1. TOBACCO USE & OLDER SMOKERS

2. OLDER SMOKERS In 2004, 3.7 million people aged 65 and older were smokers and 16% of all people aged 50 and older smoked; over 42% of all adult smokers “Hard core” smokers, long term heavy smokers who are dependent on nicotine Motivated to quit

3. COST of SMOKING for OLDER ADULTS All of the major causes of death among older adults (e.g., cancer, coronary heart disease, stroke, pulmonary disease) are associated with tobacco use (National Center for Health Statistics, 2006)

4. BENEFITS of CESSATION for OLDER ADULTS Smoking cessation, even in older adults who are frail, produces objective benefits in terms of mortality, reversed respiratory symptoms, disability level, decreased psychological distress, quality of life, and cost of care

5. OLDER vs YOUNGER SMOKERS More likely to: be successful with cessation (losing this edge because less likely to have a smoke free home) more likely to blame themselves Less likely to: believe in a strong connection between smoking and illness be treated for tobacco use

6. OLDER SMOKERS & DEPRESSION Theory that prevention of risk factors for CVD may help decrease prevalence and incidence of late life depression Smokers have higher plasma homocysteine (risk factor for CVD) than non-smokers Total plasma homocysteine associated with depression in later life (Almeida et al., 2005)

7. RISK FACTOR for DEPRESSION High levels of functional disability, mild cognitive impairment, and smoking are the most important risk factors for depression (Weyerer et al., 2008)

8. OLDER SMOKERS & ANXIETY Older adults are among the largest users of benzodiazepines Cigarette smoking associated with sustained benzodiazepine use (Stowell et al., 2008) Tobacco use/nicotine increases arousal and decreases effects of benzodiazepines Among older MI patients, smokers have significantly higher anxiety than non-smokers (Sheahan, 2006)

9. SMOKING & ALZHEIMER’S DISEASE (AD) Despite a growing body of evidence linking smoking with AD, beliefs prevail that smoking protects against AD in both scholarly journals and lay publications

10. TOBACCO INDUSTRY INTEREST in ALZHEIMER’S DISEASE As early as 1976, the tobacco industry began to invest in AD research, with the goal of developing nicotine-related diagnostics and therapeutics

11. META-ANALYSIS: TOBACCO USE & ALZHEIMER’S DISEASE Included 26 case control and 17 cohort studies (published 1984-2006) Random effects meta-analysis used to estimate pooled risk ratios and 95% CI Tested the effects of study design, quality, secular trend and tobacco industry affiliation in a weighted multiple regression analysis

12. Smoking and Alzheimer’s Disease nStudy Design Tob Ind Affiliation Pooled Odds Ratio CI = 95% 18Case controlnoO.91 (0.75-1.10) 8Case controlyes 0.86 (0.75-0.98)* 14Cohortno 1.45 (1.16-1.80)* 3Cohortyes0.60 (0.27-1.32)

13. SMOKING is a RISK FACTOR for ALZHEIMER’S DISEASE Multiple Regression After controlling for study design, secular trend and tobacco industry affiliation: Risk of AD was 1.72+0.19 (P<.0005). (Cataldo, Prochaska, & Glantz, under review)

14. EXTENDED TREATMENT for OLDER CIGARETTE SMOKERS Tobacco dependence is an addiction with a chronic relapsing course Relapse is the norm Need to treat it like a chronic disease

15. 12 WEEK COMBINATION TREATMENT Bupropion, NRT and group counseling for the first 12 weeks of treatment: 12 weeks sustained release bupropion 10 weeks 2mg and 4mg nicotine gum Counseling based on Clear Horizons

16. See 2008 Practice Guidelines Motivation Mood management Weight control Social support Withdrawal/dependence EXTENDED COGNITIVE BEHAVIORAL TREATMENT (ECBT)

17. Extended cognitive behavioral treatment produced high tobacco abstinence rates, maintained throughout the 2 year study period: 24 week 58% 52 week55% 64 week55% 104 week55% Hall et al. (2009) Addiction

18. NEVER TOO LATE for OLDER SMOKERS Treat Treat Intensively Treat Long Term

19. IT’S NEVER TOO LATE to HELP OLDER SMOKERS QUIT Reported prevalence of smoking at the time of lung cancer diagnosis range from 24 – 60%, compared with 12-29% in the general population About 20% of lung cancer patients keep smoking

20. BENEFITS of CESSATION after a LUNG CANCER DIAGNOSIS Decrease risk of synchronous multiple primary tumors and second primary tumors Increased survival time Fewer post-operative complications Both chemotherapy and radiation therapy produce fewer complications and less morbidity