Seniors in Casino Land: Tough Luck for Older Americans An investigative report By Amy Ziettlow – Mar 25th Chat

Seniors in Casino Land

Introduction by Lisa Fields

Colin and I are pleased to have Rev. Amy Ziettlow as our guest this evening. Amy has become another important member of our Healthcare Leader community by adding another dimension both as a scholar and as a faith leader. When I read her work “Seniors in Casino Land: Tough Luck for Older Americans”, I knew she would lead us into a fascinating discussion focusing on gambling and older adults. I have learned a great deal from Amy and look forward to our chat this Tuesday as we listen and learn from each other.

Amy Ziettlow is an affiliate scholar with the Institute for American Values where she currently leads a Lilly Endowed study of Gen X caregiving and grieving titled, Homeward Bound: Aging, Death, and Dying in an Era of High Family Fragmentation. She is ordained in the mainline Evangelical Lutheran Church of America and most recently served as COO of The Hospice of Baton Rouge. Her writing has appeared at The Huffington Post, The Atlantic online, and Slate Magazine.


Blog post by Rev. Amy Ziettlow

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 thirty-five-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…

I never imagined that my life in healthcare 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 twenty-three states with commercial casinos, roughly half of the patrons were fifty 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 versus 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 wheel-chairs, 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 8000 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% 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 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% 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.


  • T1: Do you see gambling as a public health concern?
  • T2: Modifications for older adults ex. RX discounts, Depends, etc. Fair business strategy or taking advantage of older adults?
  • T3: What might HCLDR’s adapt from the casinos in terms of valuing older Americans?
  • Closing Thought: What’s one thing you’ve learned tonight that you can take to your place of influence to help a patient tomorrow?


Amy Ziettlow Seniors in Casino Land

Omar Moufakkir, “An Analysis of Elderly Gamers’ Trip Characteristics and Gambling Behavior: Comparing the Elderly with Their Younger Counterparts,” UNLV Gaming Research and Review Journal 10, no. 2 (2006): 63–75

Anna C. McCarrey et al., “Age Differences in Neural Activity during Slot Machine Gambling: An fMRI Study,” PLoS ONE 7, no. 11 (2012): e49787.

Natasha Schull “Gambling Addiction: Why are Slot Machines so Addictive?”

Natasha Schull Addicted by Design

Suzi Levens et al., “Gambling Among Older, Primary Care Patients: An Important Public Health Concern,” American Journal of Geriatric Psychology 13, no. 1 (2005): 69–76.

Marsha King “Older Adults Vulnerable to Gambling Addiction,” Seattle Times

Marcus Escobedo, “Booster Shots and Going Viral: Hartford Scholars Learn Communications Skills, Part II”, John A Hartford Foundation

“Lower the Stakes. A Public Health Approach to Gambling in British Columbia”, Ministry of Health British Columbia

Image Credit


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