SPECIFICITIES AND PERILS OF GAMBLING AT AN OLDER AGE

Betting is fundamentally a recreational activity, and older adults often have a positive attitude towards gambling, seeing gambling as an ordinary and safe form of entertainment. A recreational pattern of gambling can provide a number of benefits for older adults, including opportunities to socialize, relieve boredom, feel excitement, and reduce social isolation. Moreover, some types of gambling appear to stimulate cognitive functions, such as memory, concentration, math skills, and motor coordination.¹

Gambling has long been present in the lives of older Brazilians, as observed in the golden age of casinos, state lotteries, a pervasive clandestine lottery called Jogo do Bicho (Animal Game), bingo halls, and electronic games such as slot machines. We now live in the era of online casino games, slot machines, and sports betting.

Despite the preconceived notion that older people do not use the Internet due to difficulty dealing with electronic media, according to the Brazilian Institute of Geography and Statistics (IBGE),² Internet use is increasing among older adults: rising from 24.7% in 2016 to 66.0% in 2023, and 86.5% of older users do so on a daily basis, with mobile phones being the principal means of access. This figure is lower than desired, and there is a movement to encourage digital inclusion among older adults due to it benefits, such as reduced social isolation and increased access to services.³ However, increased online activity also involves greater exposure to online gambling, and it is a risky bet to assume that older adults will not get involved in it.

A survey by the DataSenado Institute⁴ found that of 22 million people who bet on sports online in the month prior to the survey, 14% (around 3 million) were older adults, which is similar to the proportion of older adults in the Brazilian population according to 2023 IBGE data (15.6%).⁵ Hence, being an older adult does not reduce the chance of betting specifically on sports online.

Among older adults, the population that has most increased in the last 12 years is the 60–69-year age group, reaching 7.8 million individuals.⁵ This age group belongs to a generation that is already more familiar with new technology and the Internet. Future generations of older people will have more online presence because the barrier of difficulty in dealing with electronic media will diminish, and it will be easier for them to get involved in online gambling.

The wide availability and easy access to online gambling, i.e., the convenience of betting from anywhere and at any time (with a cell phone and an Internet connection) as well as the anonymity of the activity facilitates unhealthy involvement.⁶

There are 3 levels of involvement with gambling, progressing with the need to increase the amount and frequency of bets to reach the desired level of excitement:

1. 1. Recreational gamblers, who gamble from time to time and have control over this behavior;
2. 2. Problem gamblers, who show some loss of control and negative effects from this behavior;
3. 3. Individuals with gambling disorder, which is diagnosed when an individual meets ≥ 4 criteria for this disorder for > 12 months, according to the Diagnostic and Statistical Manual of Mental Disorders – 5th edition (DSM-5; APA).⁷

These individuals lack of control over their impulse to gamble, being unable to stop despite significant losses (financial, emotional, and relational).

One diagnostic criterion for gambling disorder is: “gambling as a way of relieving a negative mood.” An international scoping review article⁸ found that a portion of older people gamble to reduce depressive or stressful emotional states and/or turn to gambling to cope with difficult situations. According to this review, older people use gambling as a temporary escape from bereavement, retirement, physical pain, and dysfunction, as well as to reduce social isolation, feelings of loneliness, and boredom.⁸ A Canadian study investigating casino gambling in 2103 individuals aged ≥ 55 years found the following motivations: to escape from worry (16.7%), to help with anxiety and depression (8.9%), to escape from boredom (39.2%) and to reduce loneliness (15.6%).⁹

According to IBGE data,¹⁰ in 2019 13% of Brazilians aged 60 to 64 had been diagnosed with depression, and the number of diagnoses increased by 48% among those aged ≥ 75 years between 2013 and 2019. According to Silva et al.¹¹ the prevalence of self-reported depression among 22,728 older Brazilians participating in the National Health Survey was 11.8%. A study using the ELSI-Brazil sample¹² found that 16.8% of the older participants reported constant loneliness and 31.7% reported occasional loneliness, while feeling constant loneliness was significantly associated with depression and other factors. In other words, a significant proportion of Brazil’s older population already has a mental condition that could make them vulnerable to problematic gambling.

According to Johnson et al.,⁸ some older adults gamble not just for fun or to fulfill psychological needs, but to earn money. Because gambling is fundamentally a recreational activity, doing it to generate income is a deviation from its original function and is indicative of problematic behavior.

According to a survey by the Central Bank of Brazil,¹³ around 800,000 adults aged ≥ 60 years bet online in August 2024 and spent median monthly amounts in excess of BRL 3,000.00 (a much higher figure than betters aged 20–30 years, whose median amount was BRL 100.00). Although there are fewer older gamblers than younger gamblers, older gamblers spend 30 times more than their younger peers. It is worth noting that this survey only considered Brazil’s Pix instant payment system (excluding credit cards payments), so the figures are underestimates and the real scenario could be even worse.

Another important factor is the common misconception that older people, due to their “life experience,” are less likely to become problematic gamblers. In other words, betting at an older age is safer than in other stages of life, which, in fact, could not be less true. By definition, betting is risking a variable amount of money in an attempt to earn a larger amount, so it is inevitably a risk behavior regardless of age or social status. Moreover, gambling is game of chance, meaning that winning or losing largely depends on randomness and the skill of others, rather than the gambler’s own skill. According to Johnson et al.,⁸ studies have reported that few older adults who gambled believed that they were not at risk of gambling-related harm, dismissing any real threat.

A Brazilian study¹⁴ found that of 585 individuals who sought treatment for gambling addiction at a specialized center between 1996 and 2007, 8.5% were older adults. How many more older adults with problem gambling in the general population haven’t sought treatment and are suffering the consequences of this disorder?

When gambling leads to bankruptcy, older adults will probably find it more difficult to recover than younger people. The reasons include low retirement pensions (in 2020, the monthly individual income of 69% of older Brazilians was ≤ 2 times the federal minimum wage¹⁵) and the difficulty of increasing their own income, largely due to difficulty re-entering the job market or a lack of family or social support, given that many families depend on financial assistance provided by older relatives (i.e., 9.2% of Brazilian families in 2015).¹⁵

The current government considers Brazil’s older adult population to be vulnerable to the risks of online gambling. A proposed bill (PL 3.718/2024) aims to limit or even prohibit bets made by older adults (among other groups). Despite its intent to protect vulnerable populations, limiting or denying broad and unrestricted access to each and every older adult would, by definition, deny their autonomy and self-determination. Therefore, to avoid stigmatizing them, a more sophisticated strategy should be considered. International councils and commissions have proposed measures to reduce the harm done to people who gamble online,^16,17 but we could find no specific guidelines for the older population. However, a study by Marionneau et al.¹⁸ in European countries found that mandatory policies, reasonable maximum bet limits, limits on betting exposure time, lower limits for young adults, and associating limits with duty-of-care appear to be reducing harm. Although these measures are not specifically aimed at older adults, they can serve as inspiration for Brazilian policy.

Older adult gambling is relevant not only because of its economic and financial impact, such as debts and bankruptcy, but also in terms of public health, since it increases the demand for social and health services. Studies in the USA,¹⁹ Australia,²⁰ Canada,²¹ and England²² have found that after the massive expansion of gambling, the demand for gambling treatment in health services increased from 30 to 60% depending on the period and type of gambling. Another reason for the increased use of health services is comorbid gambling disorder, depression, and substance abuse,²³ which often leads to treatment seeking. According to the literature,²⁴ older people with gambling problems also have greater alcohol abuse, psychiatric disorders, and cardiovascular diseases than older recreational gamblers.

Problematic gambling can become a vicious circle: older people gamble to escape loneliness, boredom, and/or depression, and they may incur debt from their losses, worsening a preexisting situation of low mood and social isolation.

It is also important to consider the negative effects of regular/frequent gambling on physical health. Problem gambling is associated with various negative health behaviors,²⁵ such as sedentarism and continuous stress, which can favor the development of sarcopenia, for example.

In short, the older population has particular vulnerabilities to traditional and online gambling, and a growing proportion of them may develop problematic gambling patterns in the coming years if preventative measures are not taken. The older population is a reservoir of online gambling demand, and once the technological barrier is eroded, this group, which has a high prevalence of depression, social isolation, and feelings of loneliness, will be further exposed to online gambling.

Thus, gerontologists and geriatricians must pay attention to this phenomenon, not dismissing patient-reported gambling behavior and investigating it in their healthcare practice. The Lie/Bet Questionnaire²⁶ is a useful screening tool for this purpose. It consists of 2 questions:

1. 1. Have you ever felt the need to gamble more and more money?
2. 2. Have you ever lied to people important to you about how much you gamble?

If one or both questions are answered positively, the patient should be referred for an in-depth interview with a professional specializing in gambling disorder.

The issue of gambling (including online gambling) among older adults is delicate from a mental health, socioeconomic, and ethical point of view. A coherent response can only come from the specialized scientific community. Ignoring this issue by crossing our arms and doing nothing is simply betting that everything will work out on its own. Unfortunately, just like winning big at gambling, this is rather unlikely.

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Notes

Author notes

Correspondence data Cecília Galetti – Rua Doutor Ovídio Pires de Campos, 785 – Cerqueira César – CEP: 05403-903 – São Paulo (SP), Brazil. E-mail: cecilia.galetti@hc.fm.usp.br; ceciliagaletti@gmail.com

Conflict of interest declaration

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