Advocacy

 

Smoking Among Older Adults in Canada


...about 1 in 10 seniors in Canada smokes.

According to the most recent statistics, about 1 in 10 seniors in Canada smokes. That is quite a bit less than the 45-64 year old age group, where in 1 in 4 smokes.

The provinces vary quite a bit in the percentage of older men and older women smokers. Among the men, it ranges from a low of 9.0% in British Columbia to a high of 16.2% in Newfoundland and Labrador. Among older women, it ranges from 7.1% in British Columbia to a high of 11.6% in Nova Scotia.

In general, smoking among older adults is much more common in the Atlantic provinces, Quebec, and Manitoba.


 

Percentage of Smokers in Canada

  2000-2001
  Age groups
  All age groups 12–14 15–19 20–34 35–44 45–64 65 and over
  %
Canada  
Both sexes1 21.5 3.0 18.3 26.1 27.1 24.9 10.4
  Males 23.5 2.2E 17.7 29.5 29.2 27.3 11.7
  Females 19.4 3.8 18.9 22.7 24.9 22.6 9.5

 

2000-2001
  Age groups
  All age groups 12–14 15–19 20–34 35–44 45–64 65 and over
  %
Canada  
Both sexes1 21.5 3.0 18.3 26.1 27.1 24.9 10.4
  Males 23.5 2.2E 17.7 29.5 29.2 27.3 11.7
  Females 19.4 3.8 18.9 22.7 24.9 22.6 9.5
Newfoundland and Labrador  
Both sexes 24.9 F 19.0 33.8 33.3 24.2 11.5
  Males 26.6 F 20.0E 36.3 33.6 25.6 16.2E
  Females 23.3 F 17.9 31.3 33.1 22.6 7.8E
Prince Edward Island  
Both sexes 24.5 F 17.0E 34.5 30.0 27.5 11.6
  Males 26.0 F 13.9E 40.2 25.7 30.0 12.2
  Females 23.1 F 20.2E 28.8 34.0 24.7 11.2E
Nova Scotia  
Both sexes 23.4 F 22.9 25.2 33.5 26.7 12.4
  Males 25.8 F 24.1 28.8 37.4 29.8 13.4
  Females 21.2 F 21.7 21.6 29.9 23.7 11.6
New Brunswick  
Both sexes 23.3 F 17.3 30.4 29.5 25.6 11.3
  Males 25.2 F 18.0 34.6 30.5 26.8 12.1
  Females 21.4 F 16.5E 26.0 28.6 24.5 10.6
Quebec  
Both sexes 24.9 6.4E 25.0 28.3 30.9 30.2 12.3
  Males 26.6 5.5E 23.2 30.9 32.3 31.8 14.0
  Females 23.3 7.4E 26.8 25.7 29.4 28.6 11.0
Note: Those reporting smoking daily.
1. Components may not add to total as sex was not stated for some respondents.
Source: Statistics Canada, CANSIM, table 105-0027 and Catalogue no. 82-221-XIE.
Last Modified: 2003-09-17.

 

 

  2000-2001
  Age groups
  All age groups 12–14 15–19 20–34 35–44 45–64 65 and over
  %
Canada  
Both sexes1 21.5 3.0 18.3 26.1 27.1 24.9 10.4
  Males 23.5 2.2E 17.7 29.5 29.2 27.3 11.7
  Females 19.4 3.8 18.9 22.7 24.9 22.6 9.5
Ontario  
Both sexes 20.1 2.0E 16.5 25.0 25.4 23.1 10.1
  Males 22.7 F 16.5 29.3 28.8 25.7 11.0
  Females 17.6 2.3E 16.5 20.7 22.1 20.5 9.4
Manitoba  
Both sexes 20.1 F 16.9 24.3 27.4 23.4 9.9
  Males 22.5 F 12.7E 29.1 27.8 28.3 12.2E
  Females 17.8 F 21.3 19.3 27.1 18.2 8.1E
Saskatchewan  
Both sexes 23.3 5.8E 21.0 29.0 30.8 28.3 8.9
  Males 23.6 F 19.3 30.6 29.2 29.8 9.4
  Females 23.0 10.2E 22.7 27.3 32.5 26.9 8.5
Alberta  
Both sexes 22.9 F 18.5 28.5 28.0 25.6 10.3
  Males 24.8 F 18.3 31.9 30.1 27.3 11.6
  Females 21.0 F 18.7 24.9 26.0 23.9 9.2
British Columbia  
Both sexes 16.3 F 10.4 20.7 20.4 18.8 7.9
  Males 17.9 F 10.1 22.5 21.9 22.2 9.0
  Females 14.7 F 10.6 18.9 19.0 15.5 7.1
Note: Those reporting smoking daily.
1. Components may not add to total as sex was not stated for some respondents.
Source: Statistics Canada, CANSIM, table 105-0027 and Catalogue no. 82-221-XIE.
Last Modified: 2003-09-17.

 


Smoking and Senior's Health

Smoking shortens people's lives considerably. According to Statistics Canada, of every 100 non-smoking men aged 45 in 1995, about 90 will survive to the age of 65, and 55 of them will still be living at the age of 80. But if you are one of 100 male smokers aged 45, then only 80 of you will survive to the age of 65, and fewer than 30  of you will still be living at the age of 80.

 A smoker, on average will die younger than a non-smoker. Men smokers aged 65 die 6 years earlier than menn who are nonsmokers. Older women smokers on average die 8.5 years sooner than older women who don't smoke. An older smoker will also be more likely to be limited or dependent in his or her activities of every day living at a younger age than a non-smoker will. In other words, an older smoker can expect more disability and at a younger age.


 

Percentage of High Risk Drinkers Who are Smokers


Many people struggling with an alcohol problem are also smokers. For example, a 2000 study of 479 high risk drinkers (Milagros et al) in primary care setting, found that 35% of them were also smokers. Other studies find even higher rates. Plus, they are often heavy smokers. Research indicates that alcohol intoxication increases the craving to smoke. (Burton & Tiffany)

Heavier drinkers are less likely to have tried to quit smoking. (McClure et al ) The more alcohol that the smoker regularly consumes, the harder it may be for him or her to quit (many heavier drinkers have shorter success periods when they try to quit smoking). (McClure et al)

 


Prevention Efforts: Quitting Smoking in Later life

January 18-24, 2004 is National Non-Smoking Week. (Weedless Wednesday, January 21).

There is debate about the how much value there is in encouraging older smokers to stop smoking. It is still common for people to ask "Aren't you just closing the stable door after the horse has left?" In other words, hasn't the damage of smoking already been done. The answer is " Yes" and "No". The longer the person smokes, and the more packs of cigarettes they smoke, the greater the lung damage they will experience. However the health of older adults who quit is better than older adults who continue smoking.

 

A 2000 study found that when persons with mild to moderate obstructive lung diseases quit smoking, their lung function declined only slightly over the next five years. However, the people who continued to smoke had rapid rates of decline in lung function. (Mannino, et al.)

 

 


 

In 2004, the B.C. Lung Association offered a bit of a historical context on cigarette advertising to help us better understand the 
kinds of smoking advertising that many older women have been exposed to throughout their lives. 
 

 

 Putting Smoking in Cultural Context


In 2002, a study by Parry and others looked at the cultural context of smoking for older adults in Scotland who had arterial disease or angina (in other words, smoking was having a demonstrable effect on their health). The seniors talked about

  • (a) how smoking was a socially acceptable behaviour of their youth and adulthood “I went in for my first heart operation (and you had an ashtray on your locker”, and
  •  (b) how those attitudes had undergone dramatic change over the course of their lives. “I feel like a second class citizen anyway for smoking now”; “We’re the outcasts now”.

They spoke about smoking as part of social activities throughout their lives (being in the pub, smoking with other smokers, smoking with watching or participating in sports).

Smoking and drinking were sometimes parallel social activities. One senior notes:

“When you’re sitting drinking, the cigarettes are there and it’s just, you smoke more... maybe it’s because you’re sitting doing nothing and you’re just sitting drinking and of course, you know what it is, jus habit really isn’t it and it’s just automatic... you just do smoke more when you are out socializing”

 

Others talked about smoking as a solitary activity. They now smoked at home alone and they associated smoking with becoming more and more isolated. For example one man had quit smoking at 73 after surgery for peripheral arterial disease, but he resumed smoking 2 years later following his wife’s death. He explained how his wife‘s death had left him lonely and bored “You come into an empty house, what do you do?”

Another man aged 82 describes returning to smoking after 19 years of abstinence after his wife developed dementia. He felt that restarting helped relieve the stressful situation of caring single-handedly for his wife until she died 4 years later.

The authors point out that we need to begin to develop a much better understanding of smoking in later life for more effective health promotion. With that information we can develop measures and combinations of measures to tackle smoking effectively at different stages of people’s lives.

 


 

Health Canada in "Tobacco Use and Smoking Cessation Among Seniors" describes some of the issues affecting older smokers:

 

A. Drug interference

 

"Smoking can affect mean levels for drugs and interfere with a range of drug therapies, including anti-depressants. As a result, drug dosages for the older smoker may be sub-therapeutic or ineffective. "

 

B. Psychiatric co-morbidities

 

"Clinical depression among smokers may exceed that among non-smokers. Nicotine may have effects to alleviate certain psychiatric symptoms. Depressed persons are less likely to quit successfully and often suffer an increase in symptoms after quitting."

 

C. Hard-core smokers

 

"There is some suggestion that older smokers are more likely to be “hard-core” smokers (heavy smokers with weak quitting histories who expect never to quit smoking). Current evidence suggests that hard-core smokers make up about 5% of all smokers and they will be largely unaffected by the messages of tobacco control. Still, it appears that current tobacco control initiatives have a long way to go before they hit a wall of recalcitrant smokers."

 

D. Readiness to quit smoking

 

"Older smokers have attitudes less favourable to being ready to try to quit smoking. Less than one-quarter say they are planning to quit in the next three months. Older smokers are far less likely to accept the health risks associated with smoking and more likely to view smoking as a beneficial coping and weight control tactic. Among smokers 50 years of age or older, those with realistic health consequences of smoking and those who perceive smoking as addictive were more likely to be ready to quit. Older smokers are less likely than younger smokers to attempt quitting, but they are more likely to be successful in the attempts."

 


 

There are only a few studies out there on older smokers and older quitters. However, those studies suggest that older person is most likely to successfully quit:

• when the older person has lower nicotine dependence

• when the older person has higher quitting self-efficacy (where people feels they can control the process)

• among older people who have more schooling (higher level of educational attainment)

• when the older person has been hospitalized for illness diagnosis of smoking-related disease (particularly cardio-vascular disease) (i.e., there is life threatening reason that creates the incentive)

• when the older person has prior success with quitting

• when the older person has prior stronger quitting motivation

• when the older person sees quitting as leading to greater health benefits for him or her

• when the older person sees there are few barriers to quitting (e.g. doesn't feel there are as many stresees or other barriers)

• when the older person uses several quitting strategies rather than just relying on one or two

• when the older person has few or no acquaintances who smoke and/or a non-smoking spouse, or

• when the older person is using the nicotine patch AND has frequent contact with physicians and pharmacists.

 


What About Suggesting Stopping Smoking to People in Outpatient Programs

or Other Heath Settings?


An Addiction Research Foundation study of clients in an outpatient alcohol treatment program who also smoked, looked at

- whether the people would like to quit smoking, and if so,

- when would be the best time to do so,

- how serious and confident they felt about stopping, and

- how stopping smoking might affect their ability to quit or reduce alcohol consumption (Ellingstad et al).

They found that some individuals whose alcohol problems are not severe and who also smoked were more receptive to a dual recovery approach than others.

Another study looked at changes in cigarette smoking and coffee drinking after alcohol detoxification in people who were alcohol dependent. The researchers find that heavy smokers may react to alcohol cues and thus reduce smoking activity when sober. Moderate smokers may increase their smoking rate to cope with alcohol abstinence. (Aubin et al). About one half of people in treatment report that they need cigarettes to cope with feeling down. (Asher et al)

The American Family Physician has an a model for physicians illustrating smoking cessation activities for use with patients in alcohol recovery. It uses "stages of change", with practical strategies at each stage.

Stopping (and not starting again) can be tough, very tough for many people. Permanent smoking cessation is difficult. Nicotine is a powerfully addictive and smoking is a pleasurable experience. In an intervention study to assess rates of smoking cessation among adults with a history of alcohol problems, the researchers found a substantial proportion of adults recently treated for alcohol problems attempted to quit smoking, even though quit rates were low. (Bobo)

Physicians are less likely to talk with older patients about stopping smoking than they are with younger patients. (Maguire)


Harm Reduction Strategies

One of the risks for older smokers who also drink is the risk of fire. Click here for a sample brochure  using harm reduction strategies for mature smokers.

 


 

Sources


Asher, M.K., Martin, R.A., Rohsenow, D.J., MacKinnon, S.V., et al. (2003). Perceived barriers to quitting smoking among alcohol dependent patients in treatment. Journal of Substance Abuse Treatment, 24(2),169-174.

Aubin, H.J., Laureaux, C., Tilikete, S. & Barrucand, D. (1999). Changes in cigarette smoking and coffee drinking after alcohol detoxification in alcoholics. Addiction. 3, 411-416.

Bobo, J. (1997). Efforts to quit smoking among persons with a history of alcohol problems - Iowa, Kansa, and Nebraska, 1995-1996. Morbidity and Mortality Weekly Report (MMWR), 12-05.

Burton, S. M. & Tiffany, S. T. (1997). The effect of alcohol consumption on craving to smoke. Addiction.

Ellingstad, T.P., Sobell, L. C., Sobell, M. B. Cleland, P. A. & Agrawal, S. (1999). Alcohol abusers who want to quit smoking: implications for clinical treatment. Drug and Alcohol Dependence, 5-3.

Health Canada. www.hc-sc.gc.ca/pphb-dgspsp/ccdpc-cpcmc/cancer/publications/lung_e.html

Health Canada, (2002). Tobacco Use and Smoking Cessation Among Seniors. Online at:

www.hc-sc.gc.ca/seniors-aines/pubs/workshop_healthyaging/pdf/tobacco_e.pdf

Lung Association of Canada www.lung.ca/diseases/cancer_lungs.html

Maguire, C. O. Ryan, J., Kelly, A., O'Neill, D. , Coakley, D., Walsh, J. B. (May 2000). Do patient age and medical condition influence medical advice to stop smoking? Age-and-Ageing, 29 (3), 264-266.

Mannino, D.M., Gagnon, R.C., Petty, T.L. & Lydick, E. (June, 2000). Obstructive Lung Disease and Low Lung Function in Adults in the United States: Data From the National Health and Nutrition Examination Survey, 1988-1994
Archives of Internal Medicine, 160,1683 - 1689.

McClure, J.B., Wetter, D.W., De Moor, C., Cinciripini, P.M., & Gritz, E.R. (2002). Relation between alcohol consumption and smoking abstinence: Results from the Working Well Trial. Addictive Behaviors, 27(3), 367-379.

Milagros C. R., Ockene, J.K., Hurley, T. G. & Reiff, S. (August, 2000). Prevalence and co-occurrence of health risk behaviors among high-risk drinkers in a primary care population. Preventive Medicine, 13 (2),140-147.

McIlvain, H., Bobo, J.K., Leed-Kelly, A. & Sitorius, M. (April 15,1998).Practical Steps to Smoking Cessation for Recovering Alcoholics, American Family Physician, www.aafp.org/afp/980415ap/mcilvain.html#al14

National Center for Tobacco-Free Older Persons, (The Center for Social Gerontology) "Tobacco and the Elderly". Online: www.tcsg.org/

Parry, O., Thomson, C. & Fowkes, G. (2002). Cultural context, older age and smoking in Scotland : Qualitative interview with older smokers with arterial disease. Health Promotion International, 17 (4) 309-31.

Statistics Canada, The Daily, Friday, June 22, 2001.  Impact of smoking on life expectancy and disability www.statcan.ca/Daily/English/010622/d010622a.htm

 

Prepared by Charmaine Spencer, for Seeking Solutions.

Page last updated Sunday October 31, 2004

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