Title: SMOKING IN THE ELDERLY POPULATION
1 SMOKING IN THE ELDERLY POPULATION THEORY
2 1. THE PROBLEM2. BENEFITS OF SMOKING
CESSATION3. STRATEGIES FOR SMOKING CESSATION
3IL PROBLEMA
4SMOKING IN THE ELDERLY POPULATION
- There are 1 billion, 100 million smokers in the
world - 1/3 of the population over the age of 15 smokes
- In developed states 42 of men and 24 of women
smoke - In Italy 30 of the population smokes. 29.1 of
men and 19.2 of women 13-14 million people
(adjusted prevalence estimates for WHO member
states, tobacco survey 2005) - Smoking causes about 90,000 deaths per year
- Smoking tobacco causes 85-90 of lung cancers
- One in six deaths in Italy are due to smoking and
every day 246 people die because of smoking
5The WHO EPIDEMIC Tobacco epidemic death
toll(WHO Mpower report 2008) Dr Margaret Chan,
WHO Director-General
- 100 million deaths in the 20th century
- 5.4 million deaths per year
- Without urgent action, it is predicted that there
will be more than 8 million deaths a year by 2030 - Of these more than 80 will be in developing
countries - 1 billion deaths are predicted for the 21st
century
6(No Transcript)
7PASSIVE SMOKING
- Passive smoking is also a risk, not only from
cigarette smoke but from stoves and gas or
kerosene cookers which raise levels of nitrogen
oxide. - Low socio-economic status is associated with
higher prevalence of Chronic Obstructive
Pulmonary Disease (COPD) compared to the general
population with the seriousness of health
problems increasing as the standard of living
conditions falls. - A diet poor in antioxidants (fruit and
vegetables) and the abuse of alcohol seem to be
correlated with a higher risk of developing COPD.
- (Smoking and Respiratory Illnesses, Risk Score
Cards for COPD and Lung Tumours, Zuccaro, Viegi,
Porta et al.)
8(No Transcript)
9PASSIVE SMOKING(WHO Mpower report 2008)
- Every year in the USA, passive smoking is
responsible for - 3,400 deaths from lung cancer
- 46,000 deaths from heart disease
- 430 cases of cot death (SIDS)
- 24,500 low birth weights
- 71,900 premature births
- 200,000 increasingly serious asthma attacks among
children
10COMPARISON WITH THE EFFECTS OF ENVIRONMENTAL
POLLUTIONShort-term effects on health of an
increase of 10-µg/m3 in the concentration of
PM10 a European study Royal College of
Physicians. Smoking and health now. London
Pitman Medical and Scientific Publishing, 1971.
Health outcome Estimated percentage increase in risk per 10 µg/m3 PM10 (95 confidence interval) Source Anderson HR et al. Meta-analysis of time series studies and panel studies of particulate matter (PM) and ozone (O3). Report of a WHO task group. Copenhagen, WHO Regional Office for Europe, 2004 Estimates risk in smokers (95 confidence interval) Source Royal College of Physicians. Smoking and health now. London Pitman medical and Sc. Publishing, 1971 Similar risk in rural area, Lancet 2003, 362 507
All-cause mortality 0.6 (0.40.8) 2.0-3.0
Mortality from respiratory diseases 1.3 (0.52.0) 2.9 (2.5-3.3)
Mortality from cardiovascular diseases 0.9 (0.51.3) 1.8 (1.7-1.9)
11THE ROLE OF COPD
- Most damage caused by smoking does not show at
the first cigarette it takes years and sometimes
decades - COPD is a disease of the elderly population 90
of COPD deaths occur after the age of 65 - Considering the increasingly important role of
COPD in the elderly population (it is estimated
that in 2020 it could become the third most
common cause of death and the fifth most common
cause of disability (Murray-Lopez, Global Burden
of Disease Study, Lancet 3491498,1997)), early
diagnosis of this smoking-related disease becomes
fundamental, so that elderly people do not seek
treatment only when they begin to have difficulty
breathing. - In this sense too society has changed, and since
2005 the Consensus American Thoracic Society -
European Respiratory Society have spoken of COPD
as a curable disease!
12BENEFITS OF SMOKING CESSATION
13BENEFITS OF SMOKING CESSATION
- Evidence-based medicine shows that the only
intervention capable of reducing morbidity and
mortality in the short and long term is giving up
smoking
14BENEFITS OF SMOKING CESSATION
- When no morbitity has occurred, often the elderly
person is not motivated to give up until they are
sick (cancer, stroke, or heart attack) - So it is important to teach the elderly person
that - GIVING UP SMOKING
- Brings HEALTH BENEFITS
- Improves QUALITY OF LIFE
- Increases LIFE EXPECTANCY
15Above all, we need to give positive messages to
older peopleSOME GOOD REASONS TO STOP SMOKING
TO SAVE MONEY TO IMPROVE HEALTH BETTER SELF
ESTEEM BETTER GENERAL APPEARANCE SETTING A GOOD
EXAMPLE TO OTHERS
16THE BENEFITS(www.sfuma.it)
- Less than 30 minutes after the last cigarette,
blood pressure and the temperature of hands and
feet return to normal. - After 8 hours levels of oxygen in the blood
return to normal and levels of carbon monoxide
are reduced. - After 48 hours senses of taste and smell are
increased and nerve endings begin to repair
themselves. - After 72 hours breathing becomes easier as lung
capacity increases. - After 1 week the risk of a heart attack is
reduced, nicotine is eliminated from the body
thus improving senses of taste and smell and
reducing bad breath. Teeth and hair are shinier. - Between 2 weeks and 3 months lung capacity
increases by 300 and circulation improves,
walking becomes easier, and you feel more
energetic.
17THE BENEFITS(www.sfuma.it)
- Between 1 and 9 months a third of those who
gained weight when quitting have regained their
original weight. Lungs clean themselves more
efficiently and the risk of infections is
drastically reduced colds, coughs, tiredness and
shortness of breath are also reduced. - After 1 year the risk of a heart attack is halved
and the risk of developing cancer begins to
reduce. - After 5 years the risk of lung cancer is reduced
by 50 and that of a stroke is reduced to that of
a non-smoker. - After 10 years the likelihood of dying from lung
cancer is equal to that of a non-smoker and the
risk of other cancers is reduced (mouth, throat,
pancreas, bladder, kidney and oesophagus).
Precancerous cells are gradually replaced. - After 15 years the principal indicators of risk
have returned to normal.
18STRATEGIES FOR SMOKING CESSATION
19STRATEGIES PROPOSED BY THE WHO TO COMBAT THE
SMOKING EPIDEMIC (WHO Policy Recommendations
for Smoking Cessation and Treatment of Tobacco
Dependence) MPOWER
- Monitor tobacco use and prevention policies
- Protect people from tobacco smoke
- Offer help to quit tobacco use
- Warn about the dangers of tobacco
- Enforce bans on tobacco advertising,
- promotion and sponsorship, and
- Raise taxes on tobacco
20WHO STRATEGIES TO COMBAT THE SMOKING EPIDEMIC
(WHO Policy Recommendations for Smoking Cessation
and Treatment of Tobacco Dependence)
- Change the social climate and promote a
supportive environment - Promoting and integrating clinical best practices
(behavioural and pharmacological) - A surveillance, research and information approach
that promotes the exchange of information and
knowledge so as to increase awareness of the need
to change social norms (Chapter I, Matrix 1,
pages 7-10).
21WHO STRATEGIES TO COMBAT THE SMOKING
EPIDEMIC(WHO Policy Recommendations for Smoking
Cessation and Treatment of Tobacco Dependence)
- Ex-smokers can serve as role models in
encouraging quitting, and can provide social
support to individuals who are attempting to
quit. - They also may reflect an environment in which
quitting is a greater priority.
22WHO STRATEGIES TO COMBAT THE SMOKING
EPIDEMIC(WHO Policy Recommendations for Smoking
Cessation and Treatment of Tobacco Dependence)
- The success of these interventions depends on
their synergistic use in a broader context of
comprehensive tobacco control programmes
- motivation,
- advice and guidance,
- counselling,
- telephone and internet support,
- appropriate pharmaceutical aids
23HOW TO ENCOURAGE CHANGE
24HOW TO ENCOURAGE CHANGEMINIMAL ADVICE
- (Agency for Health Care Policy and Research
(AHCPR) guidelines for smoking dissuasion JAMA
1996, 257/16 1270-80)
25HOW TO ENCOURAGE CHANGE
- Monitor the smoker who has given up through
repeated check-up visits these have proven
useful in reinforcing motivation to continue
giving up (Ann Intern Med 1989, 110 648-652) - Without behavioural treatment, attempts to give
up smoking are generally short-lived and present
a high risk of dropping out within a year (Eur J
Cancer 1994, 30A/2 253-263).
26MOTIVATIONAL TOOLSEACH PERSON HAS A DIFFERENT
SITUATIONEACH PERSON NEEDS A DIFFERT
STRATEGY(DOTT. FORZA G., Stop smoking clinic,
Az. Ospedaliera Padova)
27Consider the idea of changingSTRATEGY EVALUATE
THE PROs AND CONs (DECISION SCALES)
28Obtain and Maintain the changeSTRATEGY MAINTAIN
SELF-EFFECTIVENESS
29THE LANGUAGE OF CHANGE
- Open questions
- Reflective listening
- Synthesise
- Confirm
- Bring out self-motivating affirmations
30Fagerström test for nicotine dependence
(Heatherton TF, Kozlowski LT, Frecker RC,
Fagerstrom KO. The Fagerstrom Test for Nicotine
Dependence A revision of the Fagerstrom
Tolerance Questionnaire. British Journal of
Addictions 1991861119-27)
- Your nicotine dependence level is .
- 0-2 very low
- 3-4 low
- 5 medium
- 6-7 high
- 8-10 very high
- less than 5 points your level of dependence is
still low. You should act before it grows - 5 7 points you have a moderate level of
dependence, if you dont quit as soon as possible
your dependence will grow until you are seriously
addicted. Act now to free yourself from your
nicotine dependence. - more than 7 points your level of dependence is
high. You dont control your smoking, it
controls you! When you decide to give up it
would be good to speak to your doctor about a
nicotine/drug based subsitute treatment to help
you give up.
- 1. After waking do you smoke a cigarette within
- 60 minutes (0)
- 31-60 minutes (1)
- 6-30 minutes (2)
- within 5 minutes (3)
- 2. Do you find it difficult to stay in places
where smoking is banned? - No (0)
- Yes (1)
- 3. Which cigarette would you find it hardest to
give up? - The first in the morning (1)
- Any other (0)
- 4. How many cigarettes do you smoke per day?
- 10 or less (0)
- 11-20 (1)
- 21-30 (2)
- 31 or more (3)
- 5. Do you smoke more in the first hour after
waking than during the rest of te day? - No (0)
- Yes (1)
31Motivational Questionnaire(H.Mondor, Paris) The
following questionaire evaluates the motivation
of a person who sees their doctor about giving up
( www.fumo.it)
- 9. I am pregnant/my partner is pregnantYes No
- 10. I have small childrenYes No
- 11. I am in a good mood at the momen
- Yes No
- 12. I usually finish what I start
- Yes No
- 13. I am usually calm and relaxedYes No
- 14. My wieght is usually stable
- Yes No
- 15. I want to improve my quality of life
- Yes No
- 1. I decided to give up spontaneouslyYes No
- 2. I have already given up for more than a
weekYes No - 3. I dont have any problems at work at the
momentYes No - 4. I donthave any family problems at the
momentYes No - 5. I want to free myself from my addictionYes No
- 6. I do sport or I intend to do sportYes No
- 7. I want to be in better physical shapeYes No
- 8. I want to look after my physicla
appearanceYes No
32HOW TO ENCOURAGE CHANGE
- Role of the doctor
- Get the patients history of smoking
- Help the patient to better understand the
needs/motives behind their smoking in order to - Find ways of developing different responses to
these needs and motives - Provide Information
- Educational material for independent learning
- Emotional and psychological support
- And if necessary pharmaceutical support to help
the patient to stop smoking.
335 STEPS TO BEHAVIOUR CHANGE
- Fix a precise and meaningful date to give up
smoking completely, with some weeks before for
psychological preparation and informing friends,
family and the doctor of the date so that they
can provide support - Keep a written smoking diary in order to
identify the situations and times in which the
impulse to smoke is strongest - Identify alternative behaviours to respond to
specific situations where the desire to smoke is
strongest, preparing a distraction activity in
order to reduce the stress of not smoking write
a list of difficult situations and possible
alternative behaviours can seem boring but is
definitely useful in the long term. - Get positive reinforcements in order to keep
motivated write a list of reasons for giving up
smoking, rewards for achievements and regular
contact with friends who have already given up,
marking off the days since giving up on a
calendar. - Consider any lapses as mistakes along the road
and use them as a chance to better understand
reasons for smoking and how to combat the desire
more effectively next time.
34Smokers are more likely to succeed if they tackle
one problem at a time
- Smokers who fix a date to stop smoking, usually
planning a 4 to 6 week strategy, then proved more
determined in giving up smoking (Med Clin North
Am 1992, 76 477-494). - Smokers who manage to stop smoking for at least 2
weeks are more likely to continue not smoking
(JAMA 1988, 259 2883-9). - Most relapses occur within 6 weeks after smoking
cessation (J Clin Psych 1977, 27 455-6).
35Smokers are more likely to succeed if they tackle
one problem at a time
- Weight gain is a major obstacle in giving up
smoking, especially in female smokers (Ann Behav
Med 1989, 11 144-153). - The commitment to preventing eventual weight gain
related to smoking cessation (through diet
therapy, etc) can reduce the current commitment
to stop smoking (Am J Public Health 1992, 82
1238-1243).
36SMART Objectives
- Diaphragmatic breathing
- Distraction techniques (from the thought of
smoking) - Resistant breathing
- (PEP mask)
37SMART Objectives
- Learning to breathe well over time
- How to slow breathing getting to know ones
diaphragm
38SMART Objectives
Breathing resistance exercises (PEP mask)
39SMART Objectives
Distraction Techniques (from the thought of
smoking) (see www.quitguide.com)
4040
41Practical Part (1)
- Activity in multidisciplinary groups
- Groups of approx. 10 people
- Three sets of 10 minutes (101010 minutes)
- One group leader for each group (a doctor, nurse,
pharmacist or other expert) - In each group two people are chosen to act out a
dialogue between the doctor and patient/smoker
using the script of the Motivational interview
(available in the training toolkit). - At the end of the interview the rest of the group
comments on the stages, progression and
conclusion that they saw, guided by the group
leader (10 mins).
21/03/09
42Practical Part (2)
- They then discuss possible next steps, eg. plan a
follow-up visit, and how these next steps can be
planned with the patient (10 mins). - The brochure Learning to Breathe Well With the
Years is then handed out, which explains various
techniques for supporting patients in giving up
smoking, and participants discuss the contents
(10 mins).
43The challenge for public health is to make
healthy choices the easy choices