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      Age-related physical and psychological vulnerability as pathways to problem gambling in older adults

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          Abstract

          Background

          To inform clinical treatment and preventative efforts, there is an important need to understand the pathways to late-life gambling disorder.

          Aims

          This study assesses the association between age-related physical health, social networks, and problem gambling in adults aged over 65 years and assesses the mediating role of affective disorders in this association.

          Methods

          The sample comprised 595 older adults (mean age: 74.4 years, range: 65–94 years; 77.1% female) who were interviewed using a structured questionnaire to assess physical frailty, geriatric pain, loneliness, geriatric depression, geriatric anxiety, and problem gambling.

          Results

          Pathway analysis demonstrated associations between these variables and gambling problems, providing a good fit for the data, but that critically these relationships were mediated by both anxiety and depression symptoms.

          Conclusions

          This study indicates that late-life problem gambling may develop as vulnerable individuals gamble to escape anxiety and depression consequent to deteriorating physical well-being and social support. When individuals develop late-life problem gambling, it is recommended that the treatment primarily focuses upon targeting and replacing avoidant coping approaches.

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          Most cited references61

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          A global clinical measure of fitness and frailty in elderly people.

          There is no single generally accepted clinical definition of frailty. Previously developed tools to assess frailty that have been shown to be predictive of death or need for entry into an institutional facility have not gained acceptance among practising clinicians. We aimed to develop a tool that would be both predictive and easy to use. We developed the 7-point Clinical Frailty Scale and applied it and other established tools that measure frailty to 2305 elderly patients who participated in the second stage of the Canadian Study of Health and Aging (CSHA). We followed this cohort prospectively; after 5 years, we determined the ability of the Clinical Frailty Scale to predict death or need for institutional care, and correlated the results with those obtained from other established tools. The CSHA Clinical Frailty Scale was highly correlated (r = 0.80) with the Frailty Index. Each 1-category increment of our scale significantly increased the medium-term risks of death (21.2% within about 70 mo, 95% confidence interval [CI] 12.5%-30.6%) and entry into an institution (23.9%, 95% CI 8.8%-41.2%) in multivariable models that adjusted for age, sex and education. Analyses of receiver operating characteristic curves showed that our Clinical Frailty Scale performed better than measures of cognition, function or comorbidity in assessing risk for death (area under the curve 0.77 for 18-month and 0.70 for 70-month mortality). Frailty is a valid and clinically important construct that is recognizable by physicians. Clinical judgments about frailty can yield useful predictive information.
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            Required sample size to detect the mediated effect.

            Mediation models are widely used, and there are many tests of the mediated effect. One of the most common questions that researchers have when planning mediation studies is, "How many subjects do I need to achieve adequate power when testing for mediation?" This article presents the necessary sample sizes for six of the most common and the most recommended tests of mediation for various combinations of parameters, to provide a guide for researchers when designing studies or applying for grants.
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              Untangling the Concepts of Disability, Frailty, and Comorbidity: Implications for Improved Targeting and Care

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                Author and article information

                Journal
                jba
                2006
                Journal of Behavioral Addictions
                J Behav Addict
                Akadémiai Kiadó (Budapest )
                2062-5871
                2063-5303
                28 February 2018
                March 2018
                : 7
                : 1
                : 137-145
                Affiliations
                [ 1 ]School of Psychology, Forensic and Clinical Research Group, University of Lincoln , Lincoln, UK
                [ 2 ]International Gaming Research Unit, Nottingham Trent University , Nottingham, UK
                Author notes
                [* ]Corresponding author: Dr. Adrian Parke; School of Psychology, Forensic and Clinical Research Group, University of Lincoln, Sarah Swift Building, Brayford Pool, Lincoln LN6 7TS, UK; Phone: +44 1522 886376; E-mail: aparke@ 123456lincoln.ac.uk
                Article
                10.1556/2006.7.2018.18
                6035019
                29486572
                f9dcd780-c07b-430b-8399-b9519a974bc2
                © 2018 The Author(s)

                This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium for non-commercial purposes, provided the original author and source are credited, a link to the CC License is provided, and changes – if any – are indicated.

                History
                : 12 September 2017
                : 22 January 2018
                : 04 February 2018
                Page count
                Figures: 1, Tables: 2, Equations: 0, References: 57, Pages: 9
                Funding
                Funding sources: This research was funded by the Responsible Gambling Trust.
                Categories
                FULL-LENGTH REPORT

                Medicine,Psychology,Social & Behavioral Sciences,Clinical Psychology & Psychiatry
                older adults,depression,women,gambling,anxiety

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