title: Treating tobacco dependence in older adults: a survey of primary care clinicians' knowledge, attitudes, and practice.
abstract: BACKGROUND
  The benefits of smoking cessation among older people are well documented. Despite this, evidence suggests that older smokers are rarely engaged in smoking cessation efforts, and that existing tobacco dependence treatments require further tailoring to the specific needs of older smokers. This study assesses the knowledge, attitudes, and clinical practice of primary care clinicians in relation to addressing tobacco dependence among older people.
  
  
  METHODS
  A cross-sectional survey of 427 NHS primary care clinicians in a large English city was conducted using modified version of a previously validated questionnaire.
  
  
  RESULTS
  One hundred and seventy one clinicians (40 % response rate) completed the survey. While the majority (90.0 %) of respondents reported enquiring regularly about older patients' smoking status, just over half (59.1 %) reported providing older patients with smoking cessation support. A lack of awareness in relation to the prevalence and impact of smoking in later life were apparent: e.g. only 47 % of respondents were aware of that approximately 10 life years are lost due to smoking related disease, and only 59 % knew that smoking can reduce the effectiveness of medication prescribed for conditions common in later life. Self-reported attendance at smoking-related training was significantly associated with proactive clinical practice.
  
  
  CONCLUSIONS
  There is a need to improve clinicians' knowledge, in relation to smoking and smoking cessation in older patients and to build clinician confidence in seizing teachable moments.
authors.affiliation: Division of Epidemiology & Public Health, The University Of Nottingham, Clinical Sciences Building, City Hospital Campus, Nottingham, NG5 1PB, UK. Lisa.Huddlestone@nottingham.ac.uk.
authors.forename: Lisa
authors.initials: L
authors.lastname: Huddlestone
authors.affiliation: Department of Medicine, CLAHRC EM, Institute of Mental Health, University of Nottingham, Nottingham, UK. Gemma.Walker@nottingham.ac.uk.
authors.forename: Gemma Michelle
authors.initials: GM
authors.lastname: Walker
authors.affiliation: NHS Nottingham Clinical Commissioning Group, Nottingham, UK. Robana.Hussain-Mills@GP-Y03363.nhs.uk.
authors.forename: Robana
authors.initials: R
authors.lastname: Hussain-Mills
authors.affiliation: Division of Epidemiology & Public Health, The University Of Nottingham, Clinical Sciences Building, City Hospital Campus, Nottingham, NG5 1PB, UK. Elena.Ratschen@nottingham.ac.uk.
authors.forename: Elena
authors.initials: E
authors.lastname: Ratschen
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D002983:Clinical Competence / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D004739:England; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care; D016540:Smoking Cessation; D013222:State Medicine; D014029:Tobacco Use Disorder / Q000175:diagnosis / Q000628:therapy*