Tobacco in Older Adults
Goal:

To improve the learners' understanding of tobacco use and cessation issues unique to the older adult.

: 1 hr

After completing this activity participants will be able to:

  • Use knowledge of tobacco-related health effects and mortality to advise older adults on the benefits of quitting

  • Use tobacco cessation behavioral interventions to meet the needs of older adults

  • Use tobacco cessation pharmacotherapy interventions to meet the needs of older adults


Professional Practice Gaps

Tobacco use is still fairly common; in the United States. Approximately 28.4% of persons aged 12 or older used a tobacco product in the last month in a 2008 survey (NSDUH, 2009). Tobacco is estimated to be responsible for 443,000 premature deaths annually (CDCP, 2008). The percentage of elderly aged 65 and over who use tobacco is smaller but still significant: past month cigarette use in a 2008 survey was 10.3% (NSDUH, 2009). Cumulative health effects from a lifetime of smoking are more likely to be seen in this age group (Surgeon General, 2004).

The effectiveness of tobacco interventions by health care providers was evaluated in a review of the literature by the review panel for the U.S. Public Health Service Clinical Practice Guideline, Treating Tobacco Use and Dependence: 2008 Update (Fiore, et al., 2008). They found that medication and counseling are more effective for promoting tobacco cessation than no treatment and that intervention effectiveness increases with increased intervention intensity. The Clinical Practice Guideline (Fiore, et al., 2008), also provided evidence-based guidelines for clinicians on how to provide brief and more extensive interventions in tobacco use.

Despite the documented need for tobacco cessation and effectiveness of clinical interventions and availability of practice guidelines, many physicians still are not providing evidence-based tobacco interventions. A number of studies have found that screening for tobacco use and recommending cessation occurs as frequently as 75% of the time, other appropriate tobacco interventions are made by primary care physicians less frequently (Schnoll R et al, 2006; Braun et al, 2004; Jaen et al, 2001; Ellerbeck et al, 2001). Tobacco discussions occur less often with older patients than the average patient in primary care in one study (Ellerbeck et al., 2001); in another study only 71% of elderly smokers visiting a health care provider were advised to quit (CDCP, 2000).

Training physicians in evidence-based, brief tobacco interventions in order to assure that all physicians know and are confident to provide tobacco interventions to the older patient who uses tobacco will help address this practice gap.

References
Ellerbeck EF, Ahluwalia JS, Jolicoeur DG, Gladden J, Mosier MC. Direct observation of smoking cessation activities in primary care practice. Journal of Family Practice. 2001`; 50(8): 688-695.
Fiore MC, Jaen CR, Baker TB, et al. Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline. Rockville, MD: U.S. Department of Health and Human Services. Public Health Service. May 2008.
Smoking cessation treatment by primary care physicians: An update and call for training. American Journal of Preventive Medicine. 2006; 31(3): 233-239.
Smoking-Attributable Mortality, Years of Potential Life Lost, and Productivity Losses --- United States, 2000--2004. Morbidity and Mortality Weekly Report (MMWR). 2008; 57(45): 1226–1228. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5745a3.htm
Smoking-related attitudes and clinical practices of medical personnel in Minnesota. American Journal of Preventive Medicine. 2004; 27(4): 316-322.
Substance Abuse and Mental Health Services Administration (SAMHSA). Results from the 2008 National Survey on Drug Use and Health: National Findings. Office of Applied Studies, NSDUH Series H-36, DHHS Publication SMA 09-4434 . 2009. Available at: http://archive.samhsa.gov/data/NSDUH/2k8nsduh/2k8Results.htm Accessed on: 2009-09-10.
Tailoring tobacco counseling to the competing demands in the clinical encounter. Journal of Family Practice. 2001; 50(10): .
US Dept of Health and Human Services. The Health Consequences of Smoking: A Report of the Surgeon General. Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, US Dept of Health and Human Services. 2004. Available at: http://www.cdc.gov/tobacco/data_statistics/sgr/2004/pdfs/executivesummary.pdf Accessed on: 2004-12-17.