As with many adventures, I didn't know I was on one until I was deep in the belly of a south Louisiana casino where 35-cent bets flowed faster than the free Diet Coke. My elbow rested on the walker of a silver-haired gentleman as I craned my neck to hear him over the sounds of the Lucky 7s slot machine. He worried I was going to waste all my money, and I thanked him for his grandfatherly concern. As our attention returned to the screens before us, we sank into silence, enveloped in waves of pulsating sound and light... -- Read more...
I never imagined that my life in health care would lead me to a casino. I am a former hospice chief operating officer and chaplain. Currently, I lead a qualitative research project on end-of-life care and serve a congregation as a Lutheran pastor, but a term coined by journalist Gary Rivlin caught my attention:
"Casinos are a daycare for the elderly."
Oh my, I thought. Could this be true?
Two years ago I began researching casinos and older Americans as a potential public health issue. I visited casinos midweek, midday when researchers like Omar Moufakkir have charted seniors prefer to visit. I then put those ethnographic observations into conversation with academic research on seniors and gambling to gain a better understanding of why we should assess for casino visit frequency as a potential complicating factor as individuals age.
Here's a brief recap of what I learned.
•According to the annual American Gaming Association's State of the States report, in the 23 states with commercial casinos, roughly half of the patrons were 50 and over in 2012.
•Little research was done on trends in geriatric gambling until the late 1990s, when the National Gambling Impact Study Commission reported that the number of older adults who had ever gambled in their lifetime had more than doubled from 35 percent in 1975 to 80 percent in 1998. This growth can be attributed to increased access to regional casinos vs. the previous dominance of destination casinos like Las Vegas or Atlantic City.
•I quickly observed that casinos cater to the physical needs of older Americans. They provide wheelchairs, scooters, and Depends for their older patrons. They offer free transportation, cheap breakfast and lunch deals, free play rewards, and medication discounts. One casino even introduced an in-house pharmacy where 8,000 slot club points, awarded for frequent play, cover the $25 co-pay. I had never been in an entertainment venue where people with walkers, canes, wheelchairs, and oxygen machines far outnumbered those without. I was impressed by the hospitality and customer service shown to those with hearing impairment and mobility assistance needs.
•Seniors are a valuable market to regional casinos because they prefer to visit during low-peak hours and because they prefer to play the slot machine. According to the Harrah's casino industry surveys, 75 percent of older Americans favor the slot machine.
Therein lies the potential public health risk.
•Cultural anthropologist Natasha Schull traces the evolution of the modern day slot machine to become a no-skill computerized device engineered to addict people. It produces a mesmerizing experience of sound, lights, and repetitive motion that Schull describes as the "machine zone."
•This sensation can be intensely desirable for people who seek escape from their troubles. For seniors, medication, cognitive impairment, depression, and grief can interfere with judgment and decision-making.
•Neurologists see that slot machines may also be harmful to the aging brain. The overload of stimuli, along with the lack of natural light in the casino, can contribute to diminished cognitive function, disorientation, and mental confusion.
•In terms of public health, a gambling addiction not only harms the individual but the community as a whole. Studies show an individual with a gambling problem adversely affects at least five other people. Most state assistance for problem or compulsive gambling is seriously underfunded. One gambling addiction treatment center in Las Vegas reported recently that 40 percent of those treated for gambling addiction are seniors.
•The University of Windsor has created a Seniors' Problem Gambling Screen but beyond that tool little attention has been paid to the unique risk factors posed by older Americans and gambling.
In my tour through casinos, I witnessed what happens when slots and seniors come together. Slots stretch for miles across the casino floor. A silver-haired person with a cane, walker, or wheelchair filled every seat in the rows of slots. Each person sat silent and solitary, frozen in the ergonomically-designed chairs, eyes locked onto the electronic screen, moving just one finger to hit "repeat bet" again and again. I had imagined people pulling levers on a "one-armed" bandit. But those mechanical devices are long gone. Now it takes just a quiver of a muscle and a fraction of a second to make multiple bets on a single computerized machine.
At a recent forum I spoke with seniors who care about this issue. When I asked them why they thought seniors prefer the disembodied draw of the slot machine, one woman replied, "We don't want to be a burden on other gamblers. Well, we don't want to be a burden on anyone."
Addiction to a slot machine is not a character flaw or moral failing but a natural human response to the pulsating lights and response conditioning of the modern-day, computerized slot machine. A reward system that dribbles affirmation -- that feeds a common human need to know that I am valued, I have worth, I am not a burden.
What do you think?
Do you see gambling as a public health concern?
Is casino hospitality for older adults like RX discounts, Depends ,a fair business strategy or taking advantage of older adults?
What might society learn from casinos in terms of valuing older Americans?
Need help with substance abuse or mental health issues? In the U.S., call 800-662-HELP (4357) for the SAMHSA National Helpline.
This blog post first appeared at the Healthcare Leaders Blog -- join the conversation Tuesday, March 25 at 8:30pm EST by following #HCLDR