Faced with smoking among seniors, healthcare professionals in the Paris region lack confidence

A study indicates that liberal health professionals have the necessary knowledge, but attitudes and practices vary greatly depending on the profession. Additional training would be enough to make them more encouraging and supportive of smoking cessation among seniors.

Smoking prevalence declined in France during the 2010s, but remained stable at around 10 % in the 65-75 age group (10.4 % in men, 9 % in women). 70 % of tobacco-related deaths occurring after age 60, a team of researchers looked at representations related to smoking among seniors among independent health professionals in the Paris region[1].

A study exploring the representations and practices of health professionals

Using a survey method used in England, doctors (51 GPs, 49 specialists), pharmacists and independent nurses in the Paris region were interviewed by telephone. The 29 items in the questionnaire explored these professionals' knowledge of smoking among the elderly (10 "true/false" statements), their attitudes towards this population (12 statements) and their professional practices (7 questions).

The results show that 23 % of these professionals have followed at least one additional training, either in gerontology (46 %) or in tobaccology (33 %), with only a minority being trained in these two themes (20 %). While pharmacists have the most specific knowledge on the subject of smoking among seniors, doctors are those who display the best attitudes and best practices.

Underestimating the need to intervene with seniors

The representations associated with smoking among seniors highlight a number of shortcomings in encouraging people to quit smoking. Nearly 67% of health professionals consider that senior smokers would be less willing than young people to quit smoking, while the literature does not note any particular difficulty in quitting smoking in this population. Only 64% of these professionals know that there are no risks in offering nicotine substitutes to seniors, and 43% of them know that brief cessation advice is as effective as more intensive advice. More worryingly, nearly 38% of them consider that smoking is one of the few pleasures enjoyed by seniors, while a US study indicates that nearly half of smokers aged 65 and over have a chronic illness, and a quarter of cancers, linked to smoking.[2].

83 % of the professionals surveyed consider that they have sufficient knowledge about smoking cessation among the elderly and 74 % of them say they easily approach this subject with them, but only 44 % inquire about the smoking status of these people and 35 % report it in the clinical file. On the other hand, only 68 % of these professionals consider that they have sufficient knowledge about the therapeutic proposals adapted to seniors. There are still 61 % who think that support for smoking cessation requires a specialist and only 48 % provide regular support to the elderly during their smoking cessation. All these situations appear, in the eyes of the authors, as "missed opportunities", while smoking cessation significantly improves the quality of life and respiratory function of the elderly.

Strengthening the confidence of professionals to intervene

Noting a lack of confidence among health professionals, the authors of this research consider it necessary to consolidate their skills to give them more confidence in their ability to intervene with elderly smokers. They recommend strengthening communication on this topic on the one hand, and initial and continuing training for health professionals on the other.

The limitations of this study lie mainly in its small sample size (100 people per type of profession) and in the declarative aspect of the responses collected. However, it has the merit of focusing on a population that is rarely perceived as a priority in tobaccology and of highlighting one of the weaknesses of the health system.

Keywords: seniors, smoking, health professionals, training, Ile-de-France

©Tobacco Free Generation

M.F.