Smoking and the Older Person
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Since the first Surgeon General report on smoking was issued in 1964, the smoking rate in the United States has been progressively declining.1 Yet today, cigarette smoking remains the leading cause of preventable death in the United States, and it is associated with significant health and economic burdens to society.2 A vast array of resources have been assigned to address smoking cessation or abstinence programs, almost exclusively aimed at the adult and adolescent populations. Little to no attention has been paid to older smokers. Obstacles to smoking intervention in the elderly include the beliefs that little or nothing can be done to change the habits of older individuals,3 there is little health benefit from smoking cessation, and it is one of the few pleasures in life left to older persons. This article reviews current literature about the harmful effects of smoking in the elderly and the benefits of smoking cessation among this growing population.
EPIDEMIOLOGY OF AGING AND SMOKING
Older adults 65 years of age and older are the fastest growing segment of the population in the United States, totaling almost 40 million and making up more than 12% of the population.4 It is projected that their number will grow to more than 71 million and will account for close to 20% of the total population by the year 2030.5
Although smoking rates continue to decline for the adult population at large, and for the elderly population in particular, approximately 440,000 people continue to die yearly in the United States from illnesses attributable to cigarette smoking.2 Only 9.3% of adults 65 years of age and older smoke, but it is more worrisome that 21.8% of adults 45-64 years of age are current smokers. It is this large smoking population that will be of major concern to the health care system in the near future.6 Programs geared toward the elderly will be necessary to reduce the number of smokers in the present elderly age group and the soon-to-be elderly age group.
TOBACCO CHEMICALS AND CARCINOGENS
At least 4000 chemicals and 60 carcinogens have been identified in tobacco smoke.7,8 These carcinogens include aromatic amines, phenols, nitrogen dioxide compounds, aldehydes, polycyclic aromatic hydrocarbons, nitrosamines, volatile hydrocarbons, inorganic compounds, and other organic compounds. These chemicals have been shown to be carcinogenic in human and animal models. The list does not exclude the presence of other carcinogens that have yet to be identified or evaluated.
The mechanism by which smoking carcinogens cause cancer is believed to be via the production of DNA adducts.9 DNA adducts are formed by covalent bonds between the carcinogen and the DNA and can disturb the architecture of the DNA. DNA adducts are implicated in many types of human cancers, and they can block antitumor genes and activate oncogenes. Another mechanism proposed for the damage induced by smoking is via the production of free radicals. Products of free radical–induced lipid peroxidation were shown to be significantly elevated in smokers as compared to nonsmokers.10,11 Evidence of free radical damage is not only limited to lipid peroxidation, because smoking has also been shown to induce oxidative damage of proteins and DNA.12,13 Interestingly, there is evidence suggesting that smoking causes significantly greater free radical–induced damage in older smokers than in young adult smokers, implying that the elderly are more susceptible to the hazards of smoking (E. E. Tuppo, DO, unpublished data, July 2005).
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