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Special Populations > Older Adults
Quitting use early on is important, but cessation even in older age provides significant life extensions and health benefits.20
Last updated: January 20, 2012
Across all age groups, smoking is still the leading preventable cause of morbidity and mortality in the United States.18,19 Regardless of age, virtually every organ in the human body is negatively affected by smoking tobacco, causing an overall decrease in health as well as quality of life.16,18 Tobacco use greatly increases the risks of developing serious medical conditions such as:1,6,8,15,16,18
- Lung Cancer
- Mouth Cancer
- Throat Cancer
- Myocardial infarction
- Cardiovascular Diseases
- Alzheimer’s Disease
- Dementia and Memory Loss
All these medical conditions have two very important features in common; the risks increase as tobacco use increases and also as age increases. As the older a smoker becomes, the health effects become exponentially more profound on the individual. Smoking predicts quality of life as well as mortality. Non-smokers tend to have more disability-free years of life which translates to a higher quality of life.15 Cessation of smoking is associated with significant health benefits, improved quality of life, and increased life expectancy even in older adults.7,9,10,18
Understanding characteristics of older smokers is vital for growth of effective cessation programs in this population. Specialized cessation programs for older adults must target reasons why they smoke. The most common motives for smoking in this population are:15,17,18
- Weight loss
- Coping Strategy
- Coping with Social Isolation
- “Too late to quit” mentality
None of the benefits associated with those motives compensate for tobacco’s multitude of negative health effects. Persons should be encouraged to quit smoking based on the many benefits of cessation, but efforts should be on the benefits most important to the individual. The most common motivational reasons for tobacco cessation in this population are:3,6,18
- Cognitive Impairments
- Impairment of Memory and Dementia
- Emergence of Psychological Distress
- Well-being of Family
Despite data that supports older smokers are as responsive to cessation programs as the younger populations, health professionals are less likely to provide cessation advice as age increases.5,12,18 Regardless of physical or mental health conditions, this population is not likely to be advised on the effects of smoking and benefits of cessation.10,14 A CDC study estimated 70% of smokers in this population want to quit, and 41% attempted to quit in the past year, but very few were successful demonstrating a clear desire for cessation programs.2
Considerable focus has been given to young and middle-aged adults regarding smoking cessation, whereas older adults have been neglected.15 The inadequate attention to smoking cessation efforts for older adults could be due to health professionals assuming it is too late to modify risk factors or that patients are uninformed of the many benefits of cessation even at an advanced age.4,15 Smoking cessation provides immediate and long-lasting benefits at any age.11,15
A key goal for tobacco control is to promote cessation among young adults when serious health consequences have not yet developed.11 Although this is a respectable goal, this strategy should not take efforts away from the older population. All age groups should be advised to quit and given proper assistance, though programs should be specific to the age as varying characteristics influence different smoking patterns.11,18 Factors that should be considered are:11,15,18
- Financial Factors (e.g. cigarette price)
- Use of Pharmaceutical Aid
- Presence or Absence of Smoke-Free Home
- Presence of Grandchildren
Generally, financial factors do not impact the older populations the same as the younger adults. Studies have shown that the strongest predictor of long-term abstinence was presence of a smoke-free home.11 Not coincidentally, studies have shown the youngest 18-34 year-old age group have significantly higher quit attempts and smoke-free homes (84% and 43% respectively) compared to the oldest 50+ year-old age group (64% and 27.5% respectively).3,8,11,13 Additionally, a smoke-free home is associated with successful quit attempts as well as at least 6 months abstinence more often than a non-smoke-free home.8,11
Independent of a smoke-free home, the use of pharmacotherapy is the most important factor for cessation success.11,16,18 Among all age groups, use of a pharmaceutical aid is associated with a 4-fold greater odd of success.11,16 Pharmaceutical aids have been repeatedly associated with a 25% increase in the adjusted odds of trying to quit in this population, with use increasing with each age group, starting from 9.7% among 18-24 year olds.5,10,11
It is evident that older adult smokers share many characteristics with other smokers, although their motifs for smoking and smoking cessation differ greatly. It is crucial for health professionals to focus on these motifs in order to successfully promote cessation in this population.
- Almeida O., Hulse G., Lawrence D., Flicker L. Smoking as a risk factor for Alzheimer’s disease: contrasting evidence from a systematic review of case-control and cohort studies. Addiction 2002; 97: 15–28.
- Centers for Disease Control and Prevention . ( 2002 ). Cigarette smoking among adults. United States, 2000 . MMWR Morbidity and Mortality Weekly Report , 51 , 642 – 645 .
- Connolly M. J. Smoking cessation in old age: closing the stable door? Thorax 2000; 29: 193–5.
- Donze , J. , Ruffi eux , C. , & Cornuz , J. ( 2007 ). Determinants of smoking and cessation in older women . Age and Ageing , 36 , 53 – 57 .
- Glynn T. J. Relative effectiveness of physician-initiated smoking cessation programs. Cancer Bull 1988; 40: 359–64.
- Griffiths F. Women’s health concerns. Is the promotion of hormone replacement therapy for prevention important to women? Fam Pract 1995; (12): 54–59.
- Higgins M.W., Enright P. L., Kronmal R. A., SchenkerM. B., Anton-Culver H., Lyles M. et al. Smoking and lung function in elderly men and women: the Cardiovascular Health Study. JAMA 1993; 269: 2741–8.
- Holahan, C. J., North, R. J., Holahan, C. K., Hayes, R. B., Powers, D. A., & Ockene, J. K. (2011). Social influences on smoking in middle-aged and older women. Psychology Of Addictive Behaviors,
- LaCroix A. Z., Lanag J., Scherr P., Wallace R. B., Cornoni- Huntley J., Berkman L. et al. Smoking and mortality among older men and women in three communities. N Engl J Med 1991; 324: 1619–25.
- Maguire C., Ryan J., Kelly A., O’Neill D., Coakley D.,Walsh J. Do patient age and medical condition influence medical advice to stop smoking? Age Ageing 2000; 29: 264–6.
- Messer, K., Trinidad, D. R., Al-Delaimy, W. K., & Pierce, J. P. (2008). Smoking cessation rates in the United States: A comparison of young adult and older smokers. American Journal Of Public Health, 98(2), 317-322.
- Morgan G. D., Noll E. L., Orleans C. T., Rimer B. K., Amfoh K., Bonney G. Reaching midlife and older smokers: tailored interventions for routine medical care. Prev Med 1996; 25: 346–54.
- Orleans C., Jepson C., Resch N., Rimer B. Quitting motives and barriers among older smokers. Cancer 1994; 74: 2055– 61.
- Ossip-Klein D. J., McIntosh S., Utman C., Burton K., Spada J., Guido J. Smokers ages 50+: who gets physician advice to quit? Prev Med 2000; 31: 364–9.
- Sachs-Ericsson, N., Schmidt, N. B., Zvolensky, M. J., Mitchell, M., Collins, N., & Blazer, D. G. (2009). Smoking cessation behavior in older adults by race and gender: The role of health problems and psychological distress. Nicotine & Tobacco Research, 11(4), 433-443.
- Salive M. C., Cornoni-Huntley J., LaCroix A. Z., Ostfield A. M., Wallace R. B., Hennekens C. H. Predictors of smoking cessation and relapse in older adults. Am J Public Health 1992; 82: 1268–71.
- Shankar, A., McMunn, A., Banks, J., & Steptoe, A. (2011). Loneliness, social isolation, and behavioral and biological health indicators in older adults. Health Psychology, 30(4), 377-385.
- Tait, R. J., Hulse, G. K., Waterreus, A., Flicker, L., Lautenschlager, N. T., Jamrozik, K., & Almeida, O. P. (2007). Effectiveness of a smoking cessation intervention in older adults. Addiction, 102(1), 148-155.
- US Department of Health and Human Services. The Health Consequences of Smoking. A report of the Surgeon General. Atlanta, GA: US Department of Health and Human Services. Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2004.
- Taylor, D.H., Hasselblad, V., Henley J., Thun, M.D., & Sloan, F.A. (2002). Benefits of Smoking Cessation for Longevity. American Journal of Public Health, 92, 990-996.