title: Effect of smoking on the accumulation of deficits, frailty and survival in older adults: a secondary analysis from the Canadian Study of Health and Aging.
abstract: OBJECTIVE
  Smoking has adverse effects on a variety of organ systems but little is known about the relationship between smoking and frailty. We aimed to investigate differences in health status between smoking and non smoking older adults.
  
  
  METHODS
  The Canadian Study of Health and Aging, a nationally representative cohort study.
  
  
  METHODS
  Nine thousand and eight community-dwelling men and women age 65 years and over at baseline.
  
  
  METHODS
  Smoking status was determined using a Self-Assessed Risk Factor Questionnaire. Comparisons were made between never smokers, light smokers and heavy smokers with heavy smokers defined as those who smoked >or= 1 pack per day for 20 years or more. A frailty index (FI) generated from 40 self-reported health deficits was also modified to exclude 5 variables that could be directly attributed to smoking (e.g. cough). Decedent information was collected over 10 years.
  
  
  RESULTS
  Average FI values increased exponentially with age. For both men and women, heavy smokers were the most frail, light smokers had intermediate frailty status and never smokers were fittest. Modification of the FI did not impact these differences. Heavy smokers had significantly worse mortality than non smokers and higher rates of death in smokers persisted in the oldest old. 120 month survival curves, grouped for age, sex and smoking status showed that male smokers > 75 years had the highest mortality rates.
  
  
  CONCLUSIONS
  Smoking causes poorer health status at older ages which can be captured by the frailty index. Higher rates of death in smokers persist in the oldest old, with no emergence of "survivors" with fitness or longevity advantages.
authors.affiliation: Dalhousie University, Queen Elizabeth II Health Sciences Centre, Halifax, Canada.
authors.forename: R E
authors.initials: RE
authors.lastname: Hubbard
authors.forename: S D
authors.initials: SD
authors.lastname: Searle
authors.forename: A
authors.initials: A
authors.lastname: Mitnitski
authors.forename: K
authors.initials: K
authors.lastname: Rockwood
mesh_terms: D000203:Activities of Daily Living; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D002170:Canada / Q000453:epidemiology; D015331:Cohort Studies; D004198:Disease Susceptibility / Q000209:etiology; D005260:Female; D016330:Frail Elderly / Q000706:statistics & numerical data*; D015577:Geriatric Assessment / Q000379:methods / Q000706:statistics & numerical data*; D006304:Health Status; D006801:Humans; D008297:Male; D012307:Risk Factors; D012650:Self Disclosure; D017678:Sex Distribution; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D016019:Survival Analysis