Tobacco nicotine dependence

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Tobacco dependence is the most common of all substance use disorders in the elderly population; in a 1994 American national survey, among people aged 65 and older, 13 per cent of men and 11 per cent of women reported regular daily cigarette smoking. (25) Tobacco use is the leading preventable cause of death in adults. Smoking doubles the risk of death from combined causes in people aged 35 to 70,(6) and longevity is inversely associated with cigarette consumption. Smoking in older people is also associated with loss of mobility and poorer physical function, and may alter the metabolism of many prescribed drugs. Older smokers who quit have a reduced risk of death compared with current smokers that becomes evident within 1 to 2 years after quitting, and their overall risk of death approaches that of never-smokers after 15 to 20 years of abstinence/26' Among smoking cessation methods, some, like rapid smoking aversion therapy or medicinal nicotine substitutes (e.g. polacrilex gum, transdermal patches), may be contraindicated in older patients with coronary artery disease, cardiac arrhythmias, hypertension, or diabetes mellitus. Brief intervention in primary care medical settings and self-help guides can, when appropriately tailored to elderly individuals, produce 6-month or 1-year quit rates as high as 20 per cent, compared with spontaneous quit rates of 5 to 10 per cent.(27) Transdermal nicotine patch therapy yielded a 6-month quit rate of 29 per cent in one naturalistic study of elderly smokers. Older smokers who relapse report the same reasons as younger smokers for their return to smoking: irritability, weight gain, fear of weight gain, friction with family members, and inability to concentrate. (28>

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