In terms of smoking prevalence in France, the situation has improved in recent years, going from 30% of smokers in 2000 to 25.5% in 2020.
However, smoking evolves differently depending on the age group: in 2019, 9% of women aged 65 to 75 and 10.4% of men smoked.
According to Santé Publique France in 2020, 4.1% of people aged 76 to 85 smoked every day.
Cognitive decline, heart failure…
One might think that the proportion of over 65s who smoke is rather low compared to other age groups.
In reality, it is important for a population very concerned by its harmful effects: 70% of deaths attributable to tobacco occur among those over 60 years old.
At age 70, 81% of non-smoking men and 87% of non-smoking women are still alive, compared to 55% of smoking men and 68% of smoking women. At age 80, this gap is even more marked.
But the consequences of smoking go beyond premature mortality: cognitively, elderly smokers perform worse than non-smokers, with a more rapid decline in cognitive functions and a greater risk of heart disease. Alzheimer’s and vascular dementia, especially in cases of hypertension, diabetes or depression.
Smoking among seniors is also correlated with the occurrence of heart failure. In addition, smoking is a risk factor for postoperative mortality in cardiac surgery in the elderly (mortality of 14.8% compared to 2.1% in non-smokers) linked to more respiratory complications.
Smoking cessation, all the benefits!
Dr Gilles Albrand (geriatrics department of the Hospices Civils de Lyon) remains convinced that for a large proportion of seniors, smoking cessation is beneficial because life expectancy can be significant.
For him, despite the usual arguments (“a little pleasure that one cannot refuse at this age”, “it is too late to stop”), we must encourage and support the person towards weaning.
The arguments in favor of weaning are numerous. Between the ages of 70 and 79, quitting smoking reduces the risk of cardiovascular death by 27%.
Gain in life expectancy
At these ages, stopping smoking saves years of life expectancy, specifies the National Committee to Combat Smoking (CNCT).
A German meta-analysis in 50 – 74 year olds showed that smoking cessation was very beneficial and rapid even at an advanced age, with a reduction in cerebrovascular consequences (myocardial infarction, stroke, cardiovascular diseases).
Most of the excess risk disappears within five years of quitting smoking.
Quitting smoking can also limit early cognitive decline, as well as the risk of heart failure, etc. but also immediate risks, such as those linked to surgical intervention.
Significant risks linked to tobacco
Indeed, smoking disrupts the functioning of the immune system, which is already much less effective at these advanced ages, hence an increased risk of infection in the event of surgery.
Furthermore, due to smoking, certain surgical procedures carry increased risks of complications after the age of 65, such as difficulties in placing dental implants, increased postoperative complications particularly in orthopedic surgery, healing problems, or even reconstruction. bone in the event of a fracture.
Finally, starting to quit smoking after the age of 65 provides a better quality of life, breathing will be improved, as will taste and smell.
How to talk about smoking cessation with a senior?
It’s on a case-by-case basis, replies Dr. Gilles Albrand. Indeed, you have to be very pragmatic, depending on the clinical context.
If sometimes caregivers and those close to them must accept that the elderly person continues to smoke, sometimes cessation becomes imperative. There are also several types of elderly smokers, to whom weaning must be adapted..
“Older smokers are mainly long-term smokers, which makes them very dependent, points out the geriatrician. It may therefore be more difficult for them to quit smoking. But another part of these older smokers, on the other hand, started smoking later in life in response to difficult events, such as the death of a loved one, retirement or isolation. »
Tools, such as nicotine replacement therapy and cognitive-behavioral therapy, are just as useful as for younger smokers. It has also been shown that older smokers are as likely, or even more likely, to succeed in quitting smoking than younger smokers.
To find out more: National Committee to Combat Tobacco
Sources: Follow-up of the session of January 27, 2024: French Language Pneumology Congress (January 26 to 28, 2024 in Lille), presentation by Dr. Gilles Albrand (geriatrics department of the Hospices Civils de Lyon) entitled Tobacco: a poison for all ages of life; Pasquereau A, Andler R, Arwidson P, Guignard R, Nguyen-Thanh V. Tobacco consumption among adults: assessment of five years of the national program against tobacco, 2014-2019. Bull Epidemiol Hebd. 2020;(14):273-81; Mons U, Müezzinler A, Gellert C, et al CHANCES Consortium. BMJ. 2015 Apr 20;350:h1551; “Smoking among the elderly: there is no age to quit smoking” (“for elderly people.gouv”)
