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Nancy M. Purpose: Pathological gambling is an increasing public health concern, but very little is known about this disorder in older adults. This study evaluated gambling and psychosocial problems across age groups in treatment-seeking gamblers. De Seeking grown women Methods: At intake to gambling treatment programs, pathological gamblers completed the Addiction Severity Index ASI and gambling questionnaires. Differences in demographics, gambling variables, and ASI composite scores were compared across the groups.
When controlled for gender, older age was associated with increased employment problems, but fewer social, legal, and substance-abuse difficulties. Compared with middle-aged gamblers, older gamblers wagered on fewer days. Older women did not begin gambling regularly until an average age of 55 years, whereas older male gamblers generally reported a lifelong history of gambling. The older female gamblers also wagered the greatest amounts in the month prior to treat-ment entry.
Implications: These data suggest that older adults compose a minority of treatment-seeking gamblers, but differences in psychosocial problems across the age groups may suggest the need for interventions tailored to particular issues encountered by older pathological gamblers. Specifically, treatments focusing on later life development of problems may be indicated for older female gamblers. Pathological gambling affects about 1. The personal and social effects of this disorder include ificant financial losses, family problems, legal and employment difficulties, and psychological distress, including suicide Petry and Armentano However, relatively little is known about the antecedents or correlates of pathological gambling in older adults.
Older age is often associated with lower rates of pathological gambling National Research Council ; Shaffer et al. In general population surveys, prevalence rates of pathological gambling in older adults are Seeking grown women low. Although these data may suggest that gambling is not a ificant public health concern among older adults, this conclusion must be drawn with caution. In the NORC study, for example, less than respondents were 65 years or older. This sample size may not be large enough to derive accurate estimates of prevalence rates for a disorder that occurs at a relatively low frequency.
Only one known published report focused exclusively on gambling in older adults. McNeilly and Burke surveyed a nonrandom sample of older adults in Nebraska. Ninety-one participants were recruited from gaming facilities commercial and charitable bingo facilities or in a shuttle bus day-trip to a casinoand were recruited from senior and retirement centers of American Association of Retired Persons chapter members.
This study, albeit of a sample of convenience, suggests a clinically ificant rate of disordered gambling in older adults, especially among those with recent participation in gambling activities. The expansion of legalized gambling opportunities in the past 15 years may be associated with a rise in gambling participation, and this increase is particularly pronounced in older adults NORC A rise in disordered gambling behaviors seems to parallel the spread of legalized gambling opportunities. In a meta-analysis of all prevalence studies conducted in North America, Shaffer and colleagues found a statistically ificant increase in the percentages of adults classified with pathological gambling in studies conducted since compared with those conducted earlier.
Therefore, older adults may begin to experience gambling problems at higher rates as gambling participation expands in this age group. Because of the paucity of clinical and research attention to gambling in older adults, the National Gambling Impact Study Commission recommended further investigation of this issue. This study is one step in this direction.
Using data collected from treatment-seeking pathological gamblers, I compared gambling and related psychosocial problems across age groups, specifically focusing on gamblers in the oldest age cohort. Participants were drawn from a retrospective analysis of consecutive admissions of individuals initiating treatment for pathological gambling throughout the state of Connecticut between August and July Approximately half of the sample was initiating treatment at a state-funded gambling treatment center; this treatment combined step programs, cognitive—behavioral treatment, and educational group and individual sessions.
The other half of the sample was beginning treatment in a National Institutes of Health—funded study evaluating cognitive—behavioral therapy for pathological gambling. Only 5 individuals refused to participate, and all withdrawals were related to dissatisfaction with random asment procedures in the treatment study. Most participants learned about the treatment programs through one or more of the following sources: media advertisements, professional social service referrals, the Connecticut Compulsive Gambling Helpline, or word-of-mouth referrals. No differences in demographic characteristics were noted among participants receiving treatment at the different programs, so data were pooled for analyses.
Composite scores are derived from responses to items within each of these problem areas. Responses are standardized and summed to produce a mathematical estimate of status in each area and range from 0. A of studies have demonstrated the reliability and validity of this instrument in a variety of substance-abusing populations Kosten, Rounsaville, and Kleber ; McLellan, Alterman, Cacciola, Metzger, and O'Brien ; McLellan et al.
It has adequate-to-excellent reliability and validity in assessing gambling problems in substance abusers who also present with gambling problems, as well as among individuals with a primary diagnosis of pathological gambling Lesieur and Blume aLesieur and Blume ; Petry Scores of greater than Seeking grown women equal to 5 are indicative of a diagnosis of pathological gambling, and all participants included in this report scored over 5.
SOGS scores were not a criterion for treatment entry, but these scores suggest that all individuals seeking gambling treatment were likely to meet diagnostic criteria for pathological gambling. Participants were divided into age groups that, broadly defined, covered young adulthood 18 to 35 yearsmiddle age 36 to 55 yearsand older adulthood 56 years and older. Basic demographics were compared across the groups using chi-square tests for categorical data and analyses of variance for continuous data.
Variables that were nonnormally distributed were transformed when possible. For variables that could not be normally distributed even after transformation, nonparametric tests were used to evaluate differences among the groups.
Because more women were in the middle and older age groups compared with the younger group, subsequent age-related comparisons controlled for gender. First, multivariate analysis of covariance MANCOVA was used to evaluate differences among the groups, with gender and age as Seeking grown women factors and ASI composite index scores as the dependent variables.
Age emerged as a ificant predictor in Seeking grown women overall analysis, as well as in six of the eight domains. For domains in which overall F tests were ificant, Dunnett's post-hoc tests compared each age group to the others. Further, when an overall test for a domain was ificant, subsequent analyses evaluating differences with respect to specific variables making up these domains were protected against multiple comparisons Tabachnick and Fidell Analyses of covariance then evaluated differences among the groups on specific items associated with each problem area.
Gender was included as a fixed covariate in these analyses. For dichotomous variables associated with domains that differed among the age groups, chi-square analyses were used. The alpha value was. Because age is a continuous variable, these analyses were repeated using age as a continuous, rather than a categorical, variable. The overall MANCOVA produced similar to those reported herein, and therefore, for ease of presentation, this article presents data with age groups trichotomized.
Individuals in the middle age range demonstrated very similar patterns in ASI scores, regardless of whether ages were broken down by decades e. Finally, these same analyses were conducted classifying only adults older than age 60 years in the oldest age cohort. Table 1 shows demographic characteristics of the three groups of participants. No other demographic differences were noted among the Seeking grown women. The preferred forms of gambling are also shown across the three age groups.
Slot machine gambling was the most popular form of gambling among the middle and older age groups. These age groups also contained higher proportions of women. Except for the medical and psychiatric scores, differences in composite scores were statistically ificant across age groups for all the other ASI indexes. The means, standard deviations, and F values for each problem area are presented below. Table 2 shows gambling-related variables. Because of the gender difference across the age groups, values are presented separately for men and women within each age category.
Gambling ASI scores did not differ by Seeking grown women. Women had lower scores than men did, and this effect was most pronounced in the oldest women, who had the lowest SOGS scores, indicative of fewer lifetime gambling problems. Before entering treatment, men especially older men experienced a longer duration of gambling problems than women did. Gender and the interaction between gender and age were not related to days of gambling. Amount wagered in the past month did not differ between genders. No ificant differences in gambling debt or gambling treatment were noted across groups.
Employment, social, and legal variables are shown in Table 3. Average responses to some of the items that are included in the employment section are shown in Table 3and, as a reference point, employment composite scores in drug-abusing patients usually range from 0. No age effects emerged with respect to the percentages ever incarcerated in their lifetimes.
Drug and alcohol variables are shown in Table 4. The youngest age group had the highest ASI scores, whereas the two older age groups did not differ from one another. No age-related differences emerged in terms of percentages of the participants who had ever been treated for a substance-use disorder.
These data suggest that older treatment-seeking pathological gamblers differ from younger and middle-aged gamblers on a of dimensions. Older gamblers were more likely to be female than were younger gamblers, and they demonstrated different onsets and intensities of gambling problems. In terms of other psychosocial difficulties that may be related to gambling, older gamblers had more serious employment problems but fewer social, legal, alcohol, and drug problems.
These differences are discussed along with limitations of the study de that may bear on their interpretation. The older gamblers demonstrated different gambling histories and patterns than the younger gamblers did. The oldest group of gamblers had ASI gambling composite scores that were lower than the middle age group.
Compared with middle-aged gamblers, the older gamblers wagered on Seeking grown women days. Among the older female gamblers, age of gambling initiation and regular gambling did not occur until much later in life. Most of the women reported casino gambling, and slot machines in particular, to be their preferred form of gambling. In contrast, the older men generally reported a lifelong history of gambling. Because most states had no forms of legalized gambling in the s to s when they began gambling, these men probably were participating in illicit forms of gambling during their youth.
Prior to the widespread growth in legalized gaming, pathological gambling was almost exclusively a male disorder, and virtually no reports of female treatment-seeking pathological gamblers exist prior to the early s see LesieurLesieur ; Lesieur and Blume b ; Marks and Lesieur Although male gender is still considered a risk factor for development of gambling problems, rates of pathological gambling currently are estimated to be only 1. This gender gap may be narrowing with the widespread legalization of gambling.
As the current generation grows up accustomed to legalized gambling, development of gambling problems in the later stages of life, as shown in this sample of women, may become a less common phenomenon. Now that women are exposed to gambling throughout life, those who may be more prone to develop gambling problems may do so at younger ages.
As noted with substance-use initiation, opportunity to sample may be the greatest predictor of involvement and subsequent development of problems Van Etten, Neumark, and Anthony The gender differences noted with respect to prevalence of substance-use disorders seem to be related to girls having fewer opportunities than boys do to sample illicit drugs. Girls who have had the opportunity to sample drugs use them at the same rates as boys do Van Etten et al. Likewise, more and more women are gaining exposure to gambling opportunities, and therefore the gender differences in gambling participation seem to be decreasing NORC More research is necessary to examine the prevalence and correlates of disordered gambling among women, especially as access to legalized gambling spre.
Increases in treatment seeking among women may be reflective of a well-known phenomenon that women seek mental health treatment services more often than men do, and they do so after experiencing symptoms for a shorter duration e.
Women entered treatment an average of 4 to 5 years after development of gambling problems, compared with an average of 11 years for men. These data are consistent with gender-specific treatment-seeking patterns in other mental health disorders Horwitz ; Kessler, Brown, and Broman Other differences in psychosocial problems were noted across the age groups as well. Family and social problems were less severe in the older treatment-seeking pathological gamblers. The older gamblers were more satisfied with their living situations than were the younger gamblers.
However, older pathological gamblers scored higher on the ASI employment composite index. As expected, older adults were less likely to be employed Seeking grown women time, although few were retired. Their monthly incomes were lower than the middle age group's, yet they showed trends toward wagering larger amounts of money and increased debt. Older adults may have a more difficult time paying off gambling debts, because many receive limited incomes that are unlikely to increase over time.
Therefore, financial counseling may be an important component of treatment for older gamblers. Although few of these individuals seeking treatment for pathological gambling were actively abusing drugs or alcohol in the month prior to entering treatment, the older gamblers had less serious current substance-abuse problems than the younger gamblers did. The older gamblers were less likely to have used illicit drugs in the month prior to entering treatment.
About a third of the participants, regardless of age group, had a history of substance-abuse treatment, and these rates of substance-abuse problems are consistent with other studies of treatment-seeking pathological gamblers Lesieur, Blume, and Zoppa ; Ramirez, McCormick, Russo, and Taber Illegal activities showed a similar trend, with the youngest age group showing more serious current problems, although lifetime problems were consistent across the age groups.
This pattern may be reflective of a "maturing-out" phenomenon of illegal behaviors as individuals age Winick Several limitations to this study affect the generalization of these findings. These low percentages of older adults seeking gambling treatment may emerge because older age may be a protective factor against development of gambling problems NORCor it may reflect a general reduction in treatment seeking for mental health problems in older age groups Shapiro, Skinner, Kessler, et al.Seeking grown women
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