Overview for Health Care Providers - Smoking

Older adults suffer a large proportion of health consequences from smoking and could benefit from cessation.

Why is it important?

  • Smoking is a risk factor for lung cancer, heart disease, stroke and chronic respiratory disease (7)
  • Smoking is the leading cause of premature death; heavy smokers can lose about 9 years of life expectancy (6)
  • Older smokers are at greater risks because they have smoked longer: 61% of senior non-smokers are actually former smokers;  and they tend to be heavier smokers as 86% smoked daily (7) (1)
  • Cessation later in life adds years to life and improves quality of life: e.g. risk of myocardial infarction and stroke is reduced by 40% or more  within 5 years after the last cigarette (1) (2)
  • Intensive smoking cessation treatment has been shown to significantly reduce re-hospitalization (9)

Common Causes

  • Stress of unemployment,  homelessness, personal problems, financial strain, or physical/verbal abuse (10)
  • Addiction to alcohol, cocaine, or heroin can make one vulnerable to smoking (10)
  • Older smokers are less likely than younger smokers to believe smoking harms health or cessation offers benefits at advanced age (1)

Key Considerations

  • Rate of bone-density decline in older adults is accelerated by smoking (4)
  • Older smokers have higher risks of fractures (4)
  • Female smokers are at greater risk of post-menopausal osteoporosis (4)
  • Refer individuals who want to quit to primary care physician: inquire about the amount smoked, previous experience with quitting, other influential factors (e.g. addictions/medications/psychiatric problems), current interest in quitting,and identifying concerns (3)
  • In collaboration with primary care providers use the evidence-based clinical components of the Ottawa Model of Smoking Cessation to guide intervention process:
    1.  Identification and Documentation (ascertainment of smoking status, history)  2.  Treatment (pharmacotherapy and strategic advice)    3.  Follow-up (automatic follow-up support for 1-6moths, link to primary care, referral to community cessation programs) (9)
  • Refer individuals to primary care provider to discuss smoking cessation products/medications (e.g. nicotine patch, nicotine gum, nicotine inhaler, nicotine lozenge, nicotine mouth spray, varenicline, bupropion, etc)
  • Development of smoking cessation policies, procedures, protocols, educational programs, assessments and documentation tools can be guided by the RNAO’s Smoking Cessation, Best Practice Guideline for nurses (5)
  • Encourage and motivate individuals to maintain their goals through support groups within the community
  • Provide  information and support to help individuals manage stress, avoid weight gain, deal with setbacks and celebrate milestones (


1.  Brenner, H ,Gellert, C., Holleczek, B., Müller, H. & Schöttker, B.  (2013). Impact of smoking and quitting on
     cardiovascular outcomes and risk advancement periods among older adults
. European Journal of Epidemiology,
     28(8), 649-658.  Retrieved Feb. 2014 from:

2.  Health Canada. (2002). Healthy Aging: Tobacco Use and Smoking Cessation Among Seniors.
     Retrieved February 26, 2014 from:

3.  RNAO.(2007). Integrated Smoking Cessation into Daily Nursing Practice. Retrieved February 26, 2014 from:

4.  Statistics Canada. (2012). Current Smoking Trends. Retrieved February 26, 2014 from:   

5.  Statistics Canada. (2012). Smoking. Retrieved February 26, 2014 from:

6.  The Lung Association. (2014).  Quit Now. Retrieved February 27, 2014 from:

7.  University of Ottawa Heart Institute. (2011). Ottawa Model for Smoking Cessation.
     Retrieved February 26, 2014 from:  

8. World Education. (2009). From the First to the Last Ash: The History, Economics & Hazards of Tobacco.
      Retrieved February 26, 2014 from:

Issue/Condition - Problème / état: 
Resource Type - Type de Ressources: 
Author/Publisher - Auteur/Éditeur: 
Centre for Studies in Aging and Health
Date Published: