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