Should I take cigarettes away from my mother, who has Alzheimer's, for fear she'll start a fire?

16 answers | Last updated: Apr 12, 2014
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A fellow caregiver asked...
My 79-year-old mom has Alzheimer's and refuses to give up smoking. She's smoked a half-pack daily all her adult life. I'm worried she'll forget to use an ashtray and start a fire. What can I do?
 

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Jina "Bitsy" Lewallen is a clinical geriatric social worker with the University of Arkansas for the Medical Sciences Pat & Willard Walker Family Memory...
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How do I make sure my father with Alzheimer's remembers to take his medicines?

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Smokers with Alzheimer's are a real challenge because, with advancing age, they're already at a point when there are a lot of things they can no longer do. A caregiver always needs to be aware of that. The goal is to help your mother maintain as much of her independence as possible. Still, that has its limits.

When someone has Alzheimer's or another type of dementia, the top priorities become safety and health. You don't want your mom to set the house on fire. (Likewise, you don't want her to develop cancer, although a lifelong smoking habit has, of course, already contributed to that possibility.)

What you can do is take the cigarettes away when you're not with your mother. I'd let her smoke at other times, but only when someone else is with her. Don't make cigarettes available otherwise. And if she can't drive, she can't buy another pack easily -- or maybe at all.

I'd also look into information about smoking cessation, even at her age. A nicotine patch is often successful. If your mom has early dementia, she might benefit from a cessation program through a local hospital. With advanced dementia, it's hard for her to understand why smoking is a health issue or why she should stop. For elderly longtime smokers, the risk of cancer will already be there regardless of whether they quit; you have to consider whether smoking is a quality-of-life habit for them. Some dementia patients even forget that they ever smoked.

 

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An anonymous caregiver answered...

This is a good answer. Her safety is a concern. As someone who works in smoking cessation, talk with her health care providers. Nicotine replacement is one option, but Rx's such as Chantix, are also available. If she has mild dementia, a call to 1-800-QuitNow is helpful for over the phone counseling. Several sessions can be provided. If dementia is profound, this wont help. A combination of these approaches is the most successful, according to research. Regarding NRT, a combination patch and gum or lozenge is most successful.

 

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An anonymous caregiver answered...

It is a dreadful problem. My elderly mother, age 92.5, smokes a pack a day. She has dementia which is progressing. Smoking is her only pleasure in life and I fear that removing her cigarettes will hasten her decline and her death. Her doctors have all said at this point it's not realistic to expect her to quit. I also expect that she would pester her caregiver constantly for cigarettes. Now she hoards them, and carries a pack around, one in each pocket of her pants. It's the most difficult situation I have ever faced with her and there is no easy solution. I worry about her smoking constantly. While in the hospital last year she was given nicotine patches and yet she asked for cigarettes the entire stay in the hospital and refused to accept that they were not allowed. She is beyond giving up smoking and I cannot get through to her or reason with her in any way. I am about to move her from an assisted living facility which has a smoking patio to a smaller situation, a board and care, where she will be visible at all times while she smokes outside in the back yard. I will suggest that they take her cigarettes away from her at bedtime and othewise keep an eye on her throughout each day.

 

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An anonymous caregiver answered...

Having moved my mom from assisted living to a board and care, she has become agitated, angry because she doesn't have physical possession of a carton of cigarettes, and has spent the bulk of each day outside smoking, almost non stop. Her cigarettes are taken from her at bedtime; still, she smokes at least 25 cigarettes a day. She asks for a pack for each pocket, but the caregiver has refused that; she is given only one pack at a time. Her dementia is beyond mild; it is advanced but not extreme. She is able to dress and feed herself. I believe her to have vascular dementia. Would you suggest what type of specialist would specifically deal with management of smoking, with nicotine replacement therapy. Would her neurologist be the most appropriate? She already takes 20 mg. of Lexapro and 10 mg. of Aricept. She sleeps pretty well through the night but her waking hours are all about smoking. It's become a huge concern. Thanks.

 

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Caregiver-Daughter answered...

I've posted here earlier when my 92 year old mom was smoking up to 2 packs a day. She was prescribed Seroquel to deal with her combative behavior and it worked. She continues on that medication, along with Lexapro and Aricept, and she is a wide awake but mellow and complaint resident now. The problem has miraculously resolved itself with the help of some very skilled caregivers. I had to move my mother to a Memory Unit in an Assisted Living Facility. They agreed that she could have 4 cigarettes per day under their supervision. They made an exception for her. For the first several months she asked repeatedly all day long for a cigarette. They patiently distracted her by redirecting her attention or promising a cigarette after dinner, whatever. It didn't stop her begging for a smoke over and over but now, at age 94 and with advancing dementia, she has almost forgotten that she's a smoker. She never asks me about cigarettes or if she mentions them I too have learned to distract her. She continues to ask for a smoke after dinner, before bedtime, and I believe that evening caregivers will usually allow her one cigarette which satisfies her. I'm looking for the day soon when she will be smoking no cigarettes ever. The progressing dementia seems to have taken care of the smoking problem and she's a childlike but happy 94 year old at this point in time. I might add that the idea of a smoking cessation program seems like a futile approach when dealing with an elderly smoker who suffers from dementia. Why put yourself through the expense and frustration?

 

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stiggy66 answered...

I also worry about the smoking issue with my Mom, 72 and mid plus alz. She lives with me and I work. Taking the smokes away, she will try walk to a store. I now put out a pack at a time to limit her sometimes chain smoking. when she thinks she is low on cigs she smokes less. The less she smokes, i am hoping the less she wants to, or forgets she does. I have an alarm system set up in the house, that also has a fire alarm notification in place.

 

Mrs Beasley answered...

Mom is 97 with severe deminchia and most of the time if the smokes aren't around she forgets about them, thank God. i had to take them from her cause her sight is so bad, she was missing the ahhtray and burning the furnature. i worried about withdrawl but she goes for days and does not seem to bother her,

 

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An anonymous caregiver answered...

I'm having the same problem. My father is 72. His doctors lists him as having severe dementia. He had quit smoking for many years but 5 years ago he was offered him a cigarette. It's been a nightmare since. He was an alcoholic and will drink beer till he can't function if possible, but right now he isn't asking for beer. He is asking for cigarettes. He is banned from the stores near his home because he is constantly going there. I don't know how he acts there. We got him out of jail and paid a lawyer 7500 to deal with all that 2 years ago. He was good for awhile, but he got picked up for going to the store. One judge let him go after speaking to my mother and sent him home in a patrol car. He didn't ring the bell. He walked right back to that store to buy whatever he had collected money to buy. He usually looks for cigarettes that are half smoked and will smoke them. I know disgusting but that's how bad it is. We've tried Chantix in the past but it didn't help. We've tried patches in the past it didn't help but I'm ready to try again. I can't have him smoking in my house. He shouldn't be smoking around my mom. He burns carpets, beds, blankets, shoes, clothing, so it has come to a point where it has to stop no matter how mad he gets at me. As for that store, it must have been a different clerk because they didn't call the police. Fast forward two weeks later, he's back at the store. This time they took him to jail for criminal trespassing. I left him there Thurs, Fri, Sat, Sun, and Mon. Monday only because I was working with bail bondman who would let me remove him from the county and not be at his home address because he will just go back to that store. Along with working to get his medical records to prove he has dementia and try to get the charges dismissed. I had never read the doctor's letter till recently that said he had severe dementia and has no concept of his legal situation. He can't go back home because we will end up in the same place. It's a misdemeanor so I thought they would have set a fine by Monday that we could pay and he'd leave but the DA said they were booked and he could be transferred 400 miles away to another county if I left him because of overcrowding. I didn't ask my husband who is now upset with me for bringing my father home with me. I had to make a decision right then and there so I said okay I'll bail him out if someone will let me take him to a different county. I have to get him to stop wanting the cigarettes so he will stop leaving and getting lost or get banned from another store. My mom is 72 so she's trying to figure out what to do. I say it's time for him to be in a facility but she won't agree to it. I don't think she understands how his behavior of smoking is making her sicker, how she can't keep paying lawyers for a misdemeanor charge, or live with him burning down the house. She's 72. Her mind is pretty good but her health isn't. She didn't want me to bring him to my house but I said we can't chance him going back to that store. I've scheduled an appointment with the a psychiatrist because I can see her sooner but it's still 2 weeks away and will be scheduling one with a neurologist for medications. I think it is time for seroquel for sure because he is combative. When we asked about aircept two years ago, the doctor said that it wouldn't help. I'm trying to remember that when we did try it at first, it agitated him, but I was not with him enough to write down what was happening. He was put on Celexa but that does nothing. I think it might have even agitated him more too. His anxieties are extreme. He paces back and forth. He takes things apart constantly. He does a lot of damage to the house. Right now, he's only wearing socks cause his intent is to go to the store. I live 2 miles from a store but I know he can walk that far but I'm not sure he will do it in socks but you never know.

 

wandaw answered...

I am an Occupatioal Therapist in a Skilled Nursing Facility with a Short Term Unit and the smoking issue takes up alot of staff time and places our residents in danger. I had to have unexpected Open Heart surgery last year and of course was told not to smoke. I found out about E-cigarettes and my MDs okay'd me using them. I now provide education on the use of E-cigarettes and work part time as a distributor for a very good company, Patients are safe, staff does not have to go outside and supervise smoking and and settle smoking related disagrements. Cigarette smoking is a disgusting, filthy habit. However when you are under alot of stress, that is the last thing we are able to give up,

 

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An anonymous caregiver answered...

my mom is 75 and in stage 4 alzheimers. she has smoked a pack a day since she was 14, sometimes a few less. she is now approaching 30-40 cigarettes a day. As her live-in caretaker, I am sick to my stomach and use an asthma inhaler living with that stench. Attempts to get her to smoke outside fail. She smokes in one room with the door shut sometimes, but that only makes the opening of that door horrendous each time she emerges, and the chain smoking makes her and her mouth smell so bad it is unrelentingly putrid to be around. i bought her an e-cigarette and she seemed to like it at first and tried to cut down using it, but then she started seeing it as a real cigarette and kept trying to light it with a lighter. we live together very well otherwise, but this cigarette thing is disgusting and she will never ever ever ever quit [meaning if i take them from her she will freak out and life will be unbearable. she refuses patches or gums etc.] as of tonight i think she may also be suddenly sundowning... so she sits on her bed and smokes and smokes. i am in smokers hell. thank you for listening.

 

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Chrichy answered...

My mom is 78 years old and has Dementia. Today her cigs disappeared. I am her primary caregiver and I make the decisions that she is unable to make especially when it comes to her health! COME ON PEOPLE ITS A NO BRAINER! I love my Mom with all my heart.

 

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An anonymous caregiver answered...

I was told by my father's family doctor to never give them Chantix if they have alzheimer's or dementia it will cause them more damage such as more outburst etc...

 

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An anonymous caregiver answered...

Well your 78 year old mother and my now deceased 95 year old chain smoking mother are two different people with two different daughters. Just disappearing my mother's cigarettes was not an option. She was non stop feisty, obsessed, belligerent and combative. She broke into locked cabinets at a board and care, she smoked in her room in assisted living despite the rules and we had many many battles over cigarettes the last 5 years of her life Only after she suffered a series of TIA's and was placed in a skilled nursing facility, progressing slowly to her death, was she slipping into a fog and out of the reach of cigarettes and cigarette smoke until she finally forget about smoking the last 9 months of her life. The four years priors she needed hands-on supervision while smoking. It was a progressive process and certainly not so simplistic and easy as your naive "no-brainer" comment implies. You have no idea.

 

LizV answered...

Anon you are totally right. I would guess that the cigarette disappearance was met with pleading, begging, 1000s of repeated reasoning sessions, etc.etc. I am the one who wrote about the stench and living in cigarette hell. It is a year later and she has just turned the corner into stage 5 and a half or so. She was able to properly dispose of her cigarettes for a while, now if i leave the room she smokes where i forbid it, then hides the newly squashed butts in wonderful places like tissue boxes and paper towels and today even her own pants pocket. So today I finally took all the cigs and all the lighters and all the hidden cigs and matches she has been hoarding without my noticing. I told her she can have one at a time and that i will give her a new one every hour or 90 mins [she smokes a pack a day and always has, so trying to cut her by half if i can and hope she gradually "forgets" she smokes] and that there must be a butt in the ashtray each time i give her a new one [to keep her from hoarding half smoked ones under the couch, as i found last week.] I have explained it, reasoned with her about it, been loving, been ugly at least 50 times today because she forgets the conversation within 5 minutes and asks me again why she cant have her cigarettes. I am convinced her Alzheimers would be 95 percent more bearable if she were a non-smoker, but the repercussions of removal of cigs is perhaps a worse experience. Dunno, I [daughter and lone live-in caretaker] take it as it comes.

I love my mother with all my heart too but this mother doesn't resemble my real mother in any way shape or form. Her mother burned to death in bed when my mom was eight from... you guessed it - smoking and falling asleep. She was the most fire conscious person I knew. It's a terrible disease and hard on everyone concerned.

 

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An anonymous caregiver answered...

I totally understand the responders concerns. My 87 year old mother lives with me. She smokes, always under my close supervision. I have found that if I keep the lighter, she is sometimes ok with just puffing on a un-lit cig. Not always, but enough where it has cut back on her smoking.

 

 
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