When a person is quite elderly and has been smoking for some time, is it time to quit? Does the payoff for quitting so late in life matter?
For long term smokers, the advice and desire to quit have probably been following the person around for some time. Yet quitting is never easy, particularly when the habit of smoking has been engrained over a long period of time. What risk factors should be weighed against the enjoyment of smoking at an older age when other pleasures in life may be dwindling?
We all Know the Risks Associated with Smoking Cigarettes
Since the first Surgeon General's warning was released on January 11, 1964, people have been aware that smoking causes health conditions such as lung cancer and chronic bronchitis. Over the years the discovery of health consequences has expanded to include throat cancer, emphysema, and problems with pregnancy. Even knowing all of the adverse effects, smoking is still an addiction and isn't just set aside like an old pair of shoes. Sometimes knowing the risks isn't enough to motivate someone to quit, but knowing the benefits of quitting may be strong incentive to kick the habit.
Weighing the Health Benefits
If an elderly person decides to quit, there would be immediate health benefits. One such benefit would include a decrease in the risk of bone fractures. Researchers in Sweden found that of the 1044 women studied, aged 75 years old, the 145 who smoked over the course of the 10 year study had a higher rate of bone fractures. Those who either never smoked or used to smoke consistently had fewer fractures, particularly in the vertebrae and hips. With the risk of falling increasing with age, fewer broken bones means faster recovery time and less time in the hospital.
Other benefits of cessation include a greater capacity to exercise. Exercise provides tremendous benefits for the elderly, who find it helps keep blood pressure and blood sugars within acceptable levels without the use of costly prescription medications. Studies consistently show improvements in health conditions associated with smoking as soon as the last cigarette is smoked, such as decreased risk of heart attack and stroke.
The Alzheimer's Association has also published evidence that smoking is strongly connected to the progression of dementia and that "quitting smoking may reduce the associated risk to levels comparable to those who have not smoked." People who smoke have higher rates of cardiovascular disease. Cardiovascular disease is associated with plaques and tangles in the brain, which are hallmarks of Alzheimer's, yet are only accompanied by the symptoms of Alzheimer's dementia in conjunction with cardiovascular disease.
When Health Benefits Aren't Enough
What about cases when the elderly person is, for example, 90 years old? It's one thing for a 68 year old in otherwise good health to quit smoking. Such a person has a high likelihood of adding a number of quality years to his or her life by quitting. What if quitting at 90 years old would only add a few months of life? The balance between risks and benefits begins to swing in the other direction.
Smoking may become an issue for those around a person, however. Some assisted living facilities are smoke-free zones, and it may no longer be an option for a person in such a facility to walk across the street for a smoke when mobility diminishes. When smoking parents move in with their non-smoking children, it could be a source of contention. It can also be considered a fire safety hazard. Cigarettes have long been the leading cause of death associated with house fires, causing the deaths of 700-900 people each year.
To Vape or Not To Vape ...
Another consideration that was not available until recent years is the option to switch from traditional smoking to vaping. It may not be as appealing to older generations as it is to younger ones; however, it may be a suitable option for health and safety reasons.
For example, pneumonia is almost like a death certificate for older people. It hospitalizes hundreds of thousands of elderly people each year, and tens of thousands never walk back out. Smoking cigarettes directly increases the risk for developing pneumonia. The more a person smokes, the greater the risk. Electronic cigarettes, aka vaping, have been found to reduce that risk. Not only does vaping reduce the risk for respiratory infections and pneumonia, it has 96% less harmful toxicology than chemical-laden cigarettes. A "collateral benefit" of vaping is the ability to slowly reduce the amount of nicotine used, eventually enabling a person to quit more easily.
Although smoking is an addiction, it still is a pleasurable act that many people enjoy. It's never too late to quit smoking and reap some health benefits from doing so, but it may be that smoking improves quality of life for some aged people. In the end, it remains a personal decision.
Alzheimer's Association. (2014). Alzheimer's and Public Health Spotlight: Heart Health and Brain Health. Available at http://www.alz.org/documents_custom/public-health/spotlight-heart-health.pdf. Last visited May 24, 2016.
Campagna, D., Amaradio, M.D., Sands, M. F., and Polosa, R. BioMed Central. (2016). Respiratory Infections and Pneumonia: Potential Benefits of Switching from Smoking to Vaping. Pneumonia, 8(4). BioMed Central. Available at http://pneumonia.biomedcentral.com/articles/10.1186/s41479-016-0001-2. Last visited May 24, 2016.
National Fire Protection Association. Coalition for Fire-Safe Cigarettes. Available at http://www.pfa.org/firesafe/CFSC_facts.pdf. Last visited May 24, 2016.
Thorin, M. H., Wilhborg, A., Akesson, K., Gerdhem, P. (2016). Smoking, Smoking Cessation, and fracture risk in elderly women followed for 10 Years. Osteoporosis International, (27)1: 249-255. Available at http://link.springer.com/article/10.1007/s00198-015-3290-z/fulltext.html. Last Visited May 24, 2016.