Five ways to prevent or treat problem gambling among older adults

Skinner W, Littman-Sharp N, Leslie J, Ferentzy P, Zaheer S, Quosai T, Sztainert T, Mann R, McCready J. Best practices for the treatment of older adult problem gamblers Journal of Gambling Issues. 2018; (39).

Review question

•       What are the best ways to prevent or treat problem gambling among older adults?

Background

•       Gambling is a common practice among adults worldwide and specifically in Ontario.

•       Older adults are especially susceptible to gambling problems as they age due to cognitive changes, social isolation, and problems maintaining fixed incomes.

•       Among older adults in Ontario, 2.6% fall into the moderate-risk or high-risk categories in the Problem Gambling Severity Index, which measures the severity of an individual’s gambling problems.

•       Relatively few resources exist to help with gambling problems among this vulnerable population.

•       The aim of this review is to identify the best ways to prevent or treat gambling problems, and create a set of guidelines for the prevention and treatment of problem gambling among older adults.

How the review was done

•       The development of this review took place over three stages. First, a systematic literature review was conducted to find articles relevant to the topic at hand. Next, experts in problem gambling were consulted for their expertise in the area. Finally, overarching themes were identified and a best-practices guideline was created.

•       With regards to the systematic review, 7,632 articles were retrieved from the initial literature search for articles published from January 1994 to January 2015. From these papers, 247 were selected for inclusion in the review.

•       No specific funding source was reported.

What the researchers found

•       The best practices identified were organized into five main themes: person-centred care; screening and assessment; secondary prevention and early intervention; tertiary prevention and specialized treatment; and ongoing support and recovery resources.

•       Person-centred care involves engaging with an older person using five principles: learning to know the client as a person; sharing responsibility and power; being flexible and accessible in the provision of services; coordinating and integrating the person’s care; and providing an environment that supports staff to work in person-centred ways.

•       Screening and assessment involve screening all older adults on a routine basis for problems related to gambling, just as one would for addiction and mental health issues.

•       Secondary prevention and early intervention advise caregivers to offer brief interventions to older adults who have less than moderate gambling problems. The core components of brief interventions include client goal-setting, education about risks and harms, self-monitoring of gambling and gaming behaviour, planning of alternate behaviours, and relapse planning.

•       Tertiary prevention and specialized treatments apply to older adults with more severe gambling problems. An appropriate intervention might involve extensive ongoing assessment for physical ailments and functional issues at a specialized addiction setting. Including family members in the assessment process was found to help deepen the helper’s understanding of the older person’s situation and the amount of support that is available to them.

•       Finally, ongoing support and recovery resources can help older adults and their families recover from gambling disorders by clarifying the needs, goals, tasks and roles of those involved in the older adult’s circle of care.

Conclusion

•       The best-practice guidelines presented in this review were designed to provide practitioners, patients, families, policymakers and others with advice on appropriate care for preventing and treating problem gambling among older adults.