Benefits at any age

Elderly people, who have generally been smoking for a very long time, are at much higher risk of developing cancer and heart problems. Smoking cessation is beneficial at any age, including after 60. However, senior citizens require specific care and specialized programs to help them quit.

Quitting smoking is beneficial for the elderly

People who are now retired started smoking in an age where smoking was seen as acceptable, and even encouraged. In 1953, 69% of men and 6% of women smoked (1). Women smoked relatively little until the end of the 1960s. It is estimated that over a quarter of our senior citizens began smoking in the 1960s, before the age of 25. As a result, smoking causes more problems in the over-60s than in young smokers thanks to the much longer exposure period to cigarettes. In the USA, for example, more than 70% of the 416 000 smoking-related deaths each year occur to people aged 65 and over, despite the fact that fewer people in this age category smoke than in the rest of the population. Smoking is one of the leading causes of death among senior citizens, often following cancer (especially lung cancer), cardiovascular diseases, and respiratory diseases (emphysema, COPD, etc.). It is estimated that 50% of long-term smokers will die of smoking-related illnesses. Smoking also increases the risk of osteoporosis and dementia. So why do senior citizens continue to smoke, despite all the health campaigns? They often say that smoking is relaxing, it's a pleasure, they enjoy it, and they think that quitting so late in life won't bring any benefits. (2) However, even at an advanced age, smoking cessation does bring real benefits. Smoking cessation reduces the mortality rate among smokers, including those who smoked for more than 30 years. The effects of quitting are more immediate on cardiovascular diseases. Smokers who stop at age 65 add two years onto their expectancy on average. Independence and quality of life improve after just a few months. (3)

Elderly smokers need special care to help them quit smoking

Studies have shown that smoking cessation is more difficult for elderly people who have been smoking for a long time. These people need more help to quit, undoubtedly because smoking for them is not limited to mere nicotine addiction but contributes to defining their personal and social identity. For senior citizens, quitting smoking can mean huge life changes. A study carried out in Switzerland showed that quitting also seemed more difficult for retired women than men. The women seemed to be more attached to the smell of cigarette smoke. This could explain why gums and patches are less effective for women than men. (4) We also know that elderly people pay attention to their doctor's advice when it comes to quitting smoking. Health professionals therefore have an important role to play, especially by reminding their elderly patients of the risks linked to smoking (often underestimated in this section of the population) and by explaining that quitting smoking is beneficial, even late in life.

Specific treatments can be used by elderly people, especially if they are addicted smokers. Nicotine replacement therapy is generally fine, provided extra care is taken if there is a past history of heart problems. Bupropion (Zyban) can be used, but in smaller doses. (5) The results of research carried out over twenty years ago also showed that advice and support were effective among elderly people. For senior citizens who have smoked for a long time, more specialized care should be available, such as individual counselling, telephone helplines, and cognitive behavioral therapy (CBT). Other studies showed that prevention programs can be just as successful for elderly people as for young people, as long as they are adapted. The programs should highlight the benefits of smoking cessation and the risks that it can avoid for senior citizens, help them to set a quit date, use behavioural techniques to break old habits, provide coping mechanisms for dealing with stress, and treat nicotine withdrawal symptoms. (6) Specific programs therefore need to be put in place, including in retirement homes. At present, very few of these have anti-smoking programs in place.

Factors that help elderly people to successfully quit smoking

Elderly people do not decide to stop smoking for the same reasons as younger people. Previous health problems feature more prominently in their desire to stop smoking. Having at least one chronic illness that bothers them significantly increases an elderly person's chances of quitting smoking. Studies have highlighted several indicators that predict successful smoking cessation in elderly people: having quit successfully in the past for at least one year, a milder nicotine addiction, having not started smoking regularly until later, a partner who is a non-smoker and few or no friends who smoke, and frequent trips to the pharmacy or doctor for those who use patches. What is the profile of the ideal senior candidate for quitting successfully? Someone who is married and well informed about the dangers of passive smoking, with a degree and a comfortable income, ticks all the boxes. At the other end of the scale, people who have a low level of education, receive no regular care and suffer from a psychological disorder or anxiety have a lower chance of joining the community of ex-smokers. Psycho-behavioral therapy may help these people. Programs used to help elderly people should take into account these indicators that predict successful and unsuccessful smoking cessation.

References

1. Mauffret et alii, La loi relative à la lutte contre le tabagisme et l'alcoolisme. Rapport d'évaluation. Conseil national de l'évaluation, 1999

2. Donzé et al., Determinants of smoking and cessation in older women, Age and Ageing, 36, 1, 53-572007

3. Roche J., Tabagisme de la personne âgée, NPG, volume 8, numéro 45, 2008

4. Lundqvist, Gunnar; Weinehall, Lars; Ohman, Ann, Attitudes And Barriers Towards Smoking Cessation Among Middle Aged And Elderly Women: A Qualitative Study In Family Practice, The Internet Journal of Health, March 25, 2007

5. Roche J., Tabagisme de la personne âgée, NPG, volume 8, numéro 45, 2008

6. Appel, DW, Aldrich TK, Smoking cessation in the elderly, Clinics in geriatric medicine, 2003

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• Roche J., Tabagisme de la personne âgée, NPG, volume 8, numéro 45, 2008

• Appel, DW, Aldrich TK, Smoking cessation in the elderly, Clinics in geriatric medicine, 2003

• L. C. Dale, D. A. Olsen, C. A. Patten, D. R. Schroeder, I. T. Croghan, R. D. Hurt, K. P. Offord, and T. D. Wolter, Predictors of smoking cessation among elderly smokers treated for nicotine dependence , Tobacco Control, 1997

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• DM Burns, Cigarette smoking among the elderly: disease consequences and the benefits of cessation, American journal of health promotion: AJHP, 2000

• ASM Abdullah, LM Ho, YH Kwan, Cheung WL, McGhee SM, Chan WH, Promoting Smoking Cessation Among the Elderly, Journal of Aging and Health, 2006

• JA Bergman, J L Falit, Non-smoking policies, tobacco education, and smoking cessation programmes in facilities serving the elderly in Michigan, United States, Tobacco Control, 1997

• Elhassan A, Smoking cessation in the elderly, Clinical Geriatrics, 2007

• HE Whitson, MT Heflin, Burchett BM, Patterns and predictors of smoking cessation in an elderly cohort, Journal of the American Geriatrics Society, 2006

• Gohlke H. Eur J, Is it worth offering cardiovascular disease prevention to the elderly?, Eur J Cardiovasc Prev Rehabil, 2011

• Medbø A, Melbye H, Rudebeck CE, "I did not intend to stop. I just could not stand cigarettes any more." A qualitative interview study of smoking cessation among the elderly. BMC Fam Pract. 2011

• Besdine RW, Wetle TF., Improving health for elderly people: an international health promotion and disease prevention agenda, Aging Clin Exp Res, 2010

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