Older Smokers Struggle to Quit Despite Health Benefits

You’ve probably seen it before—an older neighbor stepping outside after dinner, lighting a cigarette with the same rhythm they’ve followed for decades. Maybe it’s your parent. Perhaps it’s you. The smoke curls into the air like clockwork, a habit tied as much to memory as to nicotine. But what feels familiar may be silently accelerating illness, threatening independence, and complicating care down the road.

Despite national declines in smoking, one group remains stubbornly hooked: older Americans.

Adults 50 and older are still smoking at higher rates than their younger counterparts and struggling more to quit. According to a 2024 Gallup poll, 18% of Americans aged 50 to 64 still smoke cigarettes, along with 9% of those 65 and older. While those percentages may seem small, they represent millions of older adults, many at the highest risk for smoking-related diseases and disability.

Toll of Smoking Later in Life

Each year, smoking causes an estimated 480,000 deaths in the United States. According to the CDC, more than 70% of these deaths occur among people over age 60. The quit rate for older smokers has remained stagnant since at least 2005, even with increased access to cessation tools and public health campaigns.

Why is quitting so difficult for older adults?

"Many older smokers still don’t realize the full benefits of quitting—even in their 60s or 70s," said Dr. Nancy Rigotti, a professor of medicine at Harvard Medical School and director of the Tobacco Research and Treatment Center at Massachusetts General Hospital.

They also tend to have more entrenched habits, more health complications, and less exposure to modern quit tools like digital coaching or smartphone-based support.

Many older adults are also unaware of free services such as quit lines, mobile text programs, or Medicare-covered counseling. A 2022 research review in Nicotine & Tobacco Research found that older adults are significantly underrepresented in tobacco cessation studies, leaving providers with limited age-specific strategies.

Routines, Addiction, and Barriers to Quitting

For some, smoking is more than a physical addiction—it’s part of a daily routine, like lighting up after meals or while relaxing on the porch. Breaking that routine can be psychologically disruptive, particularly when a smoker has decades of established habits.

Age-related changes also affect nicotine metabolism. Older adults often take multiple medications, increasing the risk of drug-nicotine interactions. Additionally, cognitive decline, social isolation, and depression—common among aging populations—can make behavioral change more difficult.

FDA-Approved Medications Can Support Quitting

For older adults trying to quit smoking—especially those with a long history of tobacco use—prescription medications may offer another path toward success. These treatments are FDA-approved and have been shown to help reduce nicotine cravings and withdrawal symptoms when used alongside behavioral support.

The two most commonly prescribed medications for smoking cessation in the U.S. are:

• Varenicline (Chantix) – This medication works by partially stimulating nicotine receptors in the brain while also blocking nicotine’s rewarding effects. It helps reduce cravings and decreases the pleasure derived from smoking. Clinical trials have shown it can significantly improve quit rates, even in long-term smokers. However, varenicline has been linked to side effects such as nausea, vivid dreams, and, in rare cases, mood changes. It’s typically prescribed for 12 weeks, with the possibility of an extended course.
• Bupropion (Zyban or Wellbutrin) – Originally developed as an antidepressant, bupropion also helps reduce the urge to smoke. It’s particularly helpful for individuals with co-occurring depression or anxiety, which can sometimes worsen during smoking cessation. Like varenicline, it’s usually prescribed as part of a structured quit plan.

According to the CDC, these medications are most effective when paired with counseling or a support program, such as a quitline, group therapy, or a Medicare-covered tobacco cessation session.

Pharmacological treatments can double or even triple the chances of successfully quitting. — CDC’s 2020 Smoking Cessation: A Report of the Surgeon General.

Prescription medications must be ordered through a physician or qualified health provider. They are typically covered by Medicare Part D, many Medicare Advantage plans, and most private insurance policies, but coverage levels and copays may vary.

If you or a loved one is considering quitting, talk with your doctor about whether a prescription-based approach could help. These treatments are particularly valuable for older adults who have struggled with multiple quit attempts or who face strong physical and psychological dependence on nicotine.

Are Oral Nicotine Pouches a Safe Option?

While counseling and traditional nicotine replacement therapies (like patches or lozenges) work for many, some older smokers struggle with these methods and seek alternatives that feel easier to adopt. One such product gaining attention is the oral nicotine pouch—a small, smokeless, and tobacco-free pouch placed between the lip and gum, slowly releasing nicotine into the bloodstream.

Unlike cigarettes or even vaping devices, ONPs contain no tobacco leaf, produce no smoke or vapor, and don’t require ignition. Their discreet use has made them more visible in settings like senior housing communities and assisted living, where traditional smoking is banned.

A 2023 study published in Nicotine & Tobacco Research found that ONPs deliver nicotine at levels similar to cigarettes, but with significantly fewer toxic byproducts. The study noted:

ONPs appear to be less toxic than cigarettes and deliver comparable nicotine, presenting an alternative for combustible product users.

Still, public health experts urge caution. These products remain nicotine-based and addictive, and their long-term safety—especially among older adults with chronic conditions—is not fully understood. ONPs are not FDA-approved for smoking cessation and are not prescribed by doctors. According to the CDC, products like Zyn, Lyft, and Lucy are regulated as tobacco products, not medical treatments.

There are also legal restrictions to consider. While ONPs are legal at the federal level, individual states have imposed limits. California, Massachusetts, and New York, for example, ban flavored nicotine pouches, which make up most of the current market. States like Vermont and Utah restrict or ban online sales entirely. Retailers must comply with state and local regulations, including age verification and shipping limitations—which can make access inconsistent depending on where you live.

If you're considering ONPs as a harm-reduction tool for yourself or a loved one, talk to your healthcare provider first. It's also wise to check your state’s laws before purchasing, especially online. What seems like a simple switch may not be the right—or legal—option where you live.

How Smoking Interacts with Chronic Health Conditions

Many older adults live with chronic conditions such as high blood pressure, type 2 diabetes, heart disease, COPD, or osteoporosis. Smoking doesn’t just increase the risk of developing these illnesses—it can worsen their progression and interfere with treatment.

According to the National Institute on Aging and the American Heart Association:

• Smoking increases blood pressure and damages arterial walls, worsening cardiovascular disease and raising stroke risk.
• In people with diabetes, smoking impairs blood flow and can lead to nerve damage, poor wound healing, and vision problems.
• Smokers with COPD or asthma experience more frequent and severe flare-ups, hospitalizations, and lung function decline.
• Tobacco use also depletes bone density, accelerating the risk of fractures and osteoporosis, especially in postmenopausal women.
• Smoking may interfere with medications used for blood pressure, cholesterol, and depression—commonly prescribed in older adults.

The combination of age, chronic illness, and smoking creates a dangerous health spiral that can lead to early disability, loss of independence, and increased reliance on caregivers or long-term care facilities.

Long-Term Care Insurance and Smoking

Being a non-smoker can also mean lower premiums and eligibility for Long-Term Care Insurance. Smoking is considered a health risk by insurers, and tobacco users often face higher premiums—or in some cases, outright denial of coverage depending on pre-existing health issues. Many insurers require applicants to be tobacco-free for at least 12 to 24 months to qualify for preferred rates.

If you're planning ahead for long-term care, quitting smoking could make the difference between paying more over the life of a policy or gaining access to affordable, comprehensive coverage that protects your income, assets, and family from the high cost of extended care.

Beyond Quitting: Improving Health and Long-Term Care Outcomes

Smoking affects more than your lungs. Long-term tobacco use is strongly linked to:

• Cardiovascular disease
• Respiratory illness
• Stroke and dementia
• Tooth loss and poor oral health
• Increased frailty and disability

Even after decades of smoking, quitting can lead to meaningful improvements. Even older adults can benefit from quitting, according to a University of Michigan School of Public Health study.

Quitting smoking even at the advanced age of 75 can meaningfully extend a person’s life expectancy.

A growing body of research confirms that adopting healthy lifestyle habits—even later in life—can significantly improve longevity and reduce disability. One study from Harvard’s T.H. Chan School of Public Health found that adults who maintained a healthy weight, avoided tobacco, exercised regularly, ate a nutritious diet, and drank alcohol in moderation lived significantly longer and spent more of those years free from chronic diseases like cancer, diabetes, and heart disease.

Similarly, a review published in the American Journal of Lifestyle Medicine emphasized that smoking cessation, combined with routine physical activity and weight control, can dramatically reduce the burden of chronic illness and enhance quality of life well into old age.

For older adults, especially those who need help with daily activities or are living in long-term care communities, quitting smoking can reduce hospitalization rates and delay the need for higher levels of care. It can also reduce the burden on caregivers and families.

Quitting is Possible

If you’ve been smoking for decades, quitting might feel impossible—but it’s not. Whether it’s been 30, 40, or even 50 years, it’s never too late to take back control of your health. Quitting smoking isn’t just about adding years to your life—it’s about protecting your independence, staying active longer, and avoiding the kind of health decline that leads to long-term care.

When someone ages 65 or older quits smoking, even as late as 75, it can meaningfully extend life expectancy—sometimes by more than a year. — Dr. Allison Magnuson of the University of Rochester’s Wilmot Cancer Institute.

That extra time could be precious years with family.

Research also shows that family and spouse involvement plays a pivotal role.

People may stop smoking unplanned… when motivation is not obvious.

With the right support system, some encouragement, and easier-to-use tools, you or your loved one can finally break the habit. You still have a lot to gain—and help is out there to get you there.

Related Resources

• Smokefree.gov – A National Cancer Institute (NCI)–led site offering tailored quitting tools for adults over 60, including quit plans, text programs (SmokefreeTXT), apps (quitSTART), and support tips for caregivers.
• CDC: How to Quit Smoking & Tobacco – The Centers for Disease Control & Prevention provides quitline access (1‑800‑QUIT‑NOW), self-help tools, counseling options, and information on medications.
• American Lung Association: Freedom From Smoking® – A proven program featuring online courses, live coaching, and group options. Widely used by older adults, with high success rates.
• Truth Initiative / BecomeAnEX & EX Program – Offers a free, interactive quit platform built with Mayo Clinic experts, containing personalized quit plans, online community support, and daily messaging.
• Agency for Healthcare Research and Quality (AHRQ): Older Smokers – Information on specific health benefits of quitting for people age 65+ and tailored clinical guidance on cessation strategies.