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 increases the risk of developing diabetes, cancer , cardiovascular disease, and lung disease.1,2 While this risk does not diminish in older age, quitting at any age can reduce risk and improve health.1,2,3

The mortality rate among older adults who smoke  is three times higher than older adult nonsmokers.1,4It’s estimated that smokers lose at least one decade of life expectancy compared to people who have never smoked.1 While smoking rates among adults 65 and older are the lowest by age group (8.4%),4 as succeeding generations age, the total number of older adult smokers in need of cessation services may increase in the near future.

What specific problems do older adults face when they smoke? 

Older adults who continue to smoke are three times more likely to die from any smoking related disease compared to older adults who have never smoked.4 Continuing to smoke in older age can compound the risk of onset for several smoking related diseases 1,2,5 For example, older age is a known risk factor for diabetes and smoking is known to increase the risk of diabetes onset by 30-40%.2 One study estimates that older adult smokers are 20% more likely to develop symptoms of depression compared to older adults who have never smoked.6

When does it become too late to quit smoking?

When older adults quit smoking, it not only increases life expectancy, but also improves their overall wellbeing.4,7 There is always hope for older adult smokers and it is never too late to quit. Smoking cessation at any age, even among those diagnosed with a smoking-related disease,4,8 can significantly reduce mortality.9 One study found that older adults who quit smoking between the ages of 60-69 can reduce their mortality risk from smoking related diseases by roughly 10%.8 Smoking cessation can also reduce the risk of lung cancer by approximately 50% with ten years of abstinence.10

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

Older adults can be receptive to smoking cessation interventions and are capable of quitting as evidenced by a declining rate of older adult smokers in the US.2,5,11 It’s been estimated that 54%12 of US adults are interested in quitting and as smoking is known to increase risk of serious cardiovascular disease, respiratory disease, and other conditions that may require hospitalization,2 older adult smoker inpatients present a critical population for whom to provide cessation services.13 It has been shown that cessation rates can be as high as 40% for older adult smokers who are hospitalized and receive cessation counseling following a myocardial infarction.13

An analysis of data from 2015 showed that while the number of older adult smokers who wanted to quit was over half (54%), the number of older adult smokers who attempted to quit in the past year was less than half (47%) and the number of successful quit attempts was low (5%).9 This same study also showed that only 6% of older adult smokers used both counseling and FDA-approved nicotine cessation medications.12 Combining these treatments in a multimodal approach have been shown to be the most effective form of intervention for cessation in older adult smokers (36.68% chance of successful quit attempt w/multimodal intervention vs. 26.10% chance for only pharmacological intervention).14 These rates may be improved by educating providers about the receptiveness of older adults to discussing smoking cessation and the efficacy of such interventions.2

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

The most commonly reported motivations to quit smoking among older adults are the prevention of cognitive impairments and increased well-being of their families.15 In the past, considerable focus has been given to young and middle-aged adults regarding smoking cessation and older adults have often been neglected.16 The inadequate focus on smoking cessation among older adults is possibly due to misperceptions about quitting in older age.  Health professionals may assume it is too late for patients to modify their risk factors and patients themselves may be unmotivated to quit, because they do not understand that quitting in older age can benefit their heath.16

Smoking cessation provides immediate and long-lasting benefits at any age and primary care providers especially have a golden opportunity to engage with older adult smokers and deliver brief interventions.17

Additional Resources:

  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. https://doi.org/10.1056/NEJMsa1211128
  2. U.S. Department of Health and Human Services. (2014). The Health Consequences of Smoking: 50 Years of Progress. A Report of the Surgeon General. Atlanta, GA: U.S. 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, https://www.ncbi.nlm.nih.gov/books/NBK179276/pdf/Bookshelf_NBK179276.pdf
  3. Burns, D. M. (2003). Tobacco-related diseases. In Seminars in oncology nursing (Vol. 19, No. 4, pp. 244-249). WB Saunders. https://doi.org/10.1053/j.soncn.2003.08.001
  4. Thun, M. J., Carter, B. D., Feskanich, D., Freedman, N. D., Prentice, R., Lopez, A. D., Hartge, P., & Gapstur, S. M. (2013). 50-year trends in smoking-related mortality in the United States. The New England journal of medicine368(4), 351–364. https://doi.org/10.1056/NEJMsa1211127
  5. Creamer MR, Wang TW, Babb S, et al. (2019) Tobacco Product Use and Cessation Indicators Among Adults — United States, 2018. MMWR Morb Mortal Wkly Rep;68:1013–1019. http://dx.doi.org/10.15585/mmwr.mm6845a2
  6. Ruopeng An, Xiaoling Xiang, Smoking, heavy drinking, and depression among U.S. middle-aged and older adults (2015). Preventive Medicine, Volume 81 , 295-302,ISSN 0091-7435, https://doi.org/10.1016/j.ypmed.2015.09.026.
  7. Doolan, D., & Froelicher, E. (2008). Smoking cessation interventions and older adults. Progress In Cardiovascular Nursing, 23(3), 119-127. https://doi.org/10.1111/j.1751-7117.2008.00001.x
  8. Nash, S. H., Liao, L. M., Harris, T. B., & Freedman, N. D. (2017). Cigarette Smoking and Mortality in Adults Aged 70 Years and Older: Results From the NIH-AARP Cohort. American journal of preventive medicine, 52(3), 276–283. https://doi.org/10.1016/j.amepre.2016.09.036
  9. Burns, D. M. (2003). Tobacco-related diseases. In Seminars in oncology nursing (Vol. 19, No. 4, pp. 244-249). WB Saunders.
  10. 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. https://doi.org/10.1053/j.soncn.2003.08.001
  11. Centers for Disease Control and Prevention (CDC). (2012). Quitting Smoking Among Adults---United States, 2001--2010. MMWR. November 11, 2011/60 (44); 1513-1519. http://dx.doi.org/10.15585/mmwr.mm6552a1
  12. Henley, S. J., Asman, K., Momin, B., Gallaway, M. S., Culp, M. B., Ragan, K. R., Richards, T. B., & Babb, S. (2019). Smoking cessation behaviors among older U.S. adults. Preventive medicine reports, 16, 100978. https://doi.org/10.1016/j.pmedr.2019.100978
  13. 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.https://doi.org/10.1016/j.amjmed.2004.12.007
  14. Chen, D., & Wu, L. T. (2015). Smoking cessation interventions for adults aged 50 or older: A systematic review and meta-analysis. Drug and alcohol dependence, 154, 14–24. https://doi.org/10.1016/j.drugalcdep.2015.06.004
  15. 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. https://doi.org/10.1111/j.1360-0443.2006.01647.x
  16. 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. https://doi.org/10.1093/ntr/ntp002
  17. 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. https://doi.org/ 10.2105/AJPH.2007.112060