Should Older Smokers Quit Smoking?

Alvin B. Lin, MD, FAAFP
Dr. Lin is an associate professor of family and community medicine at University of Nevada School of Medicine and an adjunct professor of family medicine and geriatrics at Touro University Nevada College of Medicine. He also serves as an advisory medical director for Infinity Hospice Care and as medical director of Lions HealthFirst Foundation. Dr. Lin maintains a small private practice in Las Vegas, NV. The posts represent the views of Dr. Lin, and in no way are to be construed as representative of the above listed organizations. Dr. Lin blogs about current medical literature and news at


Life can be compared to the arcade game, Whac-A-Mole. It's inevitable that we're going to die from something. Some disease is going to rear its ugly head if we beat down another one. If it's not heart disease, it just well might be cancer that kills us; after all, these two conditions still ranked as the greatest killers in 2008 in the States as published in the National Vital Statistics Reports last week. And if it's not cancer, then perhaps it'll be emphysema or stroke.

I mention this because as I make more and more home visits, I encounter older adults who've either not heard the message that smoking cigarettes kills you or they've chosen to ignore the message and continue to smoke since they've made it this far and/or have given up all other vices at this ripe old age. Until yesterday, I would've agreed. After all, it's your life to live how you want to live as long as it doesn't impact me.

But in a study published in yesterday's Archives of Internal Medicine, the authors analyzed data from 17 studies of 7 populations and came to several conclusions. First, current smoking is associated with greater all-cause mortality (in each and every study). Second, the more you smoke for a greater period of time, the greater your chance of premature death. Third and finally, excess mortality decreases with duration of cessation, even in patients 80 years of age and older. In other words, there's no bad time to quit and there's no age at which it's too old to quit. And by quitting, you lower your chance of dying from any and all-causes—you've just whacked all the moles all at once!

If you're curious about the statistics, the Asian and European populations ranged from 863 to 877,243 participants, and were followed for 3 to 50 years. Current smokers had an 83% greater risk of death while former smokers had a 34% greater risk of death, both compared to never smokers. And as noted above, relative risk of death in former smokers decreased with time since cessation. To put it succinctly, the longer you stay quit, the better off you are. In fact, the authors concluded that even those elderly who managed to smoke their whole life without suffering any clinically apparent negative health consequences would benefit from cessation and should be encouraged to quit smoking. Even the editorialists, who typically take a negative point-of-view against any study, agreed that you're never too old to quit.