Older people more successful than younger in quitting smoking

DURHAM, N.C. – Older women appear to quit smoking and stay off cigarettes in higher numbers than men in their age group, and older men and women are more likely to quit if they have recently received a diagnosis of cancer, according to researchers at Duke University Medical Center.

The study results also showed that older people are far more likely to successfully quit smoking than has been indicated in other studies of smoking cessation in younger people. The researchers said that such findings hint that the reasons older people give up smoking might be quite different than those of younger people, although their study was not designed to elicit such motives.

"The patterns of smoking cessation in older people are quite different than previous research has shown with regard to smoking cessation in younger populations," said Heather Whitson, MD, a geriatrics fellow at Duke's Center for the Study of Aging. "More research is needed, but with greater understanding of motivations for quitting in later life, better cessation programs could be developed for this population. This would be particularly true if we could determine quality of life benefits and longevity for older people who quit."

The study findings appear in the March 2006 edition of the Journal of the American Geriatrics Society. The research was supported by Duke's division of geriatrics.

Whitson's team sought to learn whether the factors that best predict smoking cessation in younger smokers would also be associated with smoking cessation in older people.

The team selected a group of 573 elderly smokers from the North Carolina Established Populations for Epidemiologic Studies of the Elderly (EPESE) database, and reviewed those participants according to their reported smoking habits for a maximum period of ten years.

The North Carolina EPESE database is a collaborative, prospective study that was funded by the National Institute on Aging. The database includes epidemiologic information on 4,162 racially and socioeconomically diverse older people living in a contiguous five-county area in central North Carolina. Participants' health information was collected over a period of ten years, from 1986 to 1996.

To be included in this current study, the EPESE participants had to have been regular smokers upon enrollment in EPESE and to have survived at least three years from the point of enrollment. Based upon their smoking behaviors at follow-up interviews for the EPESE study, the 573 observational study participants were categorized as "quitters" (100 participants) or "nonquitters" (473 participants).

The researchers found that female elderly participants were more likely to quit smoking than men in their age group. Additionally, participants who quit smoking were more likely to have received a serious health diagnosis, such as cancer or heart disease, although the measurement did not achieve statistical significance, the researchers said.

The majority of older people who quit smoking during the first three years of the study remained quitters until the time of their death or at least until the end of the EPESE study period – at which time, the health tracking period ended.

Of those who quit smoking by the first follow-up session, only 16 percent returned to smoking, which contrasts sharply with previous smoking cessation research that has shown 35 to 45 percent recidivism rates in younger populations within two years of quitting.

The researchers acknowledge that the low recidivism rate in the elderly could, in part, be due to higher mortality rates, but that it could also reflect a fundamental difference in smokers who change their habits at an advanced age, they said.

"Something novel may be motivating those older people who do give up smoking - either they are really motivated to give up the habit or factors outside of their control are influencing the decision to quit," Whitson said.

Other factors that might influence quitting include loss of transportation (therefore loss of access to cigarettes), onset of dementia, financial constraints or a move to assisted living or to a relative's home where smoking is not permitted.

Mitchell Heflin, M.D. and Bruce Burchett, Ph.D., both of Duke, are also authors on the study.