July 2, 2001 -- If you've been to a casino lately, you've no doubt seen them: senior citizens piling out of buses and filing up before beckoning blackjack tables and slot machines. And besides casino gaming, there's bingo just about every night of the week, and state and national lottery games galore, not to mention the growth of riverboat and Indian casinos and Internet betting.
For many suspected reasons -- age-related cognitive decline, boredom, underlying depression -- older adults seem to be more vulnerable to problem gambling than other age groups. And for seniors on fixed incomes, the prospects of ever fully recovering from gambling losses can be dim.
Which is why experts in aging, gambling, and problem and compulsive gambling met with members of the gaming industry at the University of Florida in Gainesville last month to develop policies and procedures aimed at identifying and helping seniors with gambling problems.
A Growing Problem
"Most seniors gamble safely, but we know that a certain percentage will develop gambling problems in any age group, and the greater numbers of senior citizens who participate in gambling mean that there are greater numbers who are developing problems," says Pat Fowler, executive director of the Florida Counsel on Compulsive Gambling.
"Certain circumstances that are present among this age group, but not younger gamblers, may make them a bit more vulnerable," she says. For example, seniors often have a tremendous amount of time on their hands after retirement and have limited options in how to fill it, Fowler says.
In Florida, where many snowbirds go to retire, the gambling options are almost limitless. There's bingo of every stripe -- from the corner church to high-stakes games. There's jai alai, dog and horse racing, lucrative lotteries, 26 floating casinos that deport twice daily and drop anchor in international water, and six Indian reservations that provide machine gambling, card games, and more.
Seniors thought to be at special risk include those who have sustained recent or cumulative losses of significant others, who have undergone a loss of status, who have undiagnosed depression, and those who have always gambled. But for the majority of seniors who develop problems, there aren't clear warning signs that trouble is looming.
"They have lived an exemplary life, worked hard, taken care of their family, educated their children, and did all the right things only to find themselves after retirement involved in an activity they can't control," Fowler says.
"Many are looking for an escape from all sorts of losses in their lives, whether loss of a spouse, a profession (after retirement), their health, their physical abilities, their physical beauty. Gambling is one activity they can engage in regardless of physical problems. There aren't many other activities that are stimulating and exciting that they can do; gambling is one of the few left," she says.
"The danger is for those who lose control over gambling, because the impact that it has on their life is different than for their younger counterparts," Fowler says. "They can't start a new profession or build a new nest egg. It's just not a possibility for most of these folks, so the impact is permanent."
Still the situation is not hopeless, she says. "You may not be able to recoup the financial loss, but you certainly can recuperate or recover your life."
Medications Show Promise
"Gambling disorders, in general, have been relatively understudied, and there have been very few articles looking at older adults to assess potential vulnerability to gambling problems," says Marc Potenza, MD, PhD, assistant professor at Yale University School of Medicine in New Haven, Conn., and director of the problem gambling clinic there.
However, the Connecticut state gambling health line reports that one of every eight calls comes form adults aged 55 or older.
The good news is that gamblers of all ages seem to respond to antidepressant medications called selective serotonin reuptake inhibitors, or SSRIs, such as Paxil and Prozac. Some also respond to naltrexone, a medication marketed as Revia that blocks the effects of opioid drugs and was recently been approved by the FDA as treatment for alcoholism and has shown potential for smoking cessation as well.
What's not completely clear is why these drugs also seem to help the compulsive gambler. The best guess is that some of them affect the brain's pleasure/reward response, which may play a role in compulsive behavior, or that depression may be an underlying factor in problem gambling.
Gambling among older people may be also be an expression of anxiety related to aging and to fear of impoverishment, says soon-to-be 80-year-old Stanley H. Cath, MD, a geriatric psychiatrist in Arlington, Mass., and faculty member at Harvard University.
"Americans have a vulnerability to magical solutions to life," Cath says, and this kind of thinking just seems to increase with age. "It's a matter of feeling 'I am entitled to something, I deserve wealth, power, or justification. It's a universal fantasy sweeping Americans into casinos," he says.
"Like many things in life, euphoria may come with gambling, but it's also self-destructive because even if you win millions of dollars, it doesn't solve problems, you're not any happier. You may have more things, but you still have to face the ravages of getting old," he says.
There are two types of senior gamblers, says Fresh Meadows, N.Y.-based social worker Mary-Ellen Siegel, MSW, co-author of Behind the Eight Ball: A Recovery Guide for Families with Gamblers.
"There are those who always gambled and now they have more time, then there's the newer gambler such as the escape gambler who is more likely to play lottery tickets," she explains.
"It's an escape because seniors have often lost family and friends, or a spouse has died, or they have lost an attachment to the workplace," she tells WebMD. "When people retire, they lose their badge or identity and sense of who they were."
"Gambling is so socially acceptable. Senior centers take you, and the places are nice, but a certain percentage of all people who gamble will get hooked," says Siegel.
Another reason seniors may be more vulnerable than younger counterparts could be mild, age-related cognitive impairment. "They may have lost their sense of normal odds and may not be able to deal with money and finance so well," she says.
So What Do You Do Now?
If you or someone you love has a gambling problem, Siegel says the first step is identifying the underlying reason for it -- such as depression or boredom -- then offer alternative activities, such as joining a senior's group or trying out new hobbies.
Some seniors who gamble do so within their means, she says, "but if it starts taking away money, time, or emotion from what they ought to be doing -- such as a grandmother skipping Mother's Day to go to Atlantic City, which is open 365 days a year -- then it's a problem."
Siegel, along with Westchester County-based social worker Linda Berman, offers these tip-offs that a senior adult is gambling too much:
- Gambling at beginning of month (corresponding with social security and pension check deposits)
- Declining or hesitating to attend local family events or celebrations
- Neglecting car or home repairs that they can afford
- Neglecting bills such as telephone, utilities, and rent
- Disinterest in old friendships
- Secrecy or double-talk about extent of trips to casinos, bingo parlors, etc.
- Assets disappearing (such as jewelry, heirlooms, or silverware)
- Unaccounted time away from home
- Unexplained moodiness, depression, preoccupations, stresses, or worries
- Unwillingness to attend to basic personal care needs such as dental work.
If you or someone you know has a gambling problem, contact the National Gambling Help Line at (800) 522-4700.