Hypertension, diabetes, depression… why older people should stop smoking ?

Tabac : il n’y a pas d’âge pour arrêter

In France, nearly 10% of people over 65 smoke. Should we encourage senior smokers to give up this habit ? For what benefits ?

In terms of the prevalence of smoking in France, the situation has improved in recent years, going from 30% of smokers in 2000 to 25.5% in 2020. Nevertheless, smoking evolves differently depending on age groups: in 2019, 9% of women aged 65 to 75 and 10.4% of men smoked. According to Santé Publique France in 2020, 4.1% of people aged 76 to 85 smoked every day.

Cognitive decline, heart failure… seniors pay a high price for their smoking

One might think that the proportion of over 65s who smoke is rather low compared to other age groups. In reality, it is important for a population very concerned by its harmful effects: 70% of deaths attributable to tobacco occur among those over 60 years old. At age 70, 81% of non-smoking men and 87% of non-smoking women are still alive, compared to 55% of smoking men and 68% of smoking women. At age 80, this gap is even more marked.

But the consequences of smoking go beyond premature mortality: cognitively, elderly smokers perform worse than non-smokers, with a more rapid decline in cognitive functions and a greater risk of disease. Alzheimer's and vascular dementia, especially in cases of hypertension, diabetes or depression. Smoking among seniors is also correlated with the occurrence of heart failure. In addition, smoking is a risk factor for postoperative mortality in cardiac surgery in the elderly (mortality of 14.8% compared to 2.1% in non-smokers) linked to more respiratory complications.

Smoking cessation, all the benefits!

Dr Gilles Albrand (geriatrics department of the Hospices Civils de Lyon) remains convinced that for a large proportion of seniors, smoking cessation is beneficial because life expectancy can be significant. For him, despite the usual arguments ("a little pleasure that one cannot refuse at this age", "it is too late to stop"), it is necessary to encourage and support the person towards withdrawal.

The arguments in favor of weaning are numerous. Between the ages of 70 and 79, quitting smoking reduces the risk of cardiovascular death by 27%. At these ages, stopping smoking saves years of life expectancy, specifies the National Committee to Combat Smoking (CNCT). A German meta-analysis among the 50 – 74 years old showed that smoking cessation was very beneficial and rapid even at an advanced age, with a reduction in cerebrovascular consequences (myocardial infarction, stroke, cardiovascular diseases). Most of the excess risk disappears within five years of quitting.

Quitting smoking can also limit early cognitive decline, as well as the risk of heart failure, etc. but also immediate risks, such as those linked to surgical intervention. Indeed, smoking disrupts the functioning of the immune system, which is already much less effective at these advanced ages, hence an increased risk of infection in the event of surgery. Furthermore, due to smoking, certain surgical procedures carry increased risks of complications after the age of 65, such as difficulties in placing dental implants, increased postoperative complications particularly in orthopedic surgery, healing problems, or even bone reconstruction in the event of a fracture. Finally, starting to quit smoking after the age of 65 provides a better quality of life, breathing will be improved, as will taste and smell.

How to talk about smoking cessation with a senior ?

It’s case by case, answers Dr. Gilles Albrand. Indeed, you have to be very pragmatic, depending on the clinical context. If sometimes caregivers and those around them must accept that the elderly person continues to smoke, sometimes cessation becomes imperative. There are also several types of elderly smokers, to whom cessation must be adapted. "Elderly smokers are mainly long-term smokers, which makes them very dependent, points out the geriatrician. This could make it more difficult for them to quit smoking. But another part of these older smokers started smoking later in life in response to difficult events, such as the death of a loved one, retirement or isolation. quot;

Tools, such as nicotine replacement therapy and cognitive-behavioral therapy, are just as useful as for younger smokers. It has also been shown that older smokers were as likely, or even more likely, to successfully quit smoking than younger smokers.

To find out more: National Committee to Combat Smoking