A 72-year-old man comes to the clinic to establish care. He has a mild, chronic cough that has not changed in quality or severity for many years. The patient has a history of hypertension and hyperlipidemia for which he takes chlorthalidone and atorvastatin. He is a current smoker and has smoked a pack of cigarettes daily for 53 years. The patient has attempted to quit multiple times in the past without success. Today, he states he is reluctant to attempt smoking cessation again given his advanced age and lack of complications from his smoking so far. Which of the following would be the most appropriate response regarding smoking cessation in this patient?

Question

A 72-year-old man comes to the clinic to establish care.  He has a mild, chronic cough that has not changed in quality or severity for many years.  The patient has a history of hypertension and hyperlipidemia for which he takes chlorthalidone and atorvastatin.  He is a current smoker and has smoked a pack of cigarettes daily for 53 years.  The patient has attempted to quit multiple times in the past without success.  Today, he states he is reluctant to attempt smoking cessation again given his advanced age and lack of complications from his smoking so far.  Which of the following would be the most appropriate response regarding smoking cessation in this patient?

Quizplus · Accepted Answer

Explanation: Although quitting at younger ages is associated with a larger absolute decline in premature mortality, cessation at age 60 or older has also been shown to lower the risk of all-cause mortality and cardiovascular events. This benefit can be seen within 5 years of quitting. Many older smokers do not attempt smoking cessation due to being unaware of the health benefits they can gain despite quitting at a late age. Many older adult smokers have failed prior attempts at cessation. This should not discourage providers from promoting continued attempts. The US Preventive Services Task Force recommends that every smoker be assessed for readiness at every office visit regardless of age. Brief interventions, such as the "The 5 A's" approach, have been proven to be effective in the promotion of cessation. Additional interventions, such as nicotine replacement, bupropion, or varenicline, may also be appropriate for some older adults. "The 5 A's" approach (Choice A) Although an eventual improvement in chronic cough is expected with cessation, providers should inform patients that there can be an initial temporary increase in cough during the first few weeks after cessation. (Choice B) Younger quitters have been shown to experience slightly more benefit in pulmonary function than older quitters, but smoking cessation slows the decline in lung function at any age and should be promoted in all patients. (Choice D) Smoking is known to accelerate bone loss and is a risk factor for osteoporosis and resulting hip fracture. Cessation can reverse loss of bone density and decrease the excess risk of fracture, but the benefits may not be apparent in the first 10 years after quitting. (Choice E) Nicotine withdrawal in older adults is thought to be similar to that in the general population. Symptoms generally peak in the first few days and improve over the course of the next few weeks. Weight gain is greater in women, nonwhites, and heavier smokers but does not appear to vary with age. Educational objective: All smokers, regardless of age, should be assessed at every office visit for their readiness to quit. Potential benefits of quitting include a reduction in mortality, reduced risk of cardiac events, reduced risk of osteoporosis, and less decline in lung function over time in comparison to current smokers. References: Managing tobacco use: the neglected cardiovascular disease risk factor. (http://www.ncbi.nlm.nih.gov/pubmed/24014389) Smoking cessation interventions and older adults. (http://www.ncbi.nlm.nih.gov/pubmed/19039892)

A 72-Year-Old Man Comes to the Clinic to Establish Care