title: Unexpected online gambling disorder in late-life: a case report.
abstract: BACKGROUND
  The lifetime prevalence of problem or Gambling disorder (GD) in the elderly (i.e., those over 60 years old) is reported to range from 0.01 to 10.9%. Research has identified several specific risk factors and vulnerabilities in the elderly. Since the late 1990s, an increase in online GD has been observed in the youth population, whereas casinos, slot machines, and bingo seem to be the activities of choice among the elderly. Interestingly, online GD has not been described in the elderly to date.
  
  
  METHODS
  We report an 83-year-old man who started online casino gambling from the age of 80 years, leading to debts that exceeded €30,000. He underwent a full clinical and neuropsychological assessment, without any evidence of cognitive impairment or any associated neurodegenerative disease. However, he had risk factors for GD, including adjustment disorder, stressful life events, previous offline casino GD when 50 years old, and dysfunctional personality traits. The change to online GD may have been due to his isolation, movement difficulties, and his high level of education, which facilitated his access to the Internet. Care management focused on individual cognitive-behavioral therapy.
  
  
  CONCLUSIONS
  The prevalence of online GD may be underestimated among the elderly, and may increase among isolated old people with movement difficulties and ready access to the Internet. However, late-life GD should be considered a diagnosis of elimination, requiring a full medical, psychiatric (including suicide risk), and cognitive assessment. Specific therapeutic approaches need to be proposed and developed.
authors.affiliation: Addictology and Liaison Psychiatry Department, Nantes University Hospital Nantes, France ; Department of Psychiatry, University Hospital of Bellvitge-IDIBELL Barcelona, Spain.
authors.forename: Anne
authors.initials: A
authors.lastname: Sauvaget
authors.affiliation: Department of Psychiatry, University Hospital of Bellvitge-IDIBELL Barcelona, Spain ; CIBER Fisiopatología Obesidad y Nutrición, Instituto de Salud Carlos III Barcelona, Spain ; Department of Clinical Sciences, School of Medicine, University of Barcelona Barcelona, Spain.
authors.forename: Susana
authors.initials: S
authors.lastname: Jiménez-Murcia
authors.affiliation: Department of Psychiatry, University Hospital of Bellvitge-IDIBELL Barcelona, Spain ; CIBER Fisiopatología Obesidad y Nutrición, Instituto de Salud Carlos III Barcelona, Spain ; Department of Clinical Sciences, School of Medicine, University of Barcelona Barcelona, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Fernández-Aranda
authors.affiliation: Department of Psychiatry, University Hospital of Bellvitge-IDIBELL Barcelona, Spain ; CIBER Fisiopatología Obesidad y Nutrición, Instituto de Salud Carlos III Barcelona, Spain.
authors.forename: Ana B
authors.initials: AB
authors.lastname: Fagundo
authors.affiliation: Department of Psychiatry, University Hospital of Bellvitge-IDIBELL Barcelona, Spain.
authors.forename: Laura
authors.initials: L
authors.lastname: Moragas
authors.affiliation: Department of Psychiatry, University Hospital of Bellvitge-IDIBELL Barcelona, Spain ; CIBER Fisiopatología Obesidad y Nutrición, Instituto de Salud Carlos III Barcelona, Spain.
authors.forename: Ines
authors.initials: I
authors.lastname: Wolz
authors.affiliation: Department of Neurology, University Hospital of Bellvitge-IDIBELL Barcelona, Spain.
authors.forename: Misericordia
authors.initials: M
authors.lastname: Veciana De Las Heras
authors.affiliation: CIBER Fisiopatología Obesidad y Nutrición, Instituto de Salud Carlos III Barcelona, Spain ; Departament de Psicobiologia i Metodologia de les Ciències de la Salut, Universitat Autònoma de Barcelona Barcelona, Spain.
authors.forename: Roser
authors.initials: R
authors.lastname: Granero
authors.affiliation: Department of Public Health, Mental Health and Perinatal Nursing, University School of Nursing, University of Barcelona Barcelona, Spain.
authors.forename: Amparo
authors.initials: A
authors.lastname: Del Pino-Gutiérrez
authors.affiliation: Department of Psychiatry, University Hospital of Bellvitge-IDIBELL Barcelona, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Baño
authors.affiliation: Department of Psychiatry, University Hospital of Bellvitge-IDIBELL Barcelona, Spain.
authors.forename: Eva
authors.initials: E
authors.lastname: Real
authors.affiliation: Department of Psychiatry, University Hospital of Bellvitge-IDIBELL Barcelona, Spain.
authors.forename: Maria N
authors.initials: MN
authors.lastname: Aymamí
authors.affiliation: Addictology and Liaison Psychiatry Department, Nantes University Hospital Nantes, France.
authors.forename: Marie
authors.initials: M
authors.lastname: Grall-Bronnec
authors.affiliation: Department of Psychiatry, University Hospital of Bellvitge-IDIBELL Barcelona, Spain ; Department of Clinical Sciences, School of Medicine, University of Barcelona Barcelona, Spain ; CIBER Salud Mental, Instituto de Salud Carlos III Barcelona, Spain.
authors.forename: José M
authors.initials: JM
authors.lastname: Menchón
keywords: behavioral addictions; elderly; gambling disorder; late-life; medical condition; online gambling