August 2002, Vol 92, No. 8 | American Journal of Public Health 1213
© 2002 American Public Health Association
Helping Older Smokers Quit
Lyndon Haviland, DrPH, Chief Operating Officer
American Legacy Foundation
My mother was a smoker for more than 30 years. Her cigarettes and the cloud of smoke that clung to her were our constant companions in an already crowded home. My siblings and I talked about it, fought over it, and nagged mom to quit even as we stole her cigarettes, having quickly learned that smoking could be a pleasant moment in a hectic day. Mom smoked in the morning, smoked in the car, smoked in the bathroom, and smoked at work (she was a nurse). It was her quiet pleasure and her addiction, and her smoking almost killed her.
My father nagged her to quit, so she eventually hid her cigarettes and denied her ongoing habit. She tried to quit, she failed, and she tried and failed again. Despite her tobaccorelated heart condition, increasing frailty, and limited mobility, no doctor advised her to quit, and there were no cessation programs designed to meet her needs. She said repeatedly that it was too late for her to quit and that few health benefits would result from her cessation. She could not have been more wrong.
For aging Americans, smoking cessation remains a public health priority. The US Census Bureau estimates that 16.4% of adults aged 55 to 75 years are smokers, with rates for men higher than for women (unpublished data). Smoking remains the No. 1 preventable cause of disease and disability in the United States and costs nearly $160 billion in direct and indirect costs each year (MMWR Morb Mortal Wkly Rep. 2002;51:300–303). Older smokers are at greater risk than younger smokers for smoking-related diseases, including stroke, cancer, cardiovascular disease, and chronic lung ailments. Even short-term abstinence can help older smokers recover more quickly from illnesses exacerbated by smoking and improve cerebral circulation. Making cessation services easily accessible and age-appropriate could reduce smoking-related mortality and improve the quality of life for older smokers.
Health care professionals have a role to play in encouraging smoking cessation at all ages and among all racial/ethnic groups, and they should do so at every opportunity. All smokers need encouragement and support in their attempts to quit. Breaking the cycle of addiction for older adults, who may have been smoking daily for 40 years or longer, will take sustained multidisciplinary efforts. There is an urgent need to support their attempts to quit by developing innovative cessation services that are sensitive to issues of dependency, depression, and limited mobility.
While more remains to be learned, we do know that physician advice, counseling interventions, buddy support systems, and nicotine replacement therapy are all effective in promoting cessation among older smokers. Indeed, it has been estimated that by providing cessation advice to 90% of Medicare recipients, we could encourage 25 000 additional smokers to quit each year (MMWR Morb Mortal Wkly Rep. 2000;49:797–801). This is a worthy goal to shoot for, as older adults and those who love them have much to gain from the increased longevity and healthier lives that will result.
Copyright © 2002 by the American Public Health Association
