Research That Matters (January 17 - 20, 2008)

Purpose: Despite low rates of lifetime (LPG) and current problem gambling (CPG), problem gambling has a negative impact on the well-being of older adults. These effects may be worse given vulnerabilities associated with aging. Problem and pathological gambling among elders are associated with lower self-rated health, including poor global health ratings and higher levels of chronic illness. Older pathological gamblers also show high levels of depression and suicidal ideation. Societal demographic changes and increases in gambling activity in this population make knowledge of gambling across the lifespan particularly relevant to social work practitioners. Using a life course perspective, we aimed to configure variations of LPG and CPG, assess risk and protective factors and the impact of gambling patterns on the well-being of older adults.

Methods: We analyzed national data from older adult gamblers (n=489) in the Gambling Impact and Behavior Study (61% age 50-64; 57% male; 11% employed; 62% married; 27% <$5K annually; 17% < HS graduate). Latent Class Analysis (LCA) was separately used to classify LPG and CPG subgroups based on 10 current and retrospective DSM-IV criteria: preoccupation, tolerance, withdrawal, loss of control, escape, chasing, lying, illegal acts, relationship impairment, and financial bail-out. As a “person centered” analysis, LCA can identify homogeneous subgroups. This technique assigns a probable class membership to individuals based on individual response patterns, beyond the mere presence or absence of disorder as indicated in the DSM-IV. After identification of LPG and CPG classes, a survey logistic regression procedure was used to identify hypothesized risk and protective predictors of problem gambling classification. Finally, the latent class membership estimated by LCA was used as an independent variable to predict measures of general health, global mental health, depression and the likelihood of experiencing bankruptcy.

Results: A two-class solution was the best fitting for LPG and CPG groups. Except for illegal acts, DSM-IV criteria distinguished the LPG and CPG groups. We identified 10.8% LPGs, 8.4% CPGs, and 2.2% who were in both LPG and CPG groups. Those who participated in religious services and had higher levels of education showed decreased odds of LPG and CPG. A gambling treatment history, problem gambling self-perception, gambling for the excitement and to win money was associated with CPG class membership. CPG class membership was also associated with higher depression, poorer general health and increased odds of bankruptcy risk.

Implications: Our findings confirm that PG status is most strongly characterized by number and type of diagnostic criteria. The criterion related to illegal behavior was an exception, in that illegal behavior did not significantly differentiate classes. Our findings also support the inclusion of clinically meaningful gambling correlates, including co-occurring depression in the assessment of gambling in older adults. Also, reasons for gambling may be particularly informative for screening and intervention efforts directed to older adults. Notably, CPG but not LPG was associated with poor health status. Future research should consider longitudinal methods to further delineate the relationship between gambling patterns in late life and current health status.