Commentary on Vandenberg <i>et al</i>.: The next step of developing and testing evidence‐based interventions for older adults who experience problem gambling and homelessness

Future research that incorporates the lived experience of older adults, recognizes the impacts of gender, sexual identity and neurodegenerative illnesses and considers the impacts of housing interventions on gambling may point us towards the discovery and testing of evidence-based interventions for older adults who experience homelessness and problem gambling. Vandenberg et al. [1] investigate the link between gambling and homelessness in older adults aged 50 years and note that gambling in homeless populations is understudied. This is largely due to the myth that only those with the means to gamble do so, and that there is a general lack of awareness of gambling in unstably housed populations. However, studies find that gambling can predate homelessness, but also start or worsen during experiences of homelessness, as it presents an element of hope to those entrenched in poverty [2, 3]. To date, there are few studies that evaluate the effectiveness of interventions for problem gambling in homeless populations [3]. This key gap in the literature prompts us to question: (1) how we can arrive at screening and treatment interventions that prove effective for older adults who experience homelessness and problem gambling; and (2) how can methodological approaches that place value on lived experience lead us towards the development of effective interventions? Like Vandenberg et al., many scholars of problem gambling across homeless populations conclude that service providers should screen for, encourage help-seeking, and offer treatment interventions for problem gambling [4, 5]. However, an avenue unexplored by Vandenberg et al. is the importance of adapting screening tools and interventions for older adults who experience homelessness, problem gambling and neurodegenerative disease. Older adults who are homeless have a higher prevalence of dementia than those who are stably housed [6]. Further, problem gambling and dementia are both associated with frontal lobe dysfunction, which leads researchers to suggest that neurological assessments should be provided to those who begin problem gambling later in life [7, 8]. Recent research on dementia and homelessness finds a need for more investigation of the relationship to produce targeted interventions [9]. As dementia is associated with both gambling and homelessness, future researchers who seek to discover effective interventions should consider the role of dementia as a contributor to both homelessness and gambling in older adults. Research is also needed to determine whether treatment options should vary for older adults based on gender and sexual identity. Studies find that women favour different forms of gambling than men (e.g. electronic gaming machines and on-line gaming), therefore indicating a potential need to screen for and treat problem gambling in women and men differently [10, 11]. In the future, researchers could work with older adults with lived experience of homelessness and problem gambling to design and test population-specific screening tools and interventions that consider the implications of gender and sexual identity on gambling behaviours. The recommendation to improve housing stability as a mechanism to reduce gambling in homeless populations is important for all age groups. Many jurisdictions in Canada now rely upon Housing First programmes to house individuals. These programmes provide rapid access to housing without substance use or mental health treatment requirements under the premise that access to housing, a basic need, must be met before other concerns can be addressed [12]. While there remains a paucity of evidence about the use of Housing First to support people experiencing gambling concerns, what does exist suggests that access to stable housing may help to reduce gambling [13, 14]. Additional studies in this area are needed before any definitive conclusions can be drawn. In order to generate robust and population-specific interventions, future research should include older adults with lived experience of homelessness and gambling as both research participants and engaged research partners [2]. Vandenburg et al. note the lack of data from individuals with direct lived experience of homelessness and gambling as a study limitation. When used well, approaches such as peer interviewing [15], interactive World Cafe events [5] and lived experience research advisory groups [16], among others, increase participant engagement, which allows researchers to meaningfully engage lived experience throughout the research process and develop interventions that work for the people who need them. Dr. Woodhall-Melnik is funded by the Canada Research Chairs Program. Further, this review contributes to the work of ‘Community Housing Canada: Partners in Resilience’, an academic-community partnership supported by the Social Sciences and Humanities Research Council (Grant Number: 1004-2019-0002). The partnership is directed by Professor Damian Collins at the University of Alberta (host institution), in collaboration with Civida (lead community partner). Dr. Flora Matheson leads the Justice and Equity Lab located at MAP Centre for Urban Health Solutions, St. Michael's Hospital. Her research is focused on solutions to reduce social and health inequities among people experiencing problem gambling and imprisonment; solutions that are built with and for these communities. As a Sociologist, she uses a gender lens and social determinants of health approach to enact change. None. Dr. Woodhall-Melnik conceptualized and prepared the first draft of the commentary. Dr. Matheson made significant contributions to the argumentation and direction of the commentary. Both authors reviewed and edited the piece.

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