Older Adults

Special Populations > Older Adults

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

Older Populations

Why is smoking especially a concern for older adults? 

Smoking is particularly dangerous for elderly smokers, who are already at heightened risk for various health conditions such as cardiovascular disease, respiratory conditions, and cancer.  Despite the lowered rate of smoking among older adults, the aging of the baby boomers will surely spike the total number of older adult smokers in need of cessation services in the years to come.   On average, smokers lose at least one decade of life expectancy, as compared with those who have never smoked.1

What specific problems do older adults face when they smoke? 

Older adults who continue to smoke have more difficulty with diseases common to old age, such as diabetes, osteoporosis, and common respiratory problems.  Additionally, smoking interferes with the metabolism of medications that older adults are commonly prescribed.2  Compared to non-smokers, older adult smokers have increased risk for difficulty of completing activities of daily living, blindness, and cognitive impairment.3  Older adult smokers are also more likely to report mental health problems such as depression,4 and even report poorer relationships with family members compared to former smokers and never smokers.5  When older adults quit smoking it not only increases life expectancy, but also improves their overall wellbeing.   

When does it become too late to quit smoking?

There is always hope for older adult smokers, and it is never too late to quit.  Smoking cessation even in later years can significantly reduce mortality,6 including those who have already been diagnosed with a smoking-related disease.2  Past studies have found that older adults with coronary heart disease who quit smoking could greatly reduce their risk of mortality in as little as 2 years.  Smoking cessation can also reduce the risk of lung cancer by approximately 50% with ten years of abstinence.7    

How receptive are older adults to the idea of quitting smoking? 

Despite the assumed “too late to quit” mentality, older adult smokers are receptive to smoking cessation interventions, and are capable of quitting in high proportions.5,15  As older adults visit doctors at increased rates, there are many opportunities within primary care to invite older patients to start smoking cessation.  However, a recent medical records review found that only 40% of older adults had received smoking cessation advice.8,9  More problematic, among older adult smokers who were in worse health and older were less likely to receive smoking cessation advice.  Advice rates may be enhanced by educating providers about older adults being willing to receive advice and its efficacy.2  Smoking interventions are more likely to work with increased duration and when they include medications, nicotine replacement therapy (NRT), and behavioral health counseling.10

What else should be considered when encouraging an older adult to quit smoking?

Persons should be encouraged to quit smoking based on the many benefits of cessation, but efforts should be made to target the benefits most important to the individual. The most common motivational reasons for tobacco cessation in this population are the prevention of cognitive impairments and the increased well-being of the family.11  In the past, considerable focus has been given to young and middle-aged adults regarding smoking cessation, whereas older adults have often been neglected.12 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 older patients are uninformed of the many cessation benefits.12,13  Smoking cessation provides immediate and long-lasting benefits at any age,14 and primary care providers have a golden opportunity to engage with patients and deliver brief interventions. 

Additional Resources:

·         American Lung Association: Smoking and Older Adults

·         National Institute of Health: Quitting Smoking for Older Adults

·         Clinics in Geriatric Medicine: Review of literature on older adults and smoking

 

Last updated: August 04, 2014
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References
  1. Jha, P., Ramasundarahettige, C., Landsman, V., Rostron, B., Thun, M., Anderson, R., & ... Peto, R. (2013). 21st-century hazards of smoking and benefits of cessation in the United States. New England Journal Of Medicine, 368(4), 341-350.
  2. Doolan, D., & Froelicher, E. (2008). Smoking cessation interventions and older adults. Progress In Cardiovascular Nursing, 23(3), 119-127.
  3. Takashima, N., Miura, K., Hozawa, A., Okamura, T., Hayakawa, T., Okuda, N., & ... Ueshima, H. (2010). Cigarette smoking in middle age and a long-term risk of impaired activities of daily living: NIPPON DATA80. Nicotine & Tobacco Research, 12(9), 944-949.
  4. Almeida, O. P., & Pfaff, J. J. (2005). Depression and smoking amongst older general practice patients. Journal Of Affective Disorders, 86(2/3), 317-321.
  5. Abdullah, A., & Simon, J. (2006). Health promotion in older adults: evidence-based smoking cessation programs for use in primary care settings. Geriatrics, 61(3), 30.
  6. Carson, K. V., Jurisevic, M. A., & Smith, B. J. (2013). Is cancer risk still reduced if you give up smoking in later life?. Lung Cancer Management, 2(5), 357-368.
  7. Burns, D. M. (2003, November). Tobacco-related diseases. In Seminars in oncology nursing (Vol. 19, No. 4, pp. 244-249). WB Saunders.
  8. Brown, D. W., Croft, J. B., Schenck, A. P., Malarcher, A. M., Giles, W. H., & Simpson Jr, R. J. (2004). Inpatient smoking-cessation counseling and all-cause mortality among the elderly. American journal of preventive medicine, 26(2), 112-118.
  9. Houston, T. K., Allison, J. J., Person, S., Kovac, S., Williams, O. D., & Kiefe, C. I. (2005). Post-myocardial infarction smoking cessation counseling: associations with immediate and late mortality in older Medicare patients. The American journal of medicine, 118(3), 269-275.
  10. Zbikowski, S. M., Magnusson, B., Pockey, J. R., Tindle, H. A., & Weaver, K. E. (2012). A review of smoking cessation interventions for smokers aged 50 and older. Maturitas, 71(2), 131-141.
  11. 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.
  12. 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.
  13. Donzé, J., Ruffieux, C., & Cornuz, J. (2007). Determinants of smoking and cessation in older women. Age and ageing, 36(1), 53-57.
  14. 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.
  15. Centers for Disease Control and Prevention (CDC). (2012). Quitting Smoking Among Adults---United States, 2001--2010. MMWR. November 11, 2011/60 (44); 1513-1519.