Smoking tied to frailty in older adults

Older adults who smoke are more likely to become physically frail than their counterparts who are former smokers or never used tobacco products, a recent study suggests.

Researchers studied people age 60 or older in the UK who had not yet developed so-called frailty, a term that describes a lack of robustness and physical reserves that leaves a person more vulnerable to disability when they become ill or experience an injury like a fall.

After four years of follow-up, smokers were 60 per cent more likely to become frail than participants who didn’t smoke.

“Those who quit smoking in the past did not have the same increased risk of frailty, which suggests that stopping smoking is likely to have benefits even if late in life,” said study leader Dr Gotaro Kojima of University College London.

“It could potentially decrease the risk of becoming frail,” Kojima said by e-mail.

While frailty is associated with aging, it’s not inevitable. Symptoms can include weight loss, fatigue, slow walking speed, low levels of physical activity, and reduced muscle mass. Frail elders are at higher risk for falls, fractures, hospitalisations and cognitive decline.

To see if smoking might influence the risk of frailty, researchers analysed data from a nationally representative UK survey of 2,542 older adults.

At the start of the study, 56 per cent of participants were considered “robust” because they reported no signs of frailty. The rest had one or two symptoms of frailty but not enough to be classified as frail.

Overall, 1,113 participants were former smokers and another 261 people currently smoked.

Current smokers had an increased risk of frailty even after researchers accounted for other factors that can play a role such as age, gender, alcohol use, education, income and cognitive function.

Past smokers, however, didn’t appear to have an increased risk of frailty. There also wasn’t a difference in frailty risk based on whether ex-smokers had quit at least a decade earlier or more recently, researchers report in Age and Ageing.

The picture looked different, however, when researchers examined chronic obstructive pulmonary disease (COPD), a common complication of smoking that makes it difficult to breathe. COPD is linked with an increased risk of balance difficulties, muscle weakness, thinning bones, blackouts and falls.

When researchers accounted for COPD, current smoking no longer appeared to influence the risk of frailty. This suggests that smokers are more apt to become frail because of COPD rather than from smoking itself, the authors conclude.

The study wasn’t a controlled experiment designed to prove whether or how smoking causes frailty.

Another limitation is that researchers lacked data on how much people smoked. In addition, participants who dropped out of the study over time tended to be frailer and sicker than those who remained and were included in the final analysis.

Even so, the findings should offer smokers yet another reason to quit, said Dr Teemu Niiranen, a researcher with Boston University’s Framingham Heart Study.

“In addition to causing cancer, smoking can damage the heart, lungs, blood vessels, mouth, reproductive organs, bones, skin and eyes,” Niiranen, who wasn’t involved in the study, said by e-mail. “Dysfunction in all of these organ systems predisposes to frailty at old age.”

Quitting can’t reverse or prevent all of the health problems associated with a lifetime of smoking, noted Dr Christian Delles of the Institute of Cardiovascular and Medical Sciences at the University of Glasgow in the UK. 

But the study does suggest smoking cessation may make a difference when it comes to frailty, Delles, who wasn’t involved in the study, said by e-mail. 

“[Ex-smokers’] risk of frailty was as low as that of people who had never smoked,” Delles said. “It is never too late to quit.”