Smoking Cessation

1. Smoking Cessation & Nicotine Replacement Therapy

2. Smoking Cessation

3. Smoking & Residents Smoking: is responsible for a large proportion of deaths in the geriatric population Associated with heart disease, cancer and stroke; all the three major causes of death among the elderly Is the leading cause of fatal fires for the elderly

4. There are healthier ways than smoking for residents to cope with stress, engage in social interaction, and escape boredom Smoking increases stress & anxiety levels. Research shows a decrease in anxiety within 2 weeks of quitting If a value becomes attached to healthy activities such as yoga, gardening, meditation, the same stress relief, freedom from boredom, and social interaction may be experienced

5. Quitting & Residents Health benefits can be seen in elderly smokers who quit It can delay the progression of illness or prevent illness altogether, and hence, affect length and quality of life (Bergman and Falit, 1997) older smokers are interested in quitting and respond positively to a program tailored to their needs Can�t assume residents do not want to cut back or quit or can�t do it

6. Taken from the Heart and Stroke Foundation of CanadaTaken from the Heart and Stroke Foundation of Canada

7. Quitting & Residents Wound healing: Nicotine and other toxins in smoke interfere with proper wound healing Repeated passive exposure to cigarette smoke (SHS) appears to have similar effects Even without wound complications, smokers can have longer postoperative stays in intensive care Medications more effective after quitting, so doses may need to be lowered

8. Nicotine Replacement Therapy NRT

9.  Nicotine Replacement Therapy NRT was introduced over two decades ago NRT is the most commonly used pharmacotherapy There are 3 types of NRT currently available in Ontario: Nicotine gum Nicotine patch Nicotine inhaler All forms of NRT are equally more effective than not using any NRT when trying to quit

10. NRT: How it works Nicotine is the drug that is inhaled from tobacco while smoking It enters the bloodstream and stimulates the brain When the blood levels of nicotine fall, people who smoke experience withdrawal symptoms (irritability, restlessness, headache, etc) Nicotine Replacement Therapy (NRT) is a safe way to provide the body with nicotine NRT delivers lower levels of nicotine at much slower rates than smoking which reduces the symptoms of nicotine withdrawal American Heart Association American Heart Association

11. Benefits of NRT Increases the odds of successful quitting Reduces intake of thousands of chemicals including Carbon Monoxide � the toxin of most concern Cleaner delivery system of nicotine Reduces or even stops withdrawal symptoms while trying to quit smoking NRT can be used as a way to manage cravings in between cigarettes (i.e. at night)

12. How to Use NRT Consult a physician or health care provider Decide which type of NRT is most suitable Set a start date (stop smoking and begin NRT) Use NRT routinely (not just �now and then�) Use NRT for at least 8-12 weeks Over time the dose of NRT is decreased and eventually stopped

13. Choosing the Most Suitable NRT Nicotine Patch Can use for 16 hours or 24 hours (overnight use) It is placed on the skin releasing a steady stream of nicotine into the bloodstream May be beneficial to those who have early morning cravings and for those who have trouble chewing (e.g. dentures) From the American Lung Association From the American Lung Association

14. Choosing the Patch Note: These are general guidelines.Note: These are general guidelines.

15. How to Use the Patch May need to clean area with alcohol wipe Touch only small corner of adhesive Rub patch after application � ensure all corners are stuck Wash hands in water after application �don�t use soap Discard old patch out of reach of children, animals � can still be harmful

16. How to Use the Patch Apply to clean dry area Rotate site every day Remove old patch before applying new one Do not use lotion, moisturizing soap on the area the patch is to be applied

17. Choosing the Most Suitable NRT Nicotine Gum Nicotine reaches bloodstream faster than the patch 2 doses: 2mg or 4mg (depends on amount of cigarettes smoke/day) �Chew and Park� method: Chew to break down then park in cheek to release nicotine which is absorbed into bloodstream May not be suitable for people with difficulty chewing Some people do not like the taste of the gum

18. How to use Nicotine Gum Must be able to chew gum (i.e. no dentures, TMJ) 2mg: use only in combination with patch as a breakthrough medication 4mg: use in combination with patch or alone Chew one piece at a time, no more than 1/hour

19. Choosing the Most Suitable NRT Nicotine Inhaler Resembles a cigarette Nicotine cartridges are inserted into it and inhaled Each cartridge provides about three 20 minute sessions May be suited to those who enjoy the �hand to mouth� action of smoking May be useful for continuing smokers who need to abstain for various periods of time

20. How to Use the Inhaler Use up to 6 �10mg cartridges per day Can use continuously for 20 min or as needed Inhale like cigar, not deeply into the lungs Flexible -use as much or as little as needed May notice a burning, warm or cool sensation when inhaling �OK unless it becomes bothersome Clean inhaler regularly with soap and water

21. Nicotine Withdrawal Cravings to smoke Frustration Anger Anxiety Difficulty concentrating Restlessness

22. Sign of Nicotine Toxicity Nausea and/or vomiting Sweating Vertigo Tremors Confusion Weakness Racing heart Light-headedness ..

23. Tips for helping people remain smoke-free Take it one day at time Engage in relaxing activities: walking, gentle exercise, or deep breathing activities Stimulate the mouth: if appropriate snack on raw vegetables, or drink a cold glass of water Occupy the hands: doodle, play cards, do a cross word or jigsaw puzzle These tips are taken from Heart and Stroke Foundation of CanadaThese tips are taken from Heart and Stroke Foundation of Canada