Older adults and smoking: Characteristics, nicotine dependence and prevalence of DSM-IV 12-month disorders

Abstract

Objectives: There are few studies investigating the characteristics of older smokers. Research on younger adults has determined that (1) the diagnostic and statistical manual (DSM) diagnosis of nicotine dependence (ND) excludes a sizable portion of the smoking population, and (2) younger smokers have high rates of comorbid DSM disorders. In this study, we sought to replicate these results in an older population.

Method: Based on a large representative sample, we examined the smoking patterns in adults aged 50 and over (N = 2139). We describe the characteristics of the current smokers (n = 410). We identified differences in smoking characteristics and prevalence rates of DSM-IV 12-month diagnoses by smoking severity.

Results: Most smokers did not meet the criteria for DSM 12-month ND. Older smokers identified as having ND were first diagnosed at a relatively older age. Smokers with ND differed from smokers without a diagnosis in several ways: they smoked more; they had more symptoms of ND and had substantially higher rates of comorbid DSM 12-month disorders. Nonetheless, there were a number of older smokers with dependency symptoms who continue to smoke throughout their lifetimes, but never meet the criteria for ND.

Conclusion: Smokers without ND are most likely to have a mood disorder whereas those smokers with ND are most likely to have an anxiety or substance use disorder. Smokers without ND still have relatively high rates of dependency symptoms. Given the late onset of ND, smoking dependence may be a progressive disorder. High rates of psychiatric disorders may interfere with smoking cessation.

Keywords:

• older smokers
• nicotine dependence and comorbid DSM-IV diagnoses