Older adults and smoking.

This review supports the following conclusions regarding the benefits of smoking cessation in older adults: 1. Older smokers who quit have a reduced risk of death compared with current smokers within 1 to 2 years after quitting. Their overall risk of death approaches that of those who never smoked after 15 to 20 years of abstinence. 2. Smoking cessation in older adults markedly reduces the risks of coronary events and of cardiac deaths within 1 year of quitting, and risk continues to decline more gradually for many years. This is true for older adults both with and without a previous history of coronary disease and symptoms. 3. Risks of dying from several smoking-related cancers are reduced by quitting. Although the decline in risk may be more gradual for older than middle-aged adults, the benefits of cessation are apparent within 5 to 10 years of quitting. 4. Smoking cessation reduces the risk of COPD mortality after 10 to 15 years of abstinence in men and 5 to 10 years of abstinence in women. Within a shorter period of time, quitting reduces the prevalence of respiratory symptoms, slows the rate of decline in pulmonary function, and may reduce functional impairments and improve tolerance for exercise. 5. Smoking cessation may help slow osteoporosis and reduce the risk of hip fractures, but effects on rates of bone loss or subsequent risk of fracture have not yet been studied adequately. 6. Continued smoking in late life is associated with the development and progression of several major chronic conditions, loss of mobility, and poorer physical function. Former smokers appear to have higher levels of physical function and better quality of life than continuing smokers. Physicians and others should encourage older adults to stop smoking. Of course, not every older adult who quits will benefit in all, or indeed any, of these ways. Nevertheless, at the population level, the prospects are excellent that smoking cessation after age 65 will extend both the number of years of life and the quality of life.