Caring for a patient who is a smoker

Smokers and second hand smoke has been a hot topic of discussion for years around the world.   Non-smokers usually hate it when people light up and blow smoke into the air they breathe.  Smokers argue that they have every right to smoke if they want to.  Meanwhile, Governments across the world are busy legislating on who can smoke and who cannot, when and where they can or cannot smoke. While the debate continues in the outside world, look into the small world of the caregiver who has a smoker for a patient.

The patient is perhaps in mild to medium stage of cognitive decline.  He has been a smoker all his life and this is a habit that is difficult to break even for one with completely intact mental faculties. Like many others, perhaps the patient too started smoking because it was considered cool to light up and got hooked to the habit. 

Usually caregivers might look at this from the patient’s perspective:  

• he lost many valuable memories and his independence
• he feels disturbed and depressed with the knowledge that his memory is failing him
• he exhibits his frustration that he/she is now dependant on caregiver(s). 

Perhaps caregivers would ask themselves philosophically, when decline has already started and death is certain, why should small pleasures like smoking a cigarette be denied to him?  So let the patient be allowed to smoke. Right?

Wrong.  There is sufficient medical research that suggests that smoking is dangerous in any circumstance to physical health. 

Extract from the Journal report Heavy smoking in midlife may be associated with dementia in later years  from the Archives of Internal Medicine, 2010 (JAMA and Archives Journals 2010, October 25).  The authors confirm “Smoking is a well-established risk factor for stroke, and may contribute to the risk of vascular dementia through similar mechanisms.  In addition, smoking contributes to oxidative stress and inflammation, believed to be important in the development of Alzheimer's disease….It is possible that smoking affects the development of dementia via vascular and neurodegenerative pathways," 

Additionally, it has also been suggested that smoking accelerates mental decline.  This is sufficient reason to stop your patient from smoking.    This is sufficient reason for anyone to stop smoking because unlike age and genetic factors, smoking is one contributing risk factor for dementia that we can change.

Importantly, consider the health of the primary caregiver. The caregiver would of necessity be exposed to unnecessary second hand smoke.  It will destroy the health of the caregiver(s) who already compromise on their well-being to take care of the patient.    It is a fact that exposure to toxins in second hand smoke can cause asthma and cancer.  An online study published by The British Medical Journal says “Breathing second-hand smoke can increase the risk of developing dementia and other forms of cognitive impairment in adults by as much as 44%.”      

So this is not just about indulging the patient, it is about the well-being of the caregiver.   Smoking should be actively discouraged.  Patients with dementia may forget that they have already had their smoke and insist on another one and then another finally ending up demanding cigarettes at all hours and becoming chain smokers.    It is hard enough to deal with a patient who has dementia.  It will probably get worse when they want their nicotine fix and they have to be denied it outright.  

But people can quit smoking.  Today no one has to quit cold turkey, there are prescription medicines, nicotine patches, lozenges available to wean away from lighting up a cigarette.   In cases of mild to moderate cognitive decline, some group counselling sessions may also be of help.

Apart from the health issues, there is also the ever present danger that a casually discarded cigarette could set the house on fire as people with dementia are less likely to carefully extinguish their cigarette.

What caregivers can do to minimise the smoking and the dangers it presents

1.  Discourage smoking by hiding away all visible reminders of smoking like cigarette packs, lighters, match box, ash trays.  It is possible that with these triggers away from sight the patient may forget about smoking.

2.  Do not to allow others to smoke in the presence of your patient to prevent memory triggers

3.   Discard shallow ashtrays and get new deep containers to use as ashtrays in which you can fill water at the bottom as an added precaution.   These should be used to submerge ashes and cigarette butts before throwing into the garbage bin.

4.   Do not allow smoking inside the house while sitting on the couch and never ever on the bed. 

5.  Take it outside. Smoking in the verandah while seated at a table is safer than smoking indoors.

6.   Do not allow the patient to step outside the house unaccompanied for a smoke. 

7.   Contact your family physician and enquire about pharmacological remedies available to quit smoking.

You have to help your patient to quit smoking for his own better health and yours.