Tobacco Dependence and Smoking Cessation in the Elderly

Older adults suffer a large proportion of the health consequences from smoking. But until recently there has been little attention paid in health policy and practice to older people who smoke. This is changing because of the increasing numbers of current mid-life smokers who continue the habit into older age and because evidence is growing of the health benefits of smoking cessation for the elderly. Yet, older smokers often receive suboptimal care. Inaccurate information and myths about older smokers may have become ingrained in the attitudes and beliefs of both older smokers and health care providers. In contrast to such myths these facts must be stated: Smoking tobacco has no benefit; it does not improve cognition or mood; smoking cessation, even among older, frail adults, produces significant benefits in terms of health and quality of life; and using "light" cigarettes or reducing the number of cigarettes smoked per day does not reduce harm. It is crucial to provide information on the benefits of smoking cessation in later life, and to give advice and support with smoking cessation. In geriatric medicine, smoking status of all older adults should be assessed at every contact, smokers should be treated with pharmacotherapy and counselling for cessation, and patients should be followed up. The majority of older smokers in Germany want to quit smoking but did not succeed despite of several attempts. Especially those patients at high risk due to comorbidity who will increase by number because of demographic transition are willing to quit and would gain particular benefit of effective smoking cessation intervention. Recent research has shown that older smokers, particularly those hospitalized with cardiovascular disease, can quit at high rates when provided an intervention. This article provides information on epidemiology and health consequences of smoking as well as on nicotine dependence, and examines the current state of research and practice for older adults and smoking cessation interventions including possible side effects such as depression and weight gain.