The risks of smoking are multiple and serious, resulting in premature death for at least 50% of long-time smokers. Although smoking is less prevalent among people over age 65 than among younger people, there are well over 3 million geriatric smokers in the United States. The firmly established habituation and fatalism of many older smokers create special challenges for those who try to encourage them to quit, but there is substantial and growing evidence that smoking cessation yields important benefits in quality and length of life, even for long-term, elderly smokers. Obstacles to smoking cessation include erroneous belief systems, misinformation, habituation, nicotine addiction, and short-term physical and psychological benefits of smoking. Geriatricians can improve the chances that their patients will quit smoking by regarding every patient contact as an opportunity to encourage smoking cessation by offering at least brief interventions to all, and, for those who agree to attempt to quit, by arranging brief or (more effectively) intense smoking cessation programs. Effective programs include behavioral modification techniques, nicotine replacement therapy, and, if indicated, bupropion therapy. The authors review in detail their approach to behavioral modification, usually in combination with nicotine replacement, an approach that results in substantial smoking cessation rates for geriatric patients. Clinicians can influence their patients to quit smoking, and they should.
