Age inequity and Smoking Cessation Hannah Jordan, Mira Hidajat, Nick Payne, Jean Adams, Martin White, Yoav Ben-Shlomo 02/12/2018

Older adults and smoking cessation: what do we know? Around 10 million adults in the UK still smoke; around 11% of them are over the age of 60. There is clear evidence for the benefits of quitting even at older ages. Reduced mortality Reduced ill health More healthy life years NICE recommends smoking cessation for all smokers regardless of age, but older adults are not a priority group. There is evidence that some older people and some health professionals believe that smoking cessation is less important for older adults.

Older adults and smoking cessation: the study Do older adults have equitable access to smoking cessation therapies? Compared to younger smokers, are older people as likely to Attempt to quit or cut down on cigarettes Be nicotine dependent Seek help from a GP For older smokers, are General Practitioners as likely to Discuss smoking cessation Refer patients to smoking cessation services or prescribe NRTs

The data Data from the Smoking Toolkit Study 102 waves of data (N=181,157) Baseline age group 16-54 year olds, then five-year bands up to 80+ Smoking status either Current smoker Recent smoker Past smoker Never smoker Smoking cessation categorised as Yes/No for the use of NRTs and/or stop smoking counselling Gender, secular period (year of survey) and social class confounders

The methods Logistic regression analysis for age groups OR for: Compared to advice to quit but no referral, did the GP refer patient for NRT; refer patient for smoking cessation counselling or advice; or give no active management of smoking

The results Baseline group 16-54 55-64 65-74 75+ Less likely to have been prescribed NRT Less likely to have raised cessation with GP Less likely to have been referred for counselling From 55, participants were more likely to have attempted to quit, and more likely to have used NRTs Nicotine dependency reduces from age 70. Use of stop smoking counselling more common in this age group Baseline group 75+ 55-64 16-54 65-74

OR for support to quit, by age groups

Differences in GP management of smokers by age Older adults less likely to report raising smoking in a GP consultation GPs reliably raising the topic across all age groups For smokers >70, there is less quitting support reported: Probability of being prescribed NRT fell with age after 75 years Probability of being referred for counselling fell with age after 70 years OR for not being advised to quit was raised after the age of 65 Men are less likely to report being given support to quit People from lower social grades were given more support.

Strengths and Limitations Measured older ages in 5-year groups instead of aggregating 65+ as commonly found in previous studies Able to adjust for socioeconomic status in our models Measures are self-reported, no smoking history and previous failed attempts

Conclusions There are potential missed opportunities to facilitate smoking cessation in older smokers Older smokers are less nicotine dependent, and smoke fewer cigarettes, are more successful when they do try to quit, but are not being supported What are the underlying factors? Motivation? Health assumptions? ‘The damage is done’ A need for more targeted services: acceptable, available, appropriate interventions?