Can older smokers be motivated to stop?

Older smokers can be a tough group. After decades of tobacco use, it can take a lot to get them to even talk about considering the remote possibility of thinking about stopping their habit. Smoking got them through some hard times, pardner. Their grandfather smoked three packs a day, maybe more on bad days, and lived until he was 103. Smoking may be one of their last remaining comforts as they move down that rocky path into their older years. All non-pediatrician PCPs have heard patients say, “Doc, I’m too old to stop now. What’s the point?”

Well, a new study just published in the BMJ provides some information we can offer such patients. The study is a meta-analysis looking at 25 cohorts, encompassing over 500,000 people ages 60 and older, to ascertain the impact of smoking cessation on cardiovascular mortality. Since the study did not look at cancer and COPD, the favorable impact of smoking cessation on overall mortality is probably even stronger. So what was the bottom line? According to the half million lives surveyed, it is never too late to stop smoking. Especially not for older folks.

How can this study help motivate our patients? Many older patients do not respond to general assurances their health will improve if they stop smoking. It is even less likely they will be swayed by erudite data such as: they can reduce their hazard ratio from 2.07 to 1.37 by stopping smoking. But if you tell a 60-year-old patient that if they stop smoking now, they can likely add a year and four months to their life, maybe that will generate some interest. Sixteen months may not be very motivating for some older folks, but for others it may just be the straw they need.

Here at PHC, we are on a ceaseless quest to offer our network useful tools of the trade. Hopefully this recent study will be helpful fodder you can use to counter the fatalistic falderal to which older smokers sometimes cling.

Richard Fleming, MD

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