Smoking Cessation in Older Adults

Danielle Slupski PAS 655

Dr. Gairola

Outline

• Introduction to older adults• Background on smoking • Barriers specific to older adults• Tailoring a cessation program• Application to PA’s• Conclusion

The Graying of America

• 2012 approx. 10,000 Americans will turn 65 everyday

• By 2030, 20% of the U.S. population, or 71 million people, will be 65+

Centers for disease control and prevention. Public health and aging: trends in aging--United States and worldwide. MMWR 2003; 52(06):101-6.

Smoking in Older Adults

• National smoking average for people 65+ is 10.1%

• Kentucky ranks 51 out of 50 states and D.C. with 16.9% of population over 65 continuing to smoke

The state of aging and health in America 2004. www.cdc.gov/aging

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• 95% of health care expenditures for older adults are for chronic diseases

• Life expectancy for smokers is decreased by 13-15 years, this eliminates retirement years for most smokers

Hoffman, Rice. JAMA, 1996.

So, why care?

• Stopping smoking at ANY age confers immediate health benefits

• Quitting at 65 or older reduces by nearly 50% a person’s risk of dying from a smoking-related disease

Centers for Disease Control and Prevention. MMWR 2000; 49:797-801.

• Estimated that 25,000 additional smokers could be encouraged to quit each year by providing cessation advice to 90% of medicare patients

Disesases caused by Tobacco

• AAA• Acute myeloid

leukemia• Cataracts• Cervical cancer• Kidney cancer• Pancreatic cancer• Pneumonia• Periodontitis• Stomach cancer• Alzheimer’s/dementia

• Bladder cancer• Esophageal cancer• Laryngeal cancer• Lung cancer• Oral cancer• Throat cancers• Chronic lung diseases• Coronary heart • Cardiovascular

diseases• SIDS

Health consequences of smoking: A Report of the Surgeon General, 2004

Short-term Benefits of Quitting

• 20min- BP and pulse begin to drop to normal and temp increasees to normal

• 8h- CO level in blood drops to normal

• 24h- chances of having MI decreases

• 48h- food tastes and smells better

• 72h- bronchial tubes relax and breathing becomes easier, lung capacity increases

• 1-9mo- coughing, sinus congestion, fatigue, SOB lessens

Black, D. Calling it quits: your body will thank you immediately. Centre for health promotion, University of Toronto, 1999.

Barriers

• Often highly nicotine dependent• Less likely to believe smoking is

harmful to their health • Less likely to have tried to quit • War veterans• Psychological distress• No regular source for care• Lower SES and educational

attainment

Alarming

• Ossip-Klein et al. physicians more likely to give advice to sicker patients, especially if had cv, cerebrov., or resp. diseases– Missing important primary prevention

oppurtunities

Ossip-Klein DJ, et al. Smokers ages 50+:who gets physocoan advice to quit? Prev Med2000; 31:364-69.

AMI and counseling

Brown et al. and Houston et al. found that

only 40 and 41% respectively of patient hospitalized for AMI received advice to quit before discharge

• The TRAGEDY is even without confirmation of cessation, those patients who received advice to quit remained at sig. reduced all cause mortality compared to those not counseled

Hope

• Physician advice to quit and will-power were listed as 2 most influential factors of successful smoking cessation in both current and former smokers

• Older adult’s contacts with physicians and dentists are strongly negatively associated with smoking

Kaplan, Newsom, McFarland, 2002. Williams, Lewis-Jack, Johnson, Adams-Campbell, 2001

Tailoring

• Establish a quit date– Best within 2 weeks, and inform friends

• Behavioral modification techniques– How to manage stress

• Withdrawal symptoms– Provide directions for cessation aids

• One-on-one coaching• Link specific symptoms to smoking• Follow-up

– Phone call or office visit; praise the patient

• Pamphlets– Graphic style and preferences; info pertaining to older

adults

Morgan et al.

• Effectiveness of a tailored office-based smoking cessation program

• Tailoring: attention to graphic and style preference of older adults, inclusion of content specific to older smokers, address unique barriers, concerns, and motivations for quitting among older adults

Intervention protocol

• 1. Ask about smoking at every chance• 2. Advise all smokers to stop• 3. Assist patient to stop smoking• 4. Arrange for follow-up

– HCP also trained to praise for previous quit efforts, provide personalized feedback linking smoking to symptoms, health benfits of quitting in an older adults, and give a clear message to quit smoking

Results

• Using this intervention six-month abstinence rates were nearly doubled

• Most successful practices had a top-down commitment

Application to the PA

• Part of the health care team• Relationship with the patient• Go through the process together

– Begin together, patient at office on quit date

• Every patient, every time!

Conclusion

• It is never too late to receive benefits from smoking cessation

• Tailoring matters

• HEALTH CARE PROVIDERS HAVE GREAT OPPURTUNITIES TO INFLUENCE SMOKERS TO QUIT EVERYDAY AND EVERY CHANCE SHOULD BE TAKEN!

References• Brown DW, Croft JB, Schenck AP, Malarcher AM, Giles WH, Simpson RJ.

Inpatient smoking-cessation counseling and all-cause mortality among the elderly. Am J Prev Med 2004; 26:112-18.

• Hoffman C, Rice D, Sung H. Persons with chronic conditions: their prevalence and costs. J Am Med Assoc 1996; 276:1473-9.

• Houston TK, Allison JJ, Person S, Kovac S, Williams OD, Kiefe CI. Post myocardial infarction smoking cessation counseling: associations with immediate and late mortality in older medicare patients. Am J Med 2005;118:269-75.

• Morgan GD, Noll EL, Orleans CT, Rimer BK, Amfoh K, Phil M, Bonney G. Reaching

mid-life and older smokers: tailored interventions for routine medical care.

Prev Med 1996; 25:346-54.