guilt, or emotional difficulties.(Clarke D,2008)
PREVALENCE (1)
A systematic review of studies reported that lifetime prevalence rates of problem or pathological gambling for older adults (50+) ranged from 0.2% to 12.9%.
These wide ranges are likely due to differences in locations, samples, methods, and tools used to collect data. Generally, however, studies tend to find that prevalence rates of problem gambling are lower for older
adults compared to other age groups (Tse S et al, 2012)
RISKS AND VULNERABILITY FACTORS (1)
Some risk factors and comorbid problems are common across gamblers, for example, having more irrational beliefs about gambling or problems with alcohol along with gambling.(Johansson et al, 2009)
However, there are several factors more specific to the life stages of older adults. The following factors may increase the risk or vulnerability of older adults who gamble: (Subramaniam M, et al, 2015), (Southwell J et al, 2008), (McNeilly DP et al, 2002), (Lister JJ et al, 2013)
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Limited financial resources; living on a fixed income or with less ability to replenish savings or retirement funds through work.
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More free time than expected upon retirement. While individuals tend to plan financially for retirement, few plan for this increase in free time.
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Retirement may result in a loss of social networks, contributing to loneliness and social isolation.
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Older adults are more likely to experience the death of a spouse, family members, or friends. They may gamble to help cope with such losses or for the social opportunities gambling provides.
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Physical limitations or mobility issues may prevent older adults from engaging in other activities they once enjoyed.
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Some older adults may have problems with gambling because of brain-related changes (e.g., from the aging process, medication side-effects, or interactions between medications).(Tirachaimongkol LC et al, 2010) One study found that older adults with lower scores on a measure of executive functioning* had higher levels of problem gambling. They also found that gambling problems were related to higher levels of impulsivity, but only for people who had low scores on a cognitive screening tool (von Hippel W et al, 2009)
NEGATIVE IMPACTS ON HEALTH (1)
Problem gambling in older adults has been found to be related to negative health outcomes, including (Tse S et al, 2012), (Lister JJ et al, 2013) :
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Physical Health
higher use of medical services, more general health concerns and poorer overall health status, higher chronic conditions (e.g., heart disease, arthritis), and more obesity-related conditions.
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Mental Health
higher levels of depression, anxiety, personality disorders, paranoia, loneliness, family and social problems, alcohol problems, and lower life satisfaction.
Gambling research is in its infancy compared to other addictions research. Therefore, the strength and direction of relationships is not yet clear in much of the aging and gambling literature. For example, does problem gambling “cause” health problems or are people with more health problems more likely to gamble, or both?
More research with greater control and longitudinal data is needed to clarify these and other relationships.
TREATMENT (1)
Older adults may be less likely than other populations to recognize gambling as a potential problem. Therefore screening for problem gambling is especially important when older adults present for treatment of other mental health concerns, such as depression, anxiety, or substance use.
Older adults are less likely to seek treatment for problem gambling than their younger counterparts. This could be due to less awareness of gambling as a problem and/or more stigma toward mental illness or addictions.
BENEFITS OF RECREATIONAL GAMBLING (1)
For older adults who gamble recreationally, and do not have problems with gambling, gambling can be a positive activity.
While few studies have examined the potential benefits of gambling, those that have suggest that older recreational gamblers have better self-reported health, lower depression scores, and greater perceived social support compared to older non-gamblers.
Researchers have also suggested that some forms of gambling may help with memory, problem solving, math skills, concentration skills, and hand-eye coordination (Tse S et al, 2012), (Desai RA et al, 2004)
FREE online training courses in Brief Intervention
for Healthcare Professionals
SBIRT (Indiana University)
The primary goal of SBIRT efforts is to identify and respond to patients who use substances, including alcohol, in a hazardous, risky, or harmful manner. A secondary benefit of SBIRT is that patients with substance use disorders (i.e. abuse, dependency) are recognized too and may be referred for additional assessment and/or specialty addiction treatment.
Understanding SBRIT : All about SBRIT and how to use it
Beyond SBRIT : All about Detox, Relapse, Specialized care, Abusable medications
Duration : 2 hours each
Requires registration. Does not include certificate of completion.
Go to : Understanding SBRIT course
Go to : Beyond SBRIT course
HSC Public Agency (Queen's University Belfast)
Aim : To equip Health and Wellbeing advisers with the knowledge and skills necessary to deliver effective brief interventions in practice.
Following completion of this course you should be able to:
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apply the model of behaviour change to your practice
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outline the principles of effective communication
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raise the subjects of smoking, alcohol consumption or physical inactivity with patients in routine practice
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advise on the risks to health posed by smoking, alcohol and physical inactivity
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assist patients/clients by signposting and providing additional information sources.
Duration : 2 hours
Requires registration. Includes certificate of completion.
Go to HSC Public Agency course
Look in e-learning page, under Public Health
This is one of several topics presented in the Thorny Issues sector of this toolkit
Back To : Thorny Issues