Some seniors may have started smoking at a younger age and it can then be harder to kick the habit. They may even write off the fact that it is too late to quit to get any health benefit.

But, it is never too late to quit. Ageless Online speaks to Dr Alvin Ng Choon Yong, consultant respiratory physician and intensivist with The Respiratory Practice, to find out more about the health problems as a result of smoking and how seniors can take the first steps:

 

Do seniors smoke more than younger people?

In Singapore, a study found that the prevalence of smoking in seniors is lower than in the general adult population, largely due to efforts to stop smoking due to health concerns as they age. Patients who embark on smoking cessation in my clinic tend to be of an older age. Most started smoking at a younger age, and the prolonged tobacco use makes them more susceptible to potential health concerns such as diabetes, cancer, cardiovascular disease, and lung diseases like Chronic Obstructive Pulmonary Disease (COPD).

 

Can you share more about seniors and smoking?

Seniors, as well as smokers of other ages, can often choose to smoke due to habitual use or psychological dependence. We see greater reduction in smoking prevalence in Singapore (10.1 percent in 2019) in recent years due to successful tobacco reduction measures like the tobacco tax, heightened public education by Health Promotion Board (iQuit), and hence, greater awareness over the dangers of tobacco use. This awareness could have been lower in the past.

 

Is pipe and cigar smoking just as bad as cigarette smoking?

All forms of smoking, whether pipe, cigar or cigarette, are harmful and carry similar health risks. The difference between each smoking type is the amount of tobacco. Research has found little to no difference in mortality between pipe and cigarette smoking.

 

Why is smoking especially a concern for seniors?

Elderly smokers, especially long-term smokers, are vulnerable to physical disorders and chronic diseases. These can worsen with the consumption of tobacco. Smoking has the potential to increase the risk of age-related diseases, such as Alzheimer’s disease or possibly other dementias. A recent study also identified smoking as one of the modifiable risk factors for dementia. Smoking is also one of the leading risk factors for heart diseases.

 

Can you elaborate further on some of the specific problems?

Most seniors are chronic smokers who have picked up smoking at a young age. Chronic smoking damages the airways by causing them to be inflamed and produce more mucus. It results in chronic cough and this is called chronic bronchitis. Smoking also causes narrowing of the airways. Over the years, the patient will have increased shortness of breath. The air sacs in the lungs will slowly be destroyed and this process is known as emphysema. Chronic bronchitis and emphysema together form the disease process of COPD.

In addition, 90 percent of lung cancer deaths in men and 80 percent of lung cancer deaths in women are caused by chronic cigarette smoking. Smoking also increases the risk of other cancers including throat cancer, kidney cancer and bladder cancer. Chronic smoking increases the risk of heart attack, stroke, leg ischaemia and impotence. It causes accelerated skin ageing and dementia.

 

Since some seniors have been smoking for years, it can be very hard to quit and it may be worse for them than not smoking. What advice can you give to seniors?

There is somewhat a paradox for elderly smokers as they are usually less likely than younger smokers to try quitting, yet more likely to be successful when attempting to quit. Seniors are typically more receptive to the idea of quitting only when they start to experience health related concerns.

My advice would be to start your quit journey now if you are still smoking. If a smoker is ready to give up, they can be helped with the correct treatment options and counselling.

In our specialist clinics, we have many patients who want to quit smoking and we are experienced in counselling and providing the correct medical treatment options. We also follow our patients closely to ensure that the quitting is successful.

A smoker can quit without help but it is much more difficult, and long-term abstinence is higher when the attempt is aided medically. The more dependent a smoker is on nicotine, the more essential it is to have some form of quit aid to counter the physiological dependence on nicotine. Doctors or pharmacists in retail pharmacists may prescribe quit aids like nicotine replacement therapy (NRT) which can mitigate the effects of nicotine cravings without the harmful substances like tobacco, and increase one’s chances of quitting. NRTs may be in formats such as nicotine gums and nicotine patches. Speak to a healthcare professional to know more.

Find new hobbies, or exercise regularly. Support from family and friends can also be a powerful motivator to stop smoking. Share your intention with your loved ones, and get them to support you on your journey. One can also check out the Health Promotion Board’s iQuit programme for a structured support programme.

 

Is there such a thing as too late to quit?

Patients always ask if it is too late to quit. It is never too late to quit smoking. The health benefits of stopping smoking begin within the first hour of quitting, and you become healthier throughout the following days and weeks. By quitting, you preserve lung capacity and decrease your chances of a heart attack or stroke.

Studies found that the risk for stroke is reduced to be similar to non-smokers as soon as two years of being tobacco-free. Lung cancer risk can be greatly reduced within five years of smoking cessation.

 

If they are willing to take steps to quit, what should their first steps be?

The first step is to be mentally-prepared to stop smoking, choose a date to quit and stick with it. Make a list of reasons on why you want to stop smoking and put it somewhere visible. This record can help you through tough times when your resolve weakens.

Next, identify what makes you crave a cigarette, such as drinking coffee or having ashtrays lying around. By understanding triggers commonly you associate with smoking, you can further strengthen your willpower by limiting or skipping these triggers.

If needed, smokers can seek expert help and consult a doctor or visit a pharmacist at retail pharmacies to find out more about support programmes and quit aids like NRTs.

 

Can you share more about NRTs and the different types? If this doesn’t work, what other options do smokers who want to quit have?

NRT works by releasing therapeutic nicotine into your bloodstream in the form of gum, patches, sprays or lozenges, at much lower levels than a cigarette, without the tar, carbon monoxide, and other harmful tobacco smoke chemicals.

Both chewing gum and patch come in a variety of nicotine units so let the doctor or pharmacist advise on the right strength based on how much you smoke. It is typically recommended for a period between eight to 12 weeks.

By leveraging NRTs to help one quit, one can remain smoke-free for a period of time. Studies have shown that if one remains smoke-free for a week, you will be nine times more likely to succeed in quitting.

As mentioned, smokers can take the first step to quit by speaking to a doctor or retail pharmacist. There is also professional help available, where smokers can call the QuitLine (1800 438 2000) and sign up with Health Promotion Board’s I Quit programme.