In their groundbreaking book, Successful Aging, Dr.'s John Rowe and Robert Kahn defined successful aging "as the ability to maintain three key behaviors or characteristics: low risk of disease and disease-related disability; high mental and physical function; and active engagement with life."³ Recent research indicates that smoking is a direct or indirect factor in the quality of life surrounding each of these three characteristics.

Rowe and Kahn point out that "some losses in physical function and in certain kinds of cognitive capacity are indeed intrinsic to age and therefore inevitable. However, the losses experienced in the course of what we have called 'usual aging' are a combination of the inevitable and the preventable, more often the latter. People often blame aging for losses that are in fact caused by lifestyle -- overeating and poor nutrition, smoking, excessive use of alcohol, lack of regular exercise, and insufficient mental exertion."⁴

Rowe and Kahn go on to point out that "the notion that abilities, once lost in old age, are lost forever is another of the dismal assumptions proved wrong by [recent research on successful aging]."⁵ They point out that changes in lifestyle, such as smoking cessation, can cause immediate and long-term improvements in health status, and that "by harnessing the power of proper diet, exercise, smoking cessation, and so on, we can prevent or defuse" even genetic factors which many people assume pre-determine and make inevitable diseases such as cancer, heart disease, etc.⁶

Research by Dr. Anthony Vita and others found that smoking, body-mass index (weight divided by height), and exercise patterns in mid-life and late adulthood are predictors of subsequent disability. They concluded that "not only do persons with better health habits survive longer, but in such persons, disability is postponed and compressed into fewer years at the end of life."⁷ While more research is needed in this area, virtually all evidence suggests that avoiding major health risks such as smoking is a key factor in achieving healthy and successful aging.

Smoking is associated with all three major causes of death among the elderly -- heart disease, cancer and stroke. These three diseases are responsible for 70% of deaths among the elderly. Among the 65-74 age group, heart diseases and cancers are equally prevalent as causes of death. As age advances, heart disease causes an increasing share of deaths, making heart disease the leading cause of death among the elderly.⁸

In the U.S., about 19% of all deaths in 1990 were due to smoking, or about 417,000 deaths. Of the smoking-related deaths, about 70% (or 292,000) were to persons aged 65 and over, versus about 62% of all-causes deaths occurring in the 65 and over age group.⁹ Another 24% of the 417,000 deaths were to persons aged 50 to 64, or 100,080 deaths.¹⁰

The dramatic impact of smoking in causing premature deaths -- which happens to 1 out of 3 smokers -- is demonstrated vividly in the data from 1990 which showed that over 26.7% of all deaths in the 35-64 age group were due to smoking, whereas 19.4% of deaths among all age groups were due to smoking.¹¹ Among males, 29.6% of the 35-64 deaths were due to smoking; among females, 21.7%.

Dr. Michael Eriksen, Director of the Office on Smoking & Health of the federal Centers for Disease Control stated recently that "smokers are three times more likely to die between the ages of 45 and 64 and two times more likely to die between the ages of 65 and 84 than those who have never smoked. ...the fact is that 33% of non-smokers live to age 85, compared with only 12% of smokers." ¹²

In other words, smoking-related deaths have their most dramatic impact on the young-old, especially those in the 50 to 70 year old age range. These smokers are denied the opportunity to experience an old age, to say nothing of a healthy old age.

While death is the ultimate curse of smoking-related diseases, equally serious results are the pain, suffering, and loss of dignity due to dependency on others for basic life-care. Heart disease, cancer and stroke, are associated not just with death, but with suffering, chronic illness and debilitating lifestyles which erode the quality of the individual's existence and increase dependency on others.

Smokers have more acute and chronic illnesses as well as more restricted activity days, more bed disability days and more work absenteeism than former smokers or those who never smoked; smokers also make about six more visits to health care facilities annually than nonsmokers.¹³

The suffering and pain, the lack of normal physical mobility, and the dependency which accompany so many smoking-related illnesses cannot be communicated adequately just with statistics. Anyone who has had to assist a family member or friend through the final stages of lung cancer, stroke, heart disease, or emphysema can barely find it possible to describe the horrible suffering and loss of personal dignity that the victim endured. These are among the most terrifying effects of tobacco use.

While there has been increasing public education about the dangers of smoking in recent decades, this has been more than matched by the $5 billion spent annually by the tobacco industry to promote the "pleasures" of smoking. One result of this massive advertising and the continual denials by the tobacco industry of the harms caused by smoking is the lack of understanding among smokers of the risks they face.

A recent study by Dr.'s Ayanian and Cleary at the Harvard Medical School showed that "most smokers -- even heavy smokers and those with other cardiac risk factors -- do not perceive themselves at increased risk of experiencing [heart disease] or developing cancer....Many smokers continue to deny their own personal health risks."¹⁴

In the above study, of current smokers surveyed, only 29% thought they had a higher than average risk of heart disease, and only 40% thought they had a higher than average risk of cancer. Even among heavy smokers (2 packs a day or more), only 39% thought they higher than average risk of heart disease, and only 49% thought they had a higher than average risk of cancer. Thus, even among heavy smokers, less than half thought their smoking behavior put them at greater health risk than the average person. ¹⁵

The study also found that "smokers older than 64 years were less likely than younger smokers to perceive their risk of [heart disease] as higher than average." ¹⁶

This study confirms similar findings and highlights the need for health professionals and others working with older persons to educate smokers about the personal health risks of smoking and to promote smoking cessation as a key to a healthy old age.

Repeated studies have shown that smoking cessation, including among older smokers, improves health status and reduces the risks associated with smoking. The "healing" process begins immediately and, over time, can restore a person's health to the same as if s/he had never smoked for many tobacco-related diseases.

Immediate Benefits:¹⁷

• Within 20 minutes of quitting, your blood pressure and pulse rates begin to drop to normal and your body temperature increases to normal.
• Within 24 hours, the chance of heart attack begins to decrease.

• Within 48 hours, food will begin to taste and smell better.

• Within 72 hours, bronchial tubes relax and breathing becomes easier and lung capacity increases.

• Between 1 and 9 months after quitting smoking, coughing, sinus congestion, and shortness of breath decreases.

• Self-image and self-esteem improve and the sense of control over ones life increases during the first year after quitting.

Longer Term Benefits:¹⁸

• People who quit smoking before the age of 50 have one-half the risk of dying over the next 15 years compared to people who continue to smoke.

• The risk of coronary heart disease falls abruptly within months, and within 3-5 years the risk of coronary heart disease falls to a level indistinguishable from that of individuals who have never smoked. This is true no matter how long or how much one smoked.

• The risk of lung cancer declines steadily, so that after 10 years the risk is 30-50% of that in continuing smokers, and by 15 years, the risk of lung cancer is almost as low as if you had never smoked.

• Smoking cessation also reduces the risks of other tobacco-related malignancies, including cancers of the larynx, esophagus, pancreas, and urinary bladder.

• Quitting smoking also decreases the effects of other nonmalignant diseases, such as stroke, peripheral vascular disease, chronic obstructive pulmonary disease (lung diseases), and pneumonia.

• Diseases like emphysema and bronchitis are 10 times less likely among nonsmokers, and these diseases can stabilize or improve when a person quits smoking.

• Research suggests that cataract and age-related macular degeneration may be causally-related to smoking, and that the more pack-years of smoking, the greater the risk; thus, smoking cessation should be beneficial.

• Diabetics who quit smoking are much less likely to suffer serious effects like heart disease, blindness and stroke.

Healthy, successful aging and not smoking clearly go hand-in-hand, no matter when a person quits smoking.

Dr. Roberta Ferrence, director of the Ontario Tobacco Research Unit at the University of Toronto, put it very well when she said: "The longer you smoke, the more likely you are to have permanent damage. Even if you're still smoking at 60, 70 or even 80, it's always worthwhile quitting, and it will make a big difference in your health and longevity. It's not just whether you die or not. It's the quality of your life and how you recover from surgery, how often you're ill in old age." ¹⁹

NOTES

One of the most important points to remember about smoking cessation is "smokers aren't bad people. They're good people who are dependent on a bad substance. Smokers need support and effective tools to break that dependence. Recovery is a life-long process," states Dr. Richard Hurt of the Mayo Clinic's Nicotine Dependence Center in the Spring, 1999 issue of The Nicotine Challenger.

Fortunately, today's smokers are no longer faced with the alternative of quitting "cold turkey" or continuing to smoke. Today, smoking cessation treatments have been approved for over-the-counter sale, and prescription treatments are available and increasingly effective. Among the treatments approved by the FDA and available for nicotine dependence treatment are the following:

• Nicotine patch;

• Nicotine gum;

• Nicotine inhaler;

• Nicotine nasal spray; and,

• Bupropion (sold as Zyban).

Dr. John Slade, Director of the Addictions Program at the School of Public Health of the UMDNJ, says that "used singly, each of [the above] products about double the success rate in stopping smoking. This means that the effectiveness heavily depends on what the person is doing to address the addiction. If the person is getting support, success is more likely. However, even without support, success is greater with medicine than without."

Dr. Slade states that "the medicines may work better if they are used in combination....it seems helpful for many people to use, for instance, a patch as baseline treatment of nicotine withdrawal and another product as a supplement, to help cope with urges and difficult situations during the day. There are also encouraging indications that combining Zyban with a nicotine product can lead to better results."

Is one smoking cessation treatment better than another?

"Because we have no head-to-head comparisons of the therapies, because no treatment has replicated evidence of superior efficacy or adverse event profiles, and because no method to match smokers to a particular treatment has been empirically validated, patient preference should be the primary basis for choice among treatments," according to a major review of smoking cessation treatments in the January 6, 1999 Journal of the American Medical Association (JAMA).

The JAMA article made the point that most smokers make many attempts to stop smoking -- often 5 or more attempts -- before succeeding. Experience also indicated that repeating the same cessation treatment that failed previously achieves little success, and that, therefore, new treatments should be considered. Further, combination treatments, as Dr. Slade suggested (above) should be considered, as should behavioral treatment in a group or individually.

Is quitting smoking for everyone?

Yes, quitting smoking is for everyone. But, success at quitting will vary, depending, in part, on how committed and prepared you are to quit -- and, what assistance you get, as described above.

Everyone agrees successful quitting depends on readiness and planning ahead. Planning ahead can include the following:

• setting a quit date a few weeks in advance of actually quitting;

• using "nicotine fading," which is switching to cigarette brands which have lower nicotine levels;

• changing some of your smoking habits, including cutting out some of your favorite times/places for smoking;

• determining ahead of time which friends you can count on for support in quitting;

• determining what nicotine treatments to use; and,

• establishing an exercise plan, such as walking, to use to help relieve stress and to help you feel better.

Quitting smoking is for everyone; and, quitting is healthy for everyone. However, not succeeding at quitting happens to most people; don't consider that failure. Each time you try, you're increasing your chances of succeeding.

For more information on quitting smoking, contact your physician or your local heart, lung or cancer association. Or, call the Michigan Resource Center at 800 537-5666 for a free Smoker's Quit Kit.