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TOBACCO USE & OLDER SMOKERS
OLDER SMOKERS
In 2004, 3.7 million people aged 65 and older were smokers and 16% of all people aged 50 and older smoked; over 42% of all adult smokers
“Hard core” smokers, long term heavy smokers who are dependent on nicotine
Motivated to quit
COST of SMOKING for OLDER ADULTS
All of the major causes of death among older adults (e.g., cancer, coronary heart disease, stroke, pulmonary disease) are associated with tobacco use (National Center for Health Statistics, 2006)
BENEFITS of CESSATION for OLDER ADULTS
Smoking cessation, even in older adults who are frail, produces objective benefits in terms of mortality, reversed respiratory symptoms, disability level, decreased psychological distress, quality of life, and cost of care
OLDER vs YOUNGER SMOKERS
More likely to: be successful with cessation (losing this edge
because less likely to have a smoke free home)
more likely to blame themselves
Less likely to: believe in a strong connection between
smoking and illness be treated for tobacco use
OLDER SMOKERS & DEPRESSION
Theory that prevention of risk factors for CVD may help decrease prevalence and incidence of late life depression
Smokers have higher plasma homocysteine (risk factor for CVD) than non-smokers
Total plasma homocysteine associated with depression in later life (Almeida et al., 2005)
RISK FACTOR for DEPRESSION
High levels of functional disability, mild cognitive impairment, and smoking are the most important risk factors for depression (Weyerer et al., 2008)
OLDER SMOKERS & ANXIETY Older adults are among the largest users of
benzodiazepines Cigarette smoking associated with sustained
benzodiazepine use (Stowell et al., 2008)
Tobacco use/nicotine increases arousal and decreases effects of benzodiazepines
Among older MI patients, smokers have significantly higher anxiety than non-smokers (Sheahan, 2006)
SMOKING & ALZHEIMER’S DISEASE (AD)
Despite a growing body of evidence linking smoking with AD, beliefs prevail that smoking protects against AD in both scholarly journals and lay publications
TOBACCO INDUSTRY INTEREST in ALZHEIMER’S DISEASE
As early as 1976, the tobacco industry began to invest in AD research, with the goal of developing nicotine-related diagnostics and therapeutics
META-ANALYSIS: TOBACCO USE & ALZHEIMER’S DISEASE
Included 26 case control and 17 cohort studies (published 1984-2006)
Random effects meta-analysis used to estimate pooled risk ratios and 95% CI
Tested the effects of study design, quality, secular trend and tobacco industry affiliation in a weighted multiple regression analysis
Smoking and Alzheimer’s Disease
n Study Design
Tob Ind Affiliatio
n
Pooled Odds RatioCI = 95%
18 Case control no O.91 (0.75-1.10)
8 Case control yes 0.86 (0.75-0.98)*
14 Cohort no 1.45 (1.16-1.80)*
3 Cohort yes 0.60 (0.27-1.32)
SMOKING is a RISK FACTOR forALZHEIMER’S DISEASE
Multiple Regression
After controlling for study design, secular trend and tobacco industry affiliation: Risk of AD was 1.72+0.19 (P<.0005).
(Cataldo, Prochaska, & Glantz, under
review)
EXTENDED TREATMENT for OLDER CIGARETTE SMOKERS
Tobacco dependence is an addiction with a chronic relapsing course
Relapse is the norm
Need to treat it like a chronic disease
12 WEEK COMBINATION TREATMENT
Bupropion, NRT and group counseling for the first 12 weeks of treatment: 12 weeks sustained release bupropion 10 weeks 2mg and 4mg nicotine gum Counseling based on Clear Horizons
See 2008 Practice Guidelines Motivation Mood management Weight control Social support Withdrawal/dependence
EXTENDED COGNITIVE BEHAVIORAL TREATMENT (ECBT)
EXTENDED COGNITIVE BEHAVIORAL TREATMENT (ECBT)
Extended cognitive behavioral treatment produced high tobacco abstinence rates, maintained throughout the 2 year study period: 24 week 58% 52 week 55% 64 week 55% 104 week 55%
Hall et al. (2009) Addiction
NEVER TOO LATE for OLDER SMOKERS
Treat
Treat Intensively
Treat Long Term
IT’S NEVER TOO LATE to HELP OLDER SMOKERS QUIT
Reported prevalence of smoking at the time of lung cancer diagnosis range from 24 – 60%, compared with 12-29% in the general population
About 20% of lung cancer patients keep smoking
BENEFITS of CESSATION after a LUNG CANCER DIAGNOSIS
Decrease risk of synchronous multiple primary tumors and second primary tumors
Increased survival time Fewer post-operative complications Both chemotherapy and radiation
therapy produce fewer complications and less morbidity
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