resident and family council presentation 2 (1)

7/30/2019 Resident and Family Council Presentation 2 (1)

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Smoke-Free Long Term CareHomes Project


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Second Hand Smoke

&

Smoke-Free OntarioAct


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Second Hand Smoke (SHS)

Annoying or Dangerous? SHS is Dangerous

In January, 1993 the Environmental ProtectionAgency declared SHS as a human carcinogen

There is no risk-free level of second-handsmoke exposure, with even brief exposureadversely affecting the cardiovascular andrespiratory systems


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Annoying or Dangerous?

How is SHS Dangerous

SHS smoke contains higher concentrations ofharmful chemicals because idling cigarettesburn at a lower temperature

Cigarettes produce about 12 minutes ofsmoke

Typical smokers spend about 30 sec inhaling

The rest of the time, the lit cigarette isreleasing toxins into the air


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Annoying or Dangerous?

Effects of SHS

SHS is harmful to those exposed to it (bothsmokers and non-smokers)

Every year, SHS kills more than 4000 non-

smokers in Canada (Heart and Stroke Foundation of Canada,2006)

Can cause the same health problems &diseases as smoking


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Why Smoking Rooms DontWork

Peeing

Section

Non-

peeingSection


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Air quality test at CAMHOutside a designated smoke room

Pre-implementation outside DSR

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5

10

15

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12:28:48 12:57:36 13:26:24 13:55:12 14:24:00 14:52:48

Post-implementation outside DSR

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5

10

15

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12:57:3

6

13:26:2

4

13:55:1

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14:24:0

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14:52:4

8

15:21:3

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15:50:2

4


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Whats new in the Smoke-Free OntarioAct for LTC HomesFeature of Legislation Tobacco

Control Act1994

Smoke-FreeOntario Act

2005

100% province wide smoke free publicplaces

No Yes

Designated smoking rooms Allowed NotAllowed

Controlled smoking areas (CSAs) atresidential care facilities that protect

residents and healthcare workers

No Yes

Protection for Home Health Workers No Yes

Smoking at exits to health carefacilities

Yes No


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Controlled Smoking Areas (CSAs)

Designated Smoking Rooms

CSAs are designed to lower second-handsmoke exposure outside the room.

The law specifies engineering design,

function,and maintenance (Better ventilationsystem, double sets of automated doors)

Smoking in a CSA is limited to residents only

LTC Homes employees arent required to enter

a CSA

LTC Homes without CSAs can have a smokingshelter


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Safe Smoking Assessment For CSAs, the SFOA stipulates that:

A resident who desires to use the roommust be able, in the opinion of the proprietoror employer, to smoke safely without

assistance from an employee.


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Why Assess Safe Smoking Ability

Elderly have an increased risk fromsmoking related fires:

Compared to the general popn, the risk for

dying in a fire for people age 65+ is 2.5 Xsgreater

The risk increases with age:

65-74 years the risk is 1.8 Xs greater than

the general population 85+ the risk increases to 4.6 Xs greater


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Smoking,

Quitting, CuttingBack and NRT


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Smoking: Disease and Death Smoking is responsible for approximately

70% of deaths in the geriatric population

Associated with all three major causes ofdeath among the elderly: heart disease,cancer and stroke

~5% of residents in a LTC home smoke


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Smoking:True or False

Smoking helps residents cope withstress, engage in social interactionand escape boredom(Wolfsen, 2001)

Smoking increases stress & anxiety levels.Research shows a decrease in anxiety within 2weeks of quitting

If a value becomes attached to healthyactivities such as yoga, gardening, meditation,the same stress relief, freedom from boredom,and social interaction may be experienced


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Quitting: Health Benefits

Health benefits can be seen in elderlysmokers who quit

Quitting smoking can have an extremelypositive impact on the health of the elderly. Itcan delay the progression of illness or preventillness altogether, and hence, affect length andquality of life (Bergman and Falit, 1997)


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Benefits of Quitting Over Time

After Health Benefits

20minutes

Blood pressure, pulse, and hand/feet temperature return tonormal

8 hours Nicotine and Carbon Monoxide levels in blood reduced byhalf, oxygen levels return to normal

24 hours Carbon Monoxide will be eliminated from the body. Lungs

start to clear out mucus and other smoking debris48 hours Nerve endings start regrowing. Ability to taste and smell is

enhanced

72 hours Breathing becomes easier, Bronchial tubes relax, energylevels increase

2-12weeks

Circulation Improves, breathing improves, walkingbecomes easier

3-9months

Cough, wheezing, and breathing problems improve andlung function increase by up to 10%

1 year Risk of heart attack falls to about half that of a smoker

10 years Risk of lung cancer falls to about half that of a smoker


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Quitting:Additional Health

Benefits

Wound healing: Nicotine and other toxins in smoke (carbon

monoxide, hydrogen cyanide, aromatichydrocarbons) promote endothelial and epithelial

skin breaks, increase platelet aggregation, reducefibroblast proliferation, and produce cutaneousvasoconstriction (Appel, Thomas, & Aldrich, 2003).

Repeated passive exposure to cigarette smokeappears to have similar effects

Even without wound complications, smokers havelonger postoperative stays in intensive care

Medications more effective after quitting, sodoses may need to be lowered


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Quitting:True or False

Smoking cessation programs for theelderly are not necessary since there arenot that many left smoking, just a few

die-hards who are already 90 years oldand will never quit(Bergman, Falit, 1997)

A study conducted revealed that oldersmokers are interested in quitting and will

respond positively to a program tailored totheir needs.(Rimer and Orleans, 1994)

Cant assume residents do not want to cutback or quit or cant do it


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Quit Methods

Behavioural Interventions

Individual Counseling

Support group Self-help programs (books, videos,

audiotapes, telephone help lines)

Physician Advice or Counseling Other pharmacotherapy (Buproprion,

Clonidine, etc)

Nicotine Replacement Therapy


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Nicotine Replacement Therapy

(NRT)

NRT was introduced over two decades ago NRT is the most commonly used pharmacotherapy

There are 3 types of NRT currently available inOntario:

Nicotine gum

Nicotine patch

Nicotine inhaler

All forms of NRT are equally moreeffective than not using any NRT whentrying to quit


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NRT: How it works

Nicotine is the drug that is inhaled from tobaccowhile smoking

It enters the bloodstream and stimulates the brain

When the blood levels of nicotine fall, people whosmoke experience withdrawal symptoms(irritability, restlessness, headache, etc)

Nicotine Replacement Therapy (NRT) is a safe way

to provide the body with nicotine NRT delivers lower levels of nicotine at much

slower rates than smoking. This reduces thenicotine withdrawal symptoms


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Benefits of NRT as a Quit

Method

Increases the odds of successful quitting

Reduces intake of thousands of chemicalsincluding Carbon Monoxide the toxin ofmost concern

Cleaner delivery system of nicotine

Reduces or even stops withdrawal symptomswhile trying to quit smoking

Low risk of addiction (Cepedo-Benito, Reynoso, and Erath,2004)


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Choosing the Most Suitable NRT1. Nicotine Patch

Can use for 16 hours or 24 hours (overnightuse)

It is placed on the skin releasing a steadystream of nicotine into the bloodstream

May be beneficial to those who have earlymorning cravings and for those who have

trouble chewing (e.g. dentures)


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Choosing the Patch

Smoke 10-14cigarettes perday

Smoke 14 ormorecigarettes per

day

Week Dose Dose

1-6 14 mg (Step 2) 21 mg (Step 1)

7-8 7 mg (Step 3) 14 mg (Step 2)9-10 7 mg (if needed) 7 mg (Step 3)

H U h P h


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How to Use the Patch(1 of 2)

May need to clean area with alcohol wipe

Touch only small corner of adhesive

Rub patch after application ensure all

corners are stuck

Wash hands in water after application dont use soap

Discard old patch out of reach of children,animals can still be harmful

H U h P h


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How to Use the Patch(2 of 2)

Apply to clean dry area

Rotate site every day

Remove old patch before applying new

one Do not use lotion, moisturizing soap on

the area the patch is to be applied


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Choosing the Most Suitable NRT

2. Nicotine Gum

Nicotine reaches bloodstream faster than thepatch

2 doses: 2mg or 4mg (depends on amount ofcigarettes smoke/day)

Chew and Park method: Chew to breakdown then park in cheek to release nicotine

which is absorbed into bloodstream May not be suitable for people with difficulty

chewing

Some people do not like the taste of the gum


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How to use Nicotine Gum

Must be able to chew gum (i.e. nodentures, TMJ)

2mg: use only in combination with patch

as a breakthrough medication

4mg: use in combination with patch oralone

Chew one piece at a time, no more than1/hour


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How to use Nicotine Gum

Use every hour or less as needed, up to15 pieces/day

Chew and park in between teeth and

cheek Absorbed via buccal mucosa

Repeat chew every minute or so

Each piece lasts approximately 30mins Do not chew within 30 mins of

caffeine/acidic products


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Choosing the Most Suitable NRT

3. Nicotine Inhaler

Resembles a cigarette

Nicotine cartridges are inserted into it and

inhaled Each cartridge provides about three 20 min

sessions

May be suited to those who enjoy the hand

to mouth action of smoking May be useful for continuing smokers who

need to abstain for various periods of time


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How to Use the Inhaler

Use up to 6 10mg cartridges/day

Can use continuously for 20 min or asneeded

Inhale like cigar, not deeply into the lungs

Flexible -use as much or as little asneeded

May notice a burning, warm or coolsensation when inhalingOK unless itbecomes bothersome

Clean inhaler regularly with soap & water


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Nicotine Withdrawal

Cravings to smoke

Frustration

Anger

Anxiety

Difficulty concentrating

Restlessness


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Sign of Nicotine Toxicity

Nausea and/or vomiting

Sweating

Vertigo

Tremors

Confusion

Weakness

Racing heart

Light-headedness

Ti f h l i l i


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Tips for helping people remain

smoke-free

Take it one day at time

Engage in relaxing activities: walking,gentle exercise, or deep breathing

activities Stimulate the mouth: if appropriate snack

on raw vegetables, or drink a cold glass ofwater

Occupy the hands: doodle, play cards, doa cross word or jigsaw puzzle


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How to be a buddy

Friend first

Take your lead from the person who isquitting

Each person has to find their own time toquit

Understand it may be the most difficult

thing for them to do Lectures dont work


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How to be a buddy

Dont do anything to encourage start backinto old smoking habits

Dont make fun of how they are coping withthe change

Listen and be respectful, dont judge

Change activities you do together to avoidtemptation

Be positive

Be patient


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Resources

For training & consultations

call:416 535-8501 x4042

e-mail:

[email protected]

resident and family council presentation 2 (1)

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