Q: My 89 year old elderly mother has Alzheimer’s disease and lives with me, my husband, and my two children. She has no short term memory at all, but she doesn’t need a lot of hands on care. We spent thousands of dollars converting our garage into a living space so that she could stay with us, but now we’re worried that she’s going to burn the house down. She won’t stop smoking inside and her memory is so bad that sometimes she has two or even three cigarettes lit at the same time. Her furniture and the carpets are riddled with cigarette burns and I’m afraid for my family. She has been smoking two packs a day her whole adult life and she loves her Lucky Strikes so it’s been impossible to get her to quit. When we stop buying her cigarettes she constantly asks for smokes and will even try to leave the house and walk down a busy highway (without a sidewalk) to the nearest convenience store to buy a few packs.
Another concern I have is that if I ever need to move her to an assisted living facility, it would be really hard because they usually don’t let people smoke inside.
A: Your mother is fortunate to have had such a long life considering her prolific smoking habit and it’s correct that it could be very difficult to stop on her own. Nicotine is one of the most addictive substances know to man.
This is a topic that you should approach with your mother’s physician. It’s quite likely a doctor would suggest that you provide nicotine replacement to your mother. A nicotine patch would not only prevent excessive cravings (which could cause her to leave the house to seek cigarettes), it will also prevent nicotine withdrawal. In people without dementia, nicotine withdrawal, which lasts a few days or so, manifests itself in anxiety, irritability and depression. In people with dementia, nicotine withdrawal can potentially worsen symptoms or cause delerium. Nicotine patches don’t need to be applied more than once per day. In addition to nicotine replacement, your mother’s physician may prescribe a medication to help your mother quit smoking.
Even with nicotine replacement, it’s possible,your mother will have cravings for cigarettes. Besides the element of dependence to the chemical nicotine, smoking is also a psychological addiction – a habit. White lies can be tremendously helpful when caring for a loved one with dementia. When your mother asks you for a cigarette you could tell her, “Remember, Mom? You quit smoking a long time ago.”
Something that might be worth trying if nicotine patches and other efforts fail is the recently popularized electronic cigarettes, which deliver the nicotine in the form of an inert and harmless vapor. The drawback is that those devices can be pricey and they’re not backed by the medical community.
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