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

2. 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.

3. 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

4. The data
Data from the Smoking Toolkit Study
102 waves of data (N=181,157)
Baseline age group 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

5. 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

6. 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

7. OR for support to quit, by age groups

8. 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.

9. 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

10. 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?