GAMBLING AMONG OLDER ADULTS

Transcription

1 GAMBLING AMONG OLDER ADULTS Mythily Subramaniam 1,2, Edimansyah Abdin 1, Shazana Shahwan 1, Janhavi Vaingankar 1, Louisa Picco 1, Colette Browning 2, Shane Thomas 2, Siow Ann Chong 1 1 Research Division, Institute of Mental Health, Singapore 2 Faculty of Medicine, Nursing & Health Sciences, Monash University

2 BACKGROUND Definition of Gambling: Wagering money or something of material value on an event of uncertain outcome with the primary intent of winning additional money or material goods though it takes on different meanings depending on the cultural and historical context in which it is used.

3 BACKGROUND The relationship between problem gambling and age has been studied previously and problem gambling has been found to be more prevalent among those of the younger age group. However, two global phenomena are affecting this trend: Changing global population demographics Increase in the number and accessibility of legal gambling avenues in many countries

4 BACKGROUND A recent review established that the prevalence of lifetime problem or pathological gambling ranged from 0.01% (in those aged years in Denmark) to 10.9% (adults aged >65 years in Connecticut, USA). Additionally, gambling disorder among older adults was associated with significant psychiatric and physical comorbidity. Subramaniam et al. Addictive Behavior. 2014

5 AIMS AND OBJECTIVES The aims of the current study were to: (i) examine the prevalence and types of gambling (ii) establish prevalence of probable pathological gambling (iii) explore psychiatric and physical comorbidity in a sample of older adult gamblers ( 60 years) in contrast to younger gamblers (18-59 years) in a representative population sample in Singapore.

6 METHODOLOGY The data for the current study was extracted from the Singapore Mental Health Study (SMHS). A survey of Singapore Residents (including Singapore Citizens and Permanent Residents) aged >18 years, conducted from December 2009 to December 2010.

7 About Singapore A bustling cosmopolitan city populated with high-rise buildings and landscape gardens. Located in Southeast Asia, Singapore has a land area of about 710 square kilometres, making her one of the smallest countries in the world and the smallest in the region.

8 About Singapore Multi-racial nation: the present generation comprises the descendants of migrants mainly from the Southern regions of China, Malaysia, Indonesia, and India. The present resident population (citizens and permanent residents) is 5.3 million of which 75.6% are Chinese, 13.6% are Malays & 8.7% are Indians. Statistics Singapore, 2013

9 Qualitative Research SINGAPORE MENTAL HEALTH STUDY The study aimed to obtain accurate national information Qualitative Research involves finding out what about the prevalence and correlates of mental, substance, and behavioral disorders in Singapore people think, and how they feel - or at any rate, what they say they think and how they say they feel. This Duration: 3 years (April 2008 March 2011) kind of information is subjective. It involves feelings Funding: Singapore Millennium Foundation, Ministry of Health, Singapore and impressions, rather than numbers Bellenger, Bernhardt and Goldstucker, Qualitative Research in Marketing, American Marketing Association

10 Household Survey HOUSEHOLD SURVEY Study Population: Inclusion criteria Singapore citizens and PRs residing in Singapore in 2010 Age 18 years Ethnicity: Chinese, Malay, Indian and other ethnic groups Can speak English, Mandarin or Malay Exclusion criteria Non-Singapore citizens and non-prs Age <18 years Incapable of doing an interview

11 HOUSEHOLD SURVEY Survey Instrument: Socio-Demographic Questionnaire Composite International Diagnostic Interview (CIDI) Screener Major Depressive Disorder Bipolar Disorder Generalised Anxiety Disorder Obsessive Compulsive Disorder Alcohol Use Disorder South Oaks Gambling Screen Fagerstrom Nicotine Dependence Test

12 SOUTH OAKS GAMBLING SCREEN (SOGS) The SOGS has 20 scoring items, requiring a YES or NO answer. For the purpose of this study, respondents were grouped as such: Scoring Category 0 Non-Problem Gamblers * 1-4 Problem Gamblers >5 Probable Pathological Gamblers Non-Pathological Gamblers Those who stated that they had never gambled in their lives were categorized as non-gamblers.

13 SAMPLING Sampling STRATEGY Strategy Study Design Cross-sectional epidemiological study Target Population All Singapore Residents (including Singaporean and PR, aged 18 years and above, and living in Singapore) Source Population 2,750,390 residents aged 18+ years Sampling Method Disproportionate stratified sample Sampling Frame List of residents (Randomly selected from a national administrative database) Required Sample Size 6500 residents

14 RESULTS Respondent Profile N Unadjusted Adjusted % % Gender Male (48.5) Female (51.5) Interview response rate : 75.9 % Completed Interviews : 6616 Ethnicity Chinese (76.9) Malay (12.3) Indian (8.3) Others (2.4) Age Mean (SD) 42.0 (14.5) 43.9

15 RESULTS 2252 respondents who had engaged in gambling activities at least once in their lifetime were included in this study. Of this sample, 57.5% were males, Mean age = 43.9 years, ranging from 19 to 89 years (90.1%) respondents were of Chinese descent, 268 (2.7%) were Malays, 628 (5%) were Indians and 123 (2.2%) belonged to Other ethnic group.

16 RESULTS 48.9% of older adults reported ever gambling in their lives. 52.6% of those aged years had ever gambled in their lives Prevalence of probable pathological gambling among those >60 years was 2.0%, while among those with a history of lifetime gambling (i.e. have ever gambled in their life) was 4.0% versus 5.4% in younger adults.

17 TYPE OF GAMBLING BY TWO AGE GROUPS* (N=2252) Type of Gambling Gamblers aged years (N =1990) N (%) Gamblers aged 60 years and older (N=262) N (%) Played the numbers or bet on lotteries 1640 (81.9) 239 (91.3) Played cards for money 596 (34.7 ) 35 (14.6) Bet on sport 204 (11.3) 5 (1) Played dice games 113 (6.5) 2 (0.9) Mahjong 106 (8.5) 20 (13.7) Bet on horses 92 (4) 22 (9.4) *Only those with significant differences shown

18 RESULTS Logistic regression analyses indicated that older gamblers were more likely to be: Males Married or widowed (vs. never married) With pre-primary, primary and secondary education (vs. university) Economically inactive (vs. employed) Personal annual income of SGD19,999 and below (vs. SGD 50,000 and above) Malays were less likely to be older gamblers.

19 RESULTS After adjusting for demographic variables in multiple logistic regression analyses, Gamblers aged >60 years had significantly lower odds of having probable pathological gambling than those in the younger age group (OR = 0.4). Gamblers aged >60 years had significantly higher odds of having diabetes (OR = 3.2), high blood pressure (OR = 4.9), and any comorbid chronic physical condition (OR = 3.1).

20 DISCUSSION Older adults who gamble were significantly less likely to be pathological gamblers than younger adults. 12 months retrospective gambling participation rate of senior gamblers (60%) in HK on par with the gambling participation rate of the younger gamblers (59 years or younger) (61.9%). The prevalence rates of problem gambling was approximately 4.1% among the senior respondents, vs. younger respondents who had a prevalence of problem gambling of 3.1%. Ohtsuka K, Chan CC.. Asian J Gambl Issues Public Health 2014

21 DISCUSSION High prevalence of Lottery Gambling among older adults. A large proportion of Mahjong gamblers were in the older age group. Mahjong is a four-player gambling game which originated in China and is played in Chinese communities across the World The game has strong cultural roots. Played during important occasions like the Chinese New Year celebrations. Thus, the game for many individuals is an opportunity for socialization along with the monetary reward.

22 DISCUSSION Socio-demographic Correlates of Gambling: Older gamblers were likely to be males. Cultural stereotypes of good and that the expected social role of women in the Chinese society - Under-reporting of gambling behavior by women. Socio-economic Status (Lower Education and Income) Those of Malay ethnicity less likely to be older gamblers.

23 DISCUSSION Gamblers aged >60 had significantly higher odds of having diabetes and hypertension Smoking and Nicotine Dependence Disordered Gambling Stress Hypertension and Heart Disease

24 LIMITATIONS Household survey that excluded those in institutional settings including the prison population. Cross-sectional survey design limited establishment of causal relationship between gambling and other comorbid disorders. Did not establish help-seeking behavior among gamblers.

25 STRENGTHS Nationwide comprehensive survey among gamblers in a multiethnic Asian community. Diagnoses of mental disorders were established using structured interview based on DSM-IV criteria using face to face interview techniques. One of the few surveys that examined the association of gambling with chronic physical conditions. High response rate of about 76% ensures the generalizability of our findings in this population.

26 CONCLUSIONS For the majority of older adults gambling remains a recreational activity that is entertaining and a way of socialization. However, it remains important to be aware of the possible risks for some to develop disordered gambling. Financial problems associated with gambling are particularly concerning for older adults who gamble. Stigma and Barriers to care issue in this population.

27 Thank You