Response to Unreasonable Health Choices: Smoking cigarettes over age 65

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In her May 6 post about “Unreasonable Health Choices,” Sissela Bok poses the question of why people make unreasonable choices, using cigarette smoking as one example, since everyone knows that smoking is bad for your health.  In fact, during our lifetimes we have witnessed a revolution regarding attitudes and practices of smoking.  When I was growing up the detritus of cigarettes was an accepted part of our household. Both my parents smoked, as did many of their peers.  They were able to quit at age 55 (dad) and 71 (mom), and most of their friends did the same.  By contrast, I suspect that it is rare for the followers of Over 65 to even know a friend who smokes, let alone to have visitors smoke in their homes.

What caused this dramatic shift? In part it reflects the ever-expanding body of scientific knowledge that smoking is such a lethal habit, not only for the smokers but for those exposed to secondhand smoke.   This science unleashed a citizens’ movement by nonsmokers, resulting in the de-normalization of tobacco use in most of the United States, including the passage of clean indoor air laws that prohibit smoking in public places. It also translated into other effective public health measures, most notably increases in state and federal tobacco taxes. As a result, today smoking is now concentrated among the less fortunate – those with low socioeconomic status in general, and especially persons with chronic mental illnesses or substance abuse disorders.

What about smoking in those over age 65? Fewer people over 65 smoke than in any other adult age group. This is a result of two factors, one happy and one sad. The happy news is that many former smokers have quit; in fact, there are now more ex-smokers in the United States than current smokers.  The sad news is that many smokers die before they reach age 65, usually of smoking-related disorders such as lung cancer, chronic lung disease, or heart attacks.

Is it too late to stop smoking after 65, because all the damage has been done?  On the contrary.  Although the benefits of stopping smoking are greater in younger age groups (smokers who quit at age 30 gain a full decade of life expectancy), they also accrue to older quitters.  Someone who quits smoking at age 65 will gain an additional three years of life compared to his twin who continues to smoke.  And he will also enjoy greater functional capacity during his remaining years. 

Though we may take it for granted that smoking is on its way out, there are still 45 million American smokers, comprising 19% of our adult population.  There are simple ways to help smokers quit. One easy suggestion you can give to friends and family members is to call the toll-free telephone number, 1-800-QUITNOW for free expert advice.  It is not too late to reverse that unreasonable health choice.

Steven A. Schroeder, M.D., 73, is a professor at the University of California, San Francisco; director of the Smoking Cessation Leadership Center; and former CEO of the Robert Wood Johnson Foundation.

3 Responses to “Response to Unreasonable Health Choices: Smoking cigarettes over age 65”

  1. Derek Bok

    Steve Schoeder is so right, in this excellent post, to say that it is rare for the followers of Over 65 to even know a friend who smokes, let alone to have visitors smoke in their homes. But for those who do, his comments makes a point few consider. By the time someone is over 65, each year gained counts a great deal more than for younger people. The idea that it is not too late to stop smoking, given the benefits still available, should count for a lot.
    Derek Bok

    Derek Bok

  2. Daniel Callahan

    As a former smoker (who quit 30 years ago) I have some sympathy for the over-80 smoker, already in poor health, and never a heavy smoker. For many smoking is one of the few pleasure left in life.It has always seemed to me a kind of cruelty for nursing homes to forbid smoking. Sometimes in our lives there are delights that are more important than life extension.

  3. James Sabin

    Steve Schroeder, a dear friend every since we were classmates at medical school, asked me to post the following response to Dan Callahan’s comment:

    “The decision to stop (or start) smoking is an individual choice that should be well informed as to risks and benefits. Of course, an older person has the option to keep smoking. But, if he is on cancer chemotherapy he should know that his outcome would be better if he stopped smoking. As regards nursing home residents, the non-smokers have the right to not inhale someone else’s smoke and thus put them at a higher risk for heart attacks and strokes. And there are many more non-smokers than smokers in nursing homes. So, if the addicted resident is ambulatory, she should smoke outside. If not, nicotine replacement is available to stop the cravings.”