SmokeFree Long Term Care Homes Project

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Smoke-Free Long Term Care Homes Project
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Second Hand Smoke Smoke-Free Ontario Act
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Second Hand Smoke (SHS)Annoying or Dangerous?

• SHS is Dangerous
• In January, 1993 the Environmental Protection
  Agency declared SHS as a human carcinogen
• There is no risk-free level of second-hand smoke
  exposure, with even brief exposure adversely
  affecting the cardiovascular and respiratory
  systems

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Second Hand Smoke (SHS)Annoying or Dangerous?

• How is SHS Dangerous
• SHS smoke contains higher concentrations of
  harmful chemicals because idling cigarettes burn
  at a lower temperature
• Cigarettes produce about 12 minutes of smoke
• Typical smokers spend about 30 sec inhaling
• The rest of the time, the lit cigarette is
  releasing toxins into the air

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Second Hand Smoke (SHS)Annoying or Dangerous?

• Effects of SHS
• SHS is harmful to those exposed to it (both
  smokers and non-smokers)
• Every year, SHS kills more than 4000 non-smokers
  in Canada (Heart and Stroke Foundation of Canada,
  2006)
• Can cause the same health problems diseases as
  smoking

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Why Smoking Rooms Dont Work
Peeing Section
Non-peeing Section
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Air quality test at CAMH Outside a designated
smoke room
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Whats new in the Smoke-Free Ontario Act for LTC
Homes
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Controlled Smoking Areas (CSAs) ? Designated
Smoking Rooms

• CSAs are designed to lower second-hand smoke
  exposure outside the room.
• The law specifies engineering design,
  function,and maintenance (Better ventilation
  system, double sets of automated doors)
• Smoking in a CSA is limited to residents only
• LTC Homes employees arent required to enter a
  CSA
• LTC Homes without CSAs can have a smoking shelter
  

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Safe Smoking Assessment

• For CSAs, the SFOA stipulates that
• A resident who desires to use the room must be
  able, in the opinion of the proprietor or
  employer, to smoke safely without assistance
  from an employee.

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Why Assess Safe Smoking Ability

• Elderly have an increased risk from smoking
  related fires
• Compared to the general popn, the risk for dying
  in a fire for people age 65 is 2.5 Xs greater
• The risk increases with age
• 65-74 years the risk is 1.8 Xs greater than the
  general population
• 85 the risk increases to 4.6 Xs greater

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Smoking, Quitting, Cutting Back and NRT
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Smoking Disease and Death

• Smoking is responsible for approximately 70 of
  deaths in the geriatric population
• Associated with all three major causes of death
  among the elderly heart disease, cancer and
  stroke
• 5 of residents in a LTC home smoke

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Smoking True or False

• Smoking helps residents cope with stress, engage
  in social interaction and escape boredom
  (Wolfsen, 2001)
• 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

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Quitting Health Benefits

• Health benefits can be seen in elderly smokers
  who quit
• Quitting smoking can have an extremely positive
  impact on the health of the elderly. It can delay
  the progression of illness or prevent illness
  altogether, and hence, affect length and quality
  of life (Bergman and Falit, 1997)

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Benefits of Quitting Over Time
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Quitting Additional Health Benefits

• Wound healing
• Nicotine and other toxins in smoke (carbon
  monoxide, hydrogen cyanide, aromatic
  hydrocarbons) promote endothelial and epithelial
  skin breaks, increase platelet aggregation,
  reduce fibroblast proliferation, and produce
  cutaneous vasoconstriction (Appel, Thomas,
  Aldrich, 2003).
• Repeated passive exposure to cigarette smoke
  appears to have similar effects
• Even without wound complications, smokers have
  longer postoperative stays in intensive care
• Medications more effective after quitting, so
  doses may need to be lowered

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Quitting True or False

• Smoking cessation programs for the elderly are
  not necessary since there are not that many left
  smoking, just a few die-hards who are already
  90 years old and will never quit (Bergman,
  Falit, 1997)
• A study conducted revealed that older smokers
  are interested in quitting and will respond
  positively to a program tailored to their needs.
  (Rimer and Orleans, 1994)
• Cant assume residents do not want to cut back or
  quit or cant do it

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Quit Methods

• Behavioural Interventions
• Individual Counseling
• Support group
• Self-help programs (books, videos, audiotapes,
  telephone help lines)
• Physician Advice or Counseling
• Other pharmacotherapy (Buproprion, Clonidine,
  etc)
• Nicotine Replacement Therapy

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Nicotine Replacement Therapy (NRT)

• 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

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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. This reduces the
  nicotine withdrawal symptoms

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Benefits of NRT as a Quit Method

• 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
• Low risk of addiction (Cepedo-Benito, Reynoso,
  and Erath, 2004)

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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)

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Choosing the Patch
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How to Use the Patch(1 of 2)

• 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 dont use
  soap
• Discard old patch out of reach of children,
  animals can still be harmful

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How to Use the Patch(2 of 2)

• 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

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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

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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

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How to use Nicotine Gum

• Use every hour or less as needed, up to 15
  pieces/day
• Chew and park in between teeth and cheek
• Absorbed via buccal mucosa
• Repeat chew every minute or so
• Each piece lasts approximately 30mins
• Do not chew within 30 mins of caffeine/acidic
  products

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Choosing the Most Suitable NRT

• Nicotine Inhaler
• Resembles a cigarette
• Nicotine cartridges are inserted into it and
  inhaled
• Each cartridge provides about three 20 min
  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

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How to Use the Inhaler

• Use up to 6 10mg cartridges/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
  inhalingOK unless it becomes bothersome
• Clean inhaler regularly with soap water

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Nicotine Withdrawal

• Cravings to smoke
• Frustration
• Anger
• Anxiety
• Difficulty concentrating
• Restlessness

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Sign of Nicotine Toxicity

• Nausea and/or vomiting
• Sweating
• Vertigo
• Tremors
• Confusion
• Weakness
• Racing heart
• Light-headedness

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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

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How to be a buddy

• Friend first
• Take your lead from the person who is quitting
• Each person has to find their own time to quit
• Understand it may be the most difficult thing for
  them to do
• Lectures dont work

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How to be a buddy

• Dont do anything to encourage start back into
  old smoking habits
• Dont make fun of how they are coping with the
  change
• Listen and be respectful, dont judge
• Change activities you do together to avoid
  temptation
• Be positive
• Be patient

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Resources

• For training consultations
• call
• 416 535-8501 x4042
• e-mail
• michelle_gaffey_at_camh.net