In some industrialized communities smoking prevalence in elderly people is as high as 30 percent, and smoking prevalence is highest in low socioeconomic groups so that those older people with smoking-related diseases may also have other poverty-related social and medical problems. In the United Kingdom the smoking-related disease epidemic has probably passed its peak in men but is reaching its peak in women—in whom the maximum smoking uptake began with those born in the 1920s and 1930s.
Almost all smoking-related diseases are more common in old age. Furthermore, the beneficial effects of quitting smoking are for the most part maintained into old age. The reduction in risk of myocardial infarction (heart attack) is certainly not affected by aging, so that an older smoker who quits reduces his or her heart attack risk almost to normal after about three years. Quitting smoking can reduce the complications of peripheral vascular disease (hardening of the arteries to the legs and feet) in both young and elderly sufferers. Quitting produces a reduced risk of lung cancer (and probably many other cancers) in old people as well as in the middle-aged. Though only about one-quarter of heavy smokers will develop smoking-related airways obstruction (chronic obstructive pulmonary disease) resulting in chronic respiratory disability, quitting smoking will stop the accelerated decline of lung function in sufferers from this condition independent of the age at which they quit, at least up to the age of eighty.
Recent research shows that stopping smoking in middle age may extend the life of men by over seven years and in particular reduces deaths from heart disease. Even in those with preexisting smoking related lung disease, quitting smoking may extend life by up to six years.
We thus know that quitting smoking gives health gains for elderly people, but are they able to quit? The simple answer is that they are probably overall just as likely to be able to stop as younger smokers, however the situation is complex. Nicotine is an extremely addictive substance and quitting is difficult. Simply being told to quit by a medical professional produces a quit rate of about two to three percent. The most important predictor of whether a smoker is able to quit is their motivation (often judged by previous failed attempts to quit). In motivated elderly people without drug help (nicotine replacement) quit rates can be as high as 15 percent—slightly higher perhaps than in the young. However, there has been little research work into the value and acceptability of nicotine replacement or other newer drug therapies in old people. Furthermore, at least in the United States older smokers are, overall, probably less likely to want to quit than to accept advice that smoking is bad for them, however among those who do recognize the dangers there is greater motivation and urgency to quit and a higher success rate.
MARTIN J. CONNOLLY
BURCHFIEL, C. M.; MARCUS, E. B.; CURB, D.; et al. ‘‘Effects of Smoking and Smoking Cessation on Longitudinal Decline in Pulmonary Function.’’ American Journal of Respiratory and Critical Care Medicine 151 (1995): 1778–1785.
RAW, M.; MCNEILL, A.; and WEST, R. ‘‘Smoking Cessation Guidelines for Health Professionals.’’ Thorax 53, supp. 5 (1998): S1–S38.
ROSENBERG, L.; PALMER, J. R.; and SHAPIRO, S. ‘‘Decline in Risk of Myocardial Infarction Among Women Who Stopped Smoking.’’ New England Journal of Medicine 332 (1990): 213–217.
RUCHLIN, H. S. ‘‘An Analysis of Smoking Patterns Among Older Adults.’’ Medical Care 37 (1999): 615–619.
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