Approche clinique et sociale du tabagisme chez les sujets âgés : genèse, contexte, développement et prise en charge

RésuméSi la fréquence du tabagisme diminue progressivement en France, du fait du vieillissement de la population, le nombre de fumeurs âgés augmente. Or le tabagisme des sujets âgés reste un sujet peu abordé, mal connu et sans doute sous-estimé. Cet article aborde l’impact du tabagisme sur la santé des sujets âgés dans tout son ampleur (facteurs de risque, complications, maladies, décès) et offre une description minutieuse du comportement tabagique (contexte social des premières cigarettes, initiation, installation, maintien et motivations positives ou négatives à continuer à fumer à un âge avancé) en s’appuyant sur des exemples cliniques d’une grande diversité. Il montre aussi comment peut s’accomplir le sevrage tabagique chez les sujets âgés (informations, procédures de dépistage, modes d’intervention et programmes de traitement adaptés).

The frequency of smoking decreases gradually in France. But because of the ageing of the population, the number of older smokers increases. Older smokers exist, even if they spend the most often overlooked among the group often forgotten by our older citizens. They are a group of older smokers survivors that is to say that survived decades of smoking or older smokers that started smoking late because of the occurrence of negative events and stressors (bereavement, social isolation, marital separation, retirement, for example). Smoking in the elderly stays a little known and doubtless underestimated subject. This article focuses on the prevalence and health impact of smoking in elderly subjects (risk factors, complications, diseases, deaths) provides a detailed description of the smoking behavior (social context of first cigarettes, initiation, installation, maintenance and positive or negative motivations to continue smoking at an advanced age) based on clinical examples of great diversity. Smoking in the elderly is not limited to a simple dependence on tobacco (psychological and physiological dependence on tobacco) with health consequences. Smoke fills a series of symbolic functions (male virility, female empowerment, social visibility – membership in a salient social group and clearly defined…) and helps to define a social and personal identity. Smoking is the result of an itinerary that includes phases or passages and stages. Each of older smokers followed a long way with progressions, stops, backtrackings. These phases are different depending on the product and the individual. The transition from one phase to another is independent of the product itself. The discourse of older smokers reveal the many episodes in their career (early experiences and quality of experience [sympathy, excitation] or experienced physical experiments [pleasure/displeasure] and their addictive behaviors since the initiation of behavior (search for assertiveness, identification peer group…) to installation (habit, craving, loss, addictions). Among the reasons most commonly advanced to smoke and continue smoking are mentioned: pleasure, relaxation and habit (positive motivations for smoking), reducing tension, lack of benefits of weaning at an advanced age, poor health impact of light cigarettes or low number of daily cigarettes (entrenched misconceptions and ignorance of the dangers of tobacco), stress, psychological disorders and emotional mood. It also shows how can be accomplished smoking cessation in the elderly (informations, screening procedures, intervention methods and treatment programs adapted).