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176 Substance Use in Older Adults
Complementary and Alternative Medicine
Up to 80% of adults attempting to quit smoking may elect not to use
medications. For some, alternative medicine and wellness interventions
may aid smoking cessation. Yoga may enhance the effectiveness of cognitive-behavioral therapy approaches for women who have tried shortterm smoking cessation outcomes and failed
6 months (Bock et al. 2010).
Complementary and alternative medicine (CAM) practitioners such
as acupuncturists, massage therapists, hypnotherapists, or chiropractors often meet with their patients more frequently and for longer periods than biomedical clinicians. These interactions may be additional
opportunities
trained in tobacco cessation (Eaves et al. 2017). Evidence supporting the
efficacy of specific tobacco cessation interventions by CAM practices is
limited (Eaves et al. 2017). There is contradictory evidence regarding
the efficacy of hypnotherapy (Barnes et al. 2019; Tahiri et al. 2012).
for brief intervention counseling by CAM practitioners
to see significant benefit at
PUBLIC HEALTH INTERVENTIONS
Decades of public health efforts (for example, mass media campaigns)
to educate the public about the risks of smoking and promote tobacco
cessation have been found to change smoking behavior (Bala et al.
2017). Telephone-based cessation services—called quitlines—are an effective treatment (Stead et al. 2013); these services are widely accessible
and easy
line. Telephone counseling enhances the patient’s ability to quit; in general, more sessions correlate with greater success. Although services
can range from 1 to 12 calls, most receive an average of 3 calls (Stead et
al. 2013). Older adults in particular may also benefit from behavioral
counseling that is administered in a community setting (e.g., pharmacies, community centers, and churches) (Smith et al. 2019).
to use. Systems exist to help physicians refer patients to a quit-
SUMMARY
Despite significant public health efforts, tobacco use disorder remains
common in older adults and is a source of life-shortening and debilitating
cognitive, cardiovascular, respiratory, vision, dental, and bone disease.
Late-life smoking is often a chronic habit associated with anxiety, depression, social isolation, and other social determinants of health. Identifying
older adults
who smoke and assessing their willingness to quit is a re-
Tobacco Use Among Older Adults 177
quired element of each patient interaction. Older adults who quit smoking are likely to experience significant benefits. There is strong evidence
supportin
pharmacotherapy with nicotine replacement therapy, bupropion, and especially varenicline. Combining behavioral and pharmacological interventions may be especially effective at helping older adults quit smoking.
g the use of behavioral interventions, tobacco quitlines, and
KEY POINTS
• Tobacco use disorder is common in older adults and a risk factor
for debilitating cardiovascular, respiratory, eye, gum, and bone
disease. Quitting smoking is beneficial to people of any age.
• Patients should be screened for tobacco use regularly. Although no
screening tool has been validated specifically in older adults, it
would be reasonable to use the TAPS tool, which is quick and has
good sensitivity and specificity for tobacco use disorder.
• Clinicians should use a standardized approach to assess tobacco use
and readiness
proaches may be needed for older adults who are not ready to quit.
• Effective tobacco use disorder treatments are available, and every
older adult who uses tobacco and is interested
be offered at least one.
— Nicotine replacement therapy, bupropion, and varenicline are
all evidence-based treatments, with varenicline most likely to be
effective.
— Counseling (individual or group) and referral to a tobacco quit-
line (telepho
— The combination of counseling and medication is more effec-
tive than either one alone.
to quit, e.g., the 5 As. Motivational enhancement ap-
in quitting should
ne) should also be offered.
RESOURCES FOR PATIENTS, FAMILIES,
AND CAREGIVERS
National Cancer Institute
Become Smokefree (https://60plus.smokefree.gov): A government-
sponsored consumer website offering tools and tips to help patients quit smoking.
178 Substance Use in Older Adults
quitSTART (https://smokefree.gov/tools-tips/apps/quitstart): An
application offering tips, information, and challenges that engage
users on their quit journey.
SmokefreeTXT (https://smokefree.gov/tools-tips/text-programs/
quit-for-good/smokefreetxt): A mobile text messaging service designed for people across the United States who are ready to quit
oking.
sm
Centers for Disease Control and Prevention
Quitlines are proven to increase patient chances of quitting success-
fully and staying quit. The CDC offers a free quitline service in
iple languages:
mult
1-800-QUIT-NOW (1-800-784-8669)
Spanish: 1-855-335-3569
Mandarin and Cantonese: 1-800-838-8917
Korean: 1-800-556-5564
Vietnamese: 1-800-778-8440
RESOURCES FOR CLINICIANS
American Psychiatric Association
Position Statement on Tobacco Use Disorder (www.psychiatry.org/
about-apa/policy-finder/position-statement-on-tobacco-use-disorder)
National Behavioral Health Network
BHtheChange (www.bhthechange.org): The National Behavioral
Health Network for Tobacco and Cancer Control is one of eight
CDC National Networks. The National Behavioral Health Network strengthens the capacity of health care professionals to develop and implement efforts focused on eliminating tobacco- and
cancer-r
addictions.
Resource Digest: Supporting Tobacco Cessation in Older Adults
(https://www.bhthechange.org/resources/resource-digestsupporting-tobacco-cessation-in-older-adults/): A digest of avail-
able resources and information related to tobacco use and supporting cessation in older adults.
elated disparities among people with mental illnesses and
Tobacco Use Among Older Adults 179
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