Older Adults

Quitting use early on is important, but cessation even in older age provides significant life extensions and health benefits.¹

Concerns

Older smokers are less likely to believe that smoking is harmful to their health, less likely to have previous quit attempts than younger smokers, and are also highly nicotine dependent.²

Older adult smokers show increased risk of:

• Dementia (higher for men than for women)³
• Alzheimer's disease³
• Stroke⁴
• Heart attack (60% higher than for nonsmokers 65 or older)⁴
• Cataracts, the leading cause of blindness and visual loss⁵
• Bone marrow density decreases (risk for bone fracture), especially among women, and smokeless tobacco use may also be a risk factor for osteoporosis⁶
• Suffering from long periods of disability as a result of decreased lung function⁷
• Complications with many medications commonly prescribed for older adults

Case managers for homebound older adult smokers reported the following concerns in a study by Schmitt et al. (2005):

• Clients who smoke in bed, who smoke while under the influence of alcohol, who smoke while using oxygen, and those who are unable to manage their smoking safely because of dementia are vulnerable to fire incidents.
• The negative health consequences of smoking, financial burden, becoming more homebound (e.g., smoking is not permitted at adult day centers), and interference with caregiver relationships are significant reasons for smoking cessation among these clients.
• Physicians may not adequately address smoking with their clients because of time pressure, a focus on what they consider to be more pressing health problems, and an unawareness of clients' smoking habits.

Benefits of quitting use among older adults include:

• Decreased risk of all of the major causes of death including heart diseases, cancer, stroke, and chronic obstructive pulmonary diseases.⁸
• Rapid, partial reversal of arteriosclerosis, slows ongoing disease progression, prevents further development of second primary tumors in older cancer patients, and increases life expectancy.⁸
• More effective in reducing mortality rates in patients with coronary heart disease than therapy with aspirin, beta blockers, or angiotensin-converting enzyme inhibitors, and may be as important as lipid lowering, diabetes management, and hypertension therapy in preventing cardiovascular morbidity and mortality.⁹
• Circulation improves immediately, and the lungs begin to repair damage. In one year, the added risk of heart disease is cut almost in half, and risk of stroke, lung disease, and cancer diminish. Among smokers who quit at age 65, studies have shown that men may gain 1.4 to 2.0 years of life and women may gain 2.7 to 3.7 years.¹
• Older smokers who quit may demonstrate improved quality of life, relative to those who continue to smoke.¹⁰

Needs

There is a dearth of programs and treatment methods designed specifically for this special population. According to the American Lung Association, "self help and formal smoking cessation treatments for older adults must emphasize strategies to overcome high levels of nicotine dependence and lifelong psychological dependence on smoking."¹¹

Important suggestions for cessation intervention among older adults based on the findings of Schmitt et al. (2005):⁸

• Older adult smokers may benefit from a smoking cessation intervention designed for a non-treatment seeking population. (Smokers were able to identify more pros than cons of smoking, yet lacked plans to quit smoking.)
• Treatment of depression in this population prior to entering a smoking cessation program may be beneficial. (Depressed smokers were more likely to think smoking cessation would not benefit them and to think that quitting would be too difficult for them.)
• Education about the benefits of smoking cessation in older adults is important. (Many of the clients did not believe that smoking cessation would benefit their health, and some clients even thought smoking cessation would be harmful).
• Case managers or other health care providers who provide home visits and other services (e.g., Medicare and Medicaid assistance) to older adults are in optimal positions to support cessation efforts.

Helpful Links

Centers for Medicare and Medicaid Services, U.S. Department of Health and Human Services:
This webpage provides an overview of smoking cessation counseling and treatments covered by Medicare as well as a Provider Resources page.
http://www.cms.hhs.gov/SmokingCessation/01_Overview.asp#TopOfPage

Clear Horizons Online:
Supported by smokefree.gov, Clear Horizons is an online, page-by-page smoking cessation guide for smokers over age 50. Providers may recommend this website for computer-savvy older adult clients interested in self-guided quitting.
http://www.myclearhorizons.com/