Tobacco Documents Online

American Medical Association Phvsicians dedicated to the health of America a1:i North State Street Chicago, Illinois 60610 Statement to the Special Committee on Aging United States Senate RE: HEALTH EFFECTS OF TOBACCO AND ALCOHOL UPON SENIOR CITIZENS May 6, 1993 [livision 4 Federal b•t;islatirm :,12 464-477.~

STATEMENT of the AMERICAN MEDICAL ASSOCIATION to the SPECIAL CONIIvITITEE ON AGING UNITED STATES SENATE RE: HEALTH EFFECTS OF TOBACCO AND ALCOHOL UPON SENIOR CITIZENS May 6, 1993 The American Medical Association (AMA) is pleased to submit this statement for the May 6. 1993 hearing record regarding the adverse health effects of tobacco and alcohol upon senior citizens. In providing medical care, physicians have benefitted from the wisdom to be gained from listening to and learning from the experiences of the elderly. This is something to be treasured, and we are acutely saddened by the serious health effects of tobacco and alcoholic beverages upon their lives. Cigarette smoking ranks as the most devastating preventable cause of disease in this country. Each year, it causes the death of nearly 500,000 Americans---195,000 from coronary heart disease, stroke, and other vascular diseases, 157,000 from cancer, 82,800 from chronic obstructive pulmonary disease, and an estimated 50,000 deaths from other diseases and other causes. Of the nearly 500,000 total deaths, a significant number of them are senior citizens. Our senior citizens deserve better! Not only are these mortality statistics horrifying, but the morbidity associated with tobacco-related death is tragic. Former U.S. Surgeon General C. Everett Koop, MD, has referred to the "long path from health to death" in the progression of tobacco-related disease, culminating in the tremendous suffering experienced by those in the end stage of chronic lung disease, nonfatal strokes and debilitating heart disease. Most physicians have witnessed first-hand the tragic sight in VA hospitals of our once-proud fighting men tethered to oxygen bottles as a result of tobacco-related disease! In addition to the direct adverse health effects of tobacco use upon senior citizens, cigarette smoking by elderly persons has other negative repercussions. For example, the greater the amount of cigarette smoking that occurs in nursing homes, senior citizen homes and other living facilities for the elderly, the greater the likelihood of a tragic, death-producing fire. Furthermore, we should not ignore the recognized dangers of exposure to "secondhand smoke" imposed upon others by senior citizens who

2 smoke. Such smoking by senior citizens in nursing homes and other living arrangements compromises the environment of everyone else who lives in the facilities. In this regard, the AMA has developed model state legislation to prohibit smoking in nursing homes. We urge this Committee to consider action that would implement such a standard as a condition of participation for Medicare and Medicaid. Many senior citizens also live and are cared for in the homes of relatives (e.g., adult sons, daughters, etc.). Smoking in such settings could often expose their innocent grandchildren to harmful environmental tobacco smoke. These senior citizens, with their wealth of knowledge and life experience, should strive to serve as positive role models for the nation's youth; tobacco use by senior citizens is incongruous with the concept of a healthy role model. The drinking of alcoholic beverages also has serious health consequences for senior citizens. Even moderate quantities of alcohol can cause adverse reactions in people taking sedatives, tranquilizers, painkillers, and even over-the-counter drugs. Senior citizens are likely to be taking such drugs. Heavy drinking is linked to cirrhosis of the liver, pancreatitis, hypertension, cardiomyopathy, cardiac arrhythmia, and hemorrhagic stroke. By the point in life when they have reached the stage of being senior citizens, individuals often have an increased amount of "free time" on their hands; unfortunately, in many instances, this may result in increases in unhealthy behavior, such as increased tobacco and alcohol use. Depression, a serious medical condition often experienced by elderly persons, particularly those with significant amounts of unstructured time at their disposal, is worsened by the use of alcohol. Also, the use of alcohol has a profound effect in terms of the incidence of falling down, fractured hips and breaking bones on the part of elderly persons. Cigarette smoking and drinking alcoholic beverages result in economic loss as well as human suffering and death. They account for $34 billion in medical costs each year, much of which stems from care of the elderly. In fact, Medicare and Medicaid alone pay out at least $4.2 billion annually to care for those who are ill from tobacco-related diseases. If our efforts to achieve meaningful health system reform are to succeed, a major step must lie in significantly reducing the adverse health effects of tobacco and alcohol upon our citizens, including the elderly.