Smoking cessation in the elderly

Smoking cessation rates in elderly and nonelderly smokers after participating in an intensive care smoking cessation camp

Since it is a widely known fact that smoking cessation is beneficial physically and cognitively, efforts should be made to enable smokers to quit smoking through policy. Intensive care smoking cessation camps generally show a high smoking cessation success rate, but research is needed to determine which smokers should be admitted due to costeffectiveness. Although many studies have been conducted to find factors related to smoking cessation success, there is still controversy about the will and success rate of smoking cessation of elderly smokers. We performed this study to determine behavior characteristics and smoking cessation success rates in nonelderly and elderly smokers who participated in an intensive care smoking cessation camp. Heavy smokers participating in an intensive care smoking cessation camp at Chonnam National University Hospital between the August 2015 and December 2017 were classified into elderly (age ≥65 years old) or nonelderly (age <65 years old) groups after excluding missing data. Smokers were followed up at 4 weeks, 6 weeks, 12 weeks, and 6 months from the start of abstinence by self-report, measurement of carbon monoxide expiration levels or cotinine testing. A total of 351 smokers were enrolled in the study. At the 6-month follow-up, 56 of 107 (52.3%) elderly smokers and 109 of 244 (44.7%) nonelderly smokers continued to abstain from smoking. Elderly smokers showed a higher smoking cessation rate than that of nonelderly smokers, but it was not statistically significant (OR = 1.36, 95%CI: 0.862, 2.145). The most common causes of cessation failure in both groups were stress and temptation, followed by withdrawal symptoms. Smoking cessation rates in the elderly are comparable to that in the nonelderly after an intensive care smoking cessation camp. Intensive care smoking cessation camps can help both elderly and nonelderly smokers who intend to quit smoking by providing motivation, education and medication. Smoking cessation should be strongly recommended regardless of age.

Nicotine Use Disorder in Older Adults

Nicotine is one of the most abused substances worldwide. Just as in adolescence and adulthood, tobacco use is also problematic in the elderly. Older people are more vulnerable to smoking consequences because of the additive effects of smoke. Cardiovascular diseases are the most common health problems associated with smoking; however, other systems are also affected, including the respiratory, nervous, integumentary, and many other systems. Smoking cessation is a difficult task especially in the elderly; therefore, physicians should encourage older patients to quit with every patient-physician encounter by offering counseling and replacement therapy.

Psychosocial determinants of quit motivation in older smokers from deprived backgrounds: a cross-sectional survey

OBJECTIVES

To identify psychosocial determinants of quit motivation in older deprived smokers. The evidence may be used to optimise smoking cessation interventions for the target population.

DESIGN

Cross-sectional survey using online recruitment methods including Facebook-targeted advertising.

SETTING

UK, 2019.

PARTICIPANTS

Current smokers aged 50 years or older and from a socioeconomically deprived background.

MAIN OUTCOME MEASURES

Measures included motivation to stop smoking, smoking history, perceived social support, self-efficacy for quitting, self-exempting beliefs and lung cancer risk perception. Multivariable regression was used to analyse factors associated with quit motivation.

RESULTS

Of a total 578 individuals who consented to take part, 278 (48.1%) did not meet the inclusion criteria. Of the 300 eligible participants, most were recruited using Facebook (94.0%), were aged 50-64 years (83.7%) and women (85.7%). Most participants were renting from a housing association (72.0%) and had low education (61.0%). Higher motivation to quit was statistically significantly associated with a higher intensity of previous quit attempts (p=0.03), higher quit confidence (p=0.01), higher smoking self-efficacy (p=0.01), a lower risk-minimising beliefs score (p=0.01) and using traditional nicotine replacement therapy (NRT) when trying to stop smoking or cut down (p<0.001).

CONCLUSION

Older smokers from deprived backgrounds face complex barriers to quitting smoking. Interventions are needed to increase self-efficacy for quitting, modify risk-minimising beliefs and target elements of previous quit attempts (ie, the use of NRT) that are associated with motivation to stop smoking.

Factors Associated with the Intention to Quit Smoking in Elderly Korean Men: The Korea National Health and Nutrition Examination Survey 2010-2015

Background

Tobacco smoking is the most preventable cause of diseases and death in older adults. This study aimed to evaluate the factors associated with the intention to quit smoking in elderly Korean men.

Methods

We investigated 813 male smokers aged 65 years or more from the 5th and 6th Korea National Health and Nutrition Examination Survey 2010–2015. Multiple logistic regression analysis was performed to identify factors related with smoking cessation intention.

Results

Of the respondents, 26.3% had the intention to quit smoking. After adjustment for confounding factors, the intention to quit smoking was significantly associated with a history of ischemic heart disease (adjusted odds ratio, 1.88; 95% confidence interval, 1.02–3.48).

Conclusion

Identifying the factors related to the intention to quit smoking among older adults can help in developing effective smoking cessation strategies for this section of the population.

Variation in Patient Smoking Cessation Rates Among Health-Care Providers: An Observational Study

BACKGROUND

Physicians play a crucial role in providing smoking cessation counseling and medications. However, it is unknown whether individual physicians' approaches affect whether patients quit.

RESEARCH QUESTION

This study assessed patient quit rates within a national quality-improvement learning collaborative to document variation in quit rates at the physician, practice, and health system levels.

STUDY DESIGN AND METHODS

A retrospective cohort study was conducted of primary care patients identified from the Optum analytics database containing longitudinal ambulatory data for patients from 22 health-care organizations between January 2012 and December 2018. The study included smokers aged ≥ 18 years who attended at least three ambulatory visits, with two visits at least 1 year apart. The primary study outcome was abstinence for ≥ 1 year. A mixed effects logistic regression model was used to predict the probability of quitting as a function of patient variables. Quit rates were then adjusted by patient factors and calculated at the level of clinician, clinic/practice, and health system.

RESULTS

Across all systems, 56% of patients had a documented smoking status in 2017. Among nearly 1 million smokers, 24% quit smoking. In the regression model, patient characteristics associated with quitting included older age, Hispanic ethnicity, being married, urban residence, commercial insurance, pregnancy, and a diagnosis of pneumonia, myocardial infarction, ischemic heart disease, cataract, or asthma. Medicaid insurance, low income, high BMI, peripheral vascular disease, alcohol-related diagnosis, and COPD were negatively associated with smoking cessation. Adjusted quit rates ranged from 14.3% to 34.5% across 20 health systems, 5% to 66% among 1,399 practice sites, and 4% to 87% among 3,803 health-care providers. Of smokers, 10.2% were prescribed smoking deterrents, and 3.9% were referred for counseling.

INTERPRETATION

Smoking cessation rates varied substantially at the practitioner, practice site, and health system levels. It is likely that individual physician approaches to smoking cessation influence patients' likelihood of quitting.

Dyslipidaemia in the elderly: to treat or not to treat?

INTRODUCTION

The elderly population (i.e. aged ≥ 65 years) is increasing worldwide. Ageing is associated with a higher incidence and prevalence of cardiovascular disease (CVD). Areas covered: The prevalence of CVD risk factors including type 2 diabetes mellitus, hypertension and dyslipidaemia also increases with advancing age, contributing to the higher absolute CVD risk observed in the elderly. The present narrative review comments on the associations of dyslipidaemia with CVD as well as the effects of lifestyle measures and lipid-lowering drugs on lipids and CVD risk with a special focus on the elderly population. Individual treatment goals and therapeutic options according to current guidelines are also reviewed. Finally, we discuss special characteristics of the elderly that may influence the efficacy and safety of drug therapy and should be considered before selection of hypolipidaemic pharmacotherapy. Expert commentary: There may be a greater CVD benefit in older patients following drug therapy compared with younger ones. Treatment goals and therapeutic options should be individualized according to current guidelines. Specific characteristics that may influence the efficacy and safety of drug therapy in the elderly should be considered in relation to dyslipidaemia treatment.

Effects of aging on the effectiveness of smoking cessation medication

BACKGROUND

Considering the pharmacokinetic and pharmacodynamic aspects of different medications, it is plausible that the age of a smoker could affect the half-life of these drugs. The aim of this study was to compare the effectiveness of smoking cessation drugs (nicotine replacement therapy, bupropion, and varenicline) used either in isolation or in combination in adults under and over 60 years of age.

METHODS

Data were collected from 940 Brazilian patients participating in a smoking cessation program. Participants were prescribed smoking cessation medication to be used for at least 12 weeks and were followed for 52 weeks.

RESULTS

Cessation rates were significantly different among younger and older participants who were using nicotine replacement therapy (NRT) alone. Being over 60 years of age was significantly associated with increased cessation success among those who used NRT alone (OR 2.34, 95% CI: 1.36 to 4.04, p = 0.002). The effectiveness of varenicline and bupropion were not significantly different according to age groups.

CONCLUSION

Using age as a predictor for tailoring smoking cessation drugs might potentially lead to a more individualized prescription of smoking cessation therapy. These results should be tested in randomized controlled trials.

Treating tobacco dependence in older adults: a survey of primary care clinicians' knowledge, attitudes, and practice

BACKGROUND

The benefits of smoking cessation among older people are well documented. Despite this, evidence suggests that older smokers are rarely engaged in smoking cessation efforts, and that existing tobacco dependence treatments require further tailoring to the specific needs of older smokers. This study assesses the knowledge, attitudes, and clinical practice of primary care clinicians in relation to addressing tobacco dependence among older people.

METHODS

A cross-sectional survey of 427 NHS primary care clinicians in a large English city was conducted using modified version of a previously validated questionnaire.

RESULTS

One hundred and seventy one clinicians (40 % response rate) completed the survey. While the majority (90.0 %) of respondents reported enquiring regularly about older patients' smoking status, just over half (59.1 %) reported providing older patients with smoking cessation support. A lack of awareness in relation to the prevalence and impact of smoking in later life were apparent: e.g. only 47 % of respondents were aware of that approximately 10 life years are lost due to smoking related disease, and only 59 % knew that smoking can reduce the effectiveness of medication prescribed for conditions common in later life. Self-reported attendance at smoking-related training was significantly associated with proactive clinical practice.

CONCLUSIONS

There is a need to improve clinicians' knowledge, in relation to smoking and smoking cessation in older patients and to build clinician confidence in seizing teachable moments.

Understanding socio-cultural influences on smoking among older Greek-Australian smokers aged 50 and over: facilitators or barriers? A qualitative study

Smokers of all ages can benefit by quitting, but many smokers continue to smoke. Older Greek-Australian smokers, one of the largest ethnic groups in Australia, have higher rates of smoking than other groups of older Australians. This qualitative study aimed to explore older Greek-Australians’ views about socio-cultural influences on their smoking. A snowball sampling technique was used to identify twenty Greek–Australian smokers (12 males and eight females), aged ≥ 50 years. They were recruited through the Greek Orthodox Community Center of South Australia (GOCSA). Qualitative data were collected using semi-structured face-to-face interviews. The audio-taped interviews were translated and transcribed, and then analysed using content analysis. Results suggested that smoking was considered as the “norm” by older Greek-Australian smokers. There were four groups embedded in the participants’ social networks that were reported to be important in relation to either encouraging smoking or, smoking abstinence. These support groups included: family members, friends, the Greek community, and physicians. Smokers’ family members (brothers) and friends were identified as facilitators of smoking whereas non-smoker family members (children and spouses) were reported as providing barriers to smoking. Different approaches were used by supporter groups to assist smokers to quit smoking—both planned and unplanned. Knowledge, planning of social and cultural supports, and addressing barriers to smoking cessation are a important part of health planning for older Greek-Australians. Social norms, including those arising from social interactions, and predisposing traits can influence smoking behaviour. Addressing the specific barriers to smoking cessation of older Greek-Australians is critical to addressing the risk for chronic disease in this group.

Nationwide Smoking Cessation Treatment Support Program--Turkey project

BACKGROUND

In 2011, Turkish Ministry of Health (MoH) initiated a nation-wide "Smoking Cessation Treatment Support Program" (SCTSP), to provide smoking cessation drugs free of charge.

METHODS

SCTSP was conducted in all 81 cities of Turkey, at 228 smoking cessation clinics, and by over 400 physicians. In total, 164,733 participants took advantage of the program between January and November 2011. Varenicline (Champix(®), Pfizer) and Bupropion (Zyban(®), GlaxoSmithKline) were used in the program at a ratio of 0.7 and 0.3 respectively. Post-program data were obtained by phone interviews from randomly selected participants, who had completed a 1-year follow-up after enrollment in the program.

FINDINGS

Quit rates were 29.6% for those given Varenicline and 25.1% for those given Bupropion. The quit rates for participants with hypertension (35.0%), diabetes mellitus (36.9%), coronary artery disease (32.1%) and cerebrovascular events (34.0%) were higher than those without. Increased age, female gender, longer duration of cessation drug use, low Fagerstrom score, the presence of hypertension, the absence of chronic obstructive pulmonary disease, and the absence of cancer were found to be associated with higher success rates.

INTERPRETATION

SCTSP is the first successful report of a nation-wide community-based smoking cessation intervention. The real-life quit rates obtained herein are comparable to those of clinical evidence to date. The centralization of smoking cessation clinics, standardization of treatment guidelines, application of a specific drug assignment algorithm, and provision of primary care support and follow-ups by trained physicians, appeared to be key elements for success.

[Campaign against smoking in a home for the elderly: the report of an experiment]

Studies on institutionalized elderly smokers are important for developing appropriate preventive measures. This was a cross-sectional population-based study of individuals over 60 admitted to a Home for the Elderly in the Federal District. The following aspects were investigated: smoking prevalence, socio-demographic and clinical profile, gender, education, probable depression, degree of motivation to stop smoking, prior use of medication to stop smoking and perception of the harm of smoking to health. Spirometry, the measurement of exhaled carbon monoxide and classification according to severity of nicotine dependence were conducted. The program followed guidelines for stopping smoking, and was evaluated one year later. Results revealed that 25.7% were smokers, 22.8% men and 2.9% women, mean age 68.3 ± 8.5 years. A significant decrease in smoking among the more elderly was detected. Significant associations emerged between the degree of nicotine dependence and education, probable depression, degree of motivation for stopping smoking and perception of the harm of smoking to health. Higher indices of carbon monoxide were identified in individuals with severe obstruction. Initially, 37.9% of smokers agreed to participate in the campaign, and after a year 9% of them succeeded in stopping smoking.

Health maintenance in older adults: combining evidence and individual preferences

There is increasing interest in maintaining health and delaying disability for older adults as this population segment expands. And instead of focusing on a traditional disease-specific approach to health maintenance, there is an ongoing shift to a patient-centered approach, and defining outcomes based on the older adults' goals. In this approach, their goals and preferences are central, and other factors such as their health status and prognosis help determine which goals may be realistic. These subjective goals and objective characteristics are then balanced with the risks, benefits, and harms of established evidence-driven health-maintenance recommendations. Hence, older adults share their goals and preferences with clinicians; while clinicians share information on risks, benefits, harms, and uncertainties of existing health-maintenance recommendations, and help guide the older adult through how existing evidence can respond to their health goals and preferences. In this article, the concept of patient-centered care in the context of health maintenance for older adults is discussed; and health maintenance recommendations for older adults are reviewed.

The effect of stability and change in health behaviors on trajectories of body mass index in older Americans: a 14-year longitudinal study

BACKGROUND

Obesity is increasingly prevalent among older adults, yet little is known about the impact of health behaviors on the trajectories of body weight in this age group.

METHODS

We examined the effect of time-varying smoking, physical activity (PA), alcohol use, and changes thereof, on the 14-year (1992-2006) trajectory of body- mass index (BMI) in a cohort of 10,314 older adults from the Health and Retirements Study, aged 51-61 years at baseline. Hierarchical linear modeling (HLM) quantifies the effect of smoking, PA, and alcohol use (user status, initiation and cessation) on intercept and rate-of-change in BMI trajectory, and tests for variations in the strength of association between each behavior and BMI.

RESULTS

Over 14 years (82,512 observations), BMI increased approximated by a quadratic function. Smoking and PA (user status and initiation) were associated with significantly lower BMI trajectories over time. Cessation of smoking and PA resulted in higher BMI trajectories over time. The weight-gaining effect of smoking cessation increased, while the strength of association between BMI trajectories and PA or alcohol use were constant over time. Socio-economic and health status differences explained the effects of alcohol use on BMI trajectory.

CONCLUSIONS

In older adults, smoking and PA, and changes thereof, vary in their long-term effect on trajectories of BMI. Barring increases in PA levels, older smokers who quit today are expected to gain significantly more weight than two decades ago. This knowledge is essential for the design of smoking cessation, physical activityPA, and weight-control interventions in older adults.

The relation between socioeconomic status and short-term mortality after acute myocardial infarction persists in the elderly: results from a nationwide study

We assessed whether the previously observed relationship between socioeconomic status (SES) and short-term mortality (pre-hospital mortality and 28-day case-fatality) after a first acute myocardial infarction (AMI) in persons <75 years, are also observed in the elderly (i.e. ≥75 years), and whether these relationships vary by sex. A nationwide register based cohort study was conducted. Between January 1st 1998 and December 31st 2007, 76,351 first AMI patients were identified, of whom 60,498 (79.2 %) were hospitalized. Logistic regression analyses were performed to measure SES differences in pre-hospital mortality after a first AMI and 28-day case-fatality after a first AMI hospitalization. All analyses were stratified by sex and age group (<55, 55–64, 65–74, 75–84, ≥85), and adjusted for age, ethnic origin, marital status, and degree of urbanization. There was an inverse relation between SES and pre-hospital mortality in both sexes. There was also an inverse relation between SES and 28-day case-fatality after hospitalization, but only in men. Compared to elderly men with the highest SES, elderly men with the lowest SES had a higher pre-hospital mortality in both 75–84 year-olds (OR = 1.26; 95 % CI 1.09–1.47) and ≥85 year-olds (OR = 1.26; 1.00–1.58), and a higher 28-day case-fatality in both 75–84 year-olds (OR = 1.26; 1.06–1.50) and ≥85 year-olds (OR = 1.36; 0.99–1.85). Compared to elderly women with the highest SES, elderly women with the lowest SES had a higher pre-hospital mortality in ≥85 year-olds (OR = 1.20; 0.99–1.46). To conclude, in men there are SES inequalities in both pre-hospital mortality and case-fatality after a first AMI, in women these SES inequalities are only shown in pre-hospital mortality. The inequalities persist in the elderly (≥75 years of age). Clinicians and policymakers need to be more vigilant on the population with a low SES background, including the elderly.

Effects of smoking and smoking cessation on life expectancy in an elderly population in Beijing, China, 1992-2000: an 8-year follow-up study

BACKGROUND

We assessed the effects of smoking and smoking cessation on life expectancy and active life expectancy among persons aged 55 years or older in Beijing.

METHODS

This study included 1593 men and 1664 women who participated in the Beijing Longitudinal Study of Aging, which commenced in 1992 and had 4 survey waves up to year 2000. An abridged life table was used to estimate life expectancy, in which age-specific mortality and age-specific disability rates were adjusted by using a discrete-time hazard model to control confounders.

RESULTS

The mean ages (SD) for men and women were 70.1 (9.25) and 70.2 (8.72) years, respectively; mortality and disability rates during follow-up were 34.7% and 8.0%, respectively. In both sexes, never smokers had the highest life expectancy and active life expectancy across ages, as compared with current and former smokers. Current heavy smokers had a shorter life expectancy and a shorter active life expectancy than light smokers. Among former smokers, male long-term quitters had a longer life expectancy and longer active life expectancy than short-term quitters, but this was not the case in women.

CONCLUSIONS

Older adults remain at higher risk of mortality and morbidity from smoking and can expect to live a longer and healthier life after smoking cessation.

Smoking cessation for older people: neither too little nor too late

Community nurses are uniquely placed to facilitate smoking cessation with older people. Older people who smoke in the home expose not only themselves to the many health risks associated with tobacco use but also partners, children and grandchildren through second-hand smoke. Yet research has found that community nurses have several concerns about raising the issue of smoking in the home with older people including taking away one of their few pleasures; fear that the damage is done; damaging the professional relationship and a lack of knowledge about smoking cessation advice and services. In this article the authors acknowledge and challenge these concerns to encourage community nurses to embed smoking cessation in their daily practice with older people.

Primary prevention, aging, and cancer: overview and future perspectives

Cancer-specific primary prevention efforts for the geriatric population are not understood well and currently are underused despite the rapidly growing elderly population. It has been established that lifestyle changes, such as smoking cessation, dietary changes, and increasing physical activity, decrease the incidence of cancer in younger populations. However, a multitude of conceptual, methodological, and dissemination challenges arise when the objective is to apply primary prevention of cancer to the elderly. For this article, the state of the science was reviewed to reveal barriers in the uptake of cancer-specific primary prevention practices, including the lack of data for the applicability of clinical research findings to older populations. Under-representation of older adults in behavioral trials and research programs is hindering progress in understanding the physical health and lifestyle choices of older individuals. Efforts directed toward prevention in terms of promoting health behaviors may be not only clinically advantageous but also cost-effective. In addition, models for translating research findings on primary prevention from younger individuals to the elderly population needs to be addressed. Practitioners need to gain a better understanding of the opportunities for cancer-specific primary prevention, because such an understanding could enhance the management of chronic disease.

Price effects on the smoking behaviour of adult age groups

OBJECTIVES

To provide a cigarette price elasticity reference for adult age groups, and to estimate the smoking behaviour changes in US adults in light of unprecedented state excise tax increases on cigarettes during the 1990s.

STUDY DESIGN

Individual-level data from the Behavioral Risk Factor Surveillance System for 1993-2000 were merged with state-level cigarette price and tax data.

METHODS

Data were analysed for different age groups using a weighted least squares regression framework. The outcome variables measured were whether an individual was a smoker, whether he/she had tried to quit smoking during the previous year, and how many cigarettes were smoked per day among the total population and among active smokers.

RESULTS

This study confirmed previous results that younger individuals are more responsive to price changes than older individuals. Although older age groups are less sensitive to price changes, their smoking behaviour changes are still statistically significant.

CONCLUSIONS

This study found that while older individuals are less responsive to price changes than younger individuals, their behavioural changes due to cigarette price increases should not be ignored.

Diretrizes para cessação do tabagismo - 2008

Estas diretrizes constituem uma ferramenta atualizada e abrangente para auxiliar o profissional de saúde na abordagem do tabagista, recomendando atitudes baseadas em evidências clínicas como a melhor forma de conduzir cada caso. De forma reduzida e mais objetiva possível, o texto final foi agrupado em dois grandes itens: Avaliação e Tratamento. Os dois itens apresentam comentários e níveis de recomendação das referências utilizadas, bem como algumas propostas de abordagem, como por exemplo, redução de danos, em situações específicas ainda pouco exploradas, como recaídas, tabagismo passivo, tabagismo na categoria médica e uso de tabaco em ambientes específicos.

Perfil dos fumantes que procuram um centro de cessação de tabagismo

OBJETIVO: Definir o perfil do fumante que procura um serviço de cessação do tabagismo e comparar os perfis observados em homens, mulheres e idosos. MÉTODOS: Foram avaliados, prospectivamente, 203 fumantes. Os indivíduos responderam questionários relacionados ao histórico tabagístico, antecedentes psiquiátricos, questionários específicos para depressão e ansiedade, questionário de dependência à nicotina e um questionário geral auto-aplicável. RESULTADOS: Nesta amostra, 58,6% dos indivíduos eram do sexo feminino (119). A média de idade para a amostra foi 45,3 ± 12,0 anos, sem diferença significante entre os sexos (p = 0,391). A maioria da amostra estudada apresentou classificação econômica C ou superior (84,2%). Sessenta e três porcento dos fumantes possuíam pelo menos o segundo grau completo. Depressão foi muito mais referida entre as mulheres com diferença estatística marginalmente significante (p = 0,069). Porém, avaliando-se depressão pelo Inventário Beck de Depressão, não houve diferença estatisticamente significante entre os sexos e entre idosos e não-idosos. CONCLUSÕES: Foram identificados aspectos no perfil dos fumantes que procuraram este serviço que já são reconhecidos na literatura especializada como preditores de insucesso no tratamento (como pertencer ao sexo feminino e diagnóstico de depressão). Isto demonstra a importância de se realizar uma completa avaliação prévia do perfil do fumante que procura um centro especializado, para que medidas possam ser tomadas antes e durante a abordagem do fumante, com o objetivo de se aumentar as taxas de sucesso no tratamento.

The impact of executive cognitive functioning on rates of smoking cessation in the San Luis Valley Health and Aging Study

Cigarette smoking is one of the leading preventable causes of death. Previous research has shown that many common smoking cessation interventions are effective with older smokers; a few interventions have been tailored to this population. To our knowledge, however, no smoking cessation research or interventions targeted at older adults have addressed the influence of cognition on successful smoking cessation. We hypothesized that impairment of executive cognitive functioning (ECF), which is relatively prevalent among older adults, would negatively influence smoking cessation rates among older smokers. The relationship of ECF to smoking cessation was examined in a population-based sample of 1,338 community-dwelling older persons in Colorado's San Luis Valley, 204 of whom were current smokers. As predicted, current ECF did not predict early smoking behaviour, but was a significant predictor of successful smoking cessation. Older persons suffering from executive dysfunction were less likely to have quit smoking than were their cognitively intact counterparts (OR = 1.10, 95% CI 1.04-1.17, P < 0.01). Among those with normal ECF, 73.7% had quit smoking, compared with 65.1% of participants showing any level of ECF impairment. Limiting the sample to individuals who were active smokers at or after the age of 65, when executive impairment is relatively common, produced similar results. Individuals with better executive functioning were more likely to have quit smoking (OR = 1.12, 95% CI 1.02-1.23, P = 0.02).

Clinical Implications of Smoking and Aging: Breaking Through the Barriers

In the United States, there are almost 4 million smokers older than 65. Yet, older smokers often receive suboptimal care. Inaccurate information and myths about older smokers may have become ingrained in the attitudes and beliefs of both older smokers and health care providers. In this article, prominent myths about older smokers will be explored and refuted. The realities include the following: Smoking tobacco has no benefit; it does not improve cognition or mood; smoking cessation, even among older, frail adults, produces significant benefits in terms of health and quality of life; and using filtered cigarettes or reducing the number of cigarettes smoked per day does not reduce harm. Gerontological nurses are at the forefront of treating tobacco use among older smokers. They should assess the smoking status of all older adults at every contact, treat smokers with pharmacotherapy and counseling, follow up with patients, and stay informed.

The health behaviors of the older US worker

BACKGROUND

As the US workforce ages, lifestyle factors will increasingly affect their health, yet little information is available on their prevalence in older working populations.

METHODS

Using the nationally representative 1997-2003 National Health Interview Survey (NHIS), reported current smoking, risky drinking and leisure-time physical activity behaviors of older workers (> or =65 years) were compared with older non-workers. These behaviors were evaluated by age, gender, race, ethnicity, and occupation, as well as prototype "healthy" and "risky" persons.

RESULTS

The study population of 4,946 older US workers and 38,313 older non-workers represented an estimated 3.9 million older workers and 28.9 million older non-workers annually. Relative to older non-workers, older workers reported more current smoking and risky drinking, but higher levels of leisure-time physical activity with variations by subpopulations.

CONCLUSIONS

Less than 4% of the older US worker population reported overall healthy behaviors. Certain occupations and other subpopulations can be targeted for age-appropriate behavioral interventions.

Psychosocial correlates of smoking cessation among elderly ever-smokers in the United States

This study was conducted to identify the psychosocial factors associated with successful smoking cessation among ever-smokers aged 60 and older in the United States. Descriptive and multivariate analyses of the 2000 National Health Interview Survey (NHIS) were conducted. Controlling for sociodemographics and medical history of smoking-associated diseases, former smokers were less likely to have psychological distress (adjusted OR=0.71, 95% CI=0.58-0.88) and more likely to believe in the danger of second-hand smoke (adjusted OR=3.01, 95% CI=2.4-3.79) and the appropriateness of a smoking ban in indoor public places (adjusted OR=2.62, 95% CI=2.11-3.26). Having no regular source for care (adjusted OR=0.54, 95% CI=0.37-0.78) was an independent barrier to cessation, as were younger age, female, Hispanic race, being nonmarried and employed, and having lower income and education. This work contributes to a knowledge base for the development of interventions to maximize smoking cessation of elderly smokers. Findings suggest that strategies tailored to psychological distress and beliefs about smoking health harms and smoking restriction policies would aid in successful cessation. Specific measures reinforcing the importance of having a regular source for care may promote cessation. The extent to which these psychosocial factors affect elders' motivation to quit smoking remains to be explored.