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At age 82my husband was diagnosed with a form of dementia, and was given permission to smoke 1-2 cigarettes a day. He rarely adheres to this and accuses son and I of stealing them. Though he only smokes outside or in the garage, I am finding burn holes from falling ashes on patio furniture and now one inside on the sofa cover. This really scares me, as I occasionally lie down to rest and doze off. I have been startled by the smell of smoke coming from the living room. He insists he only lights up inside and then walks outside. Everything has been such a struggle as he descends into this new world of confusion. Should I mention this to his doctor?

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That is what we deal with mom.. she swears she dosent fall asleep.. we know she is indeed doing that! So we try to keep a close watch. and she only can smoke in one area.
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I don't think that lighting the cigarette is the only dangerous part. Falling asleep and dropping the lighted smoke onto a pillow or newspaper, etc. is not a risk-free proposition. None of the little burnholes throughout my mom's apartment was from a match. They were from ashes or the smokes themselves. It is a good thing that many materials are now fire-resistant, or there'd be a worse problem than holes in a bathrobe.
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I agree the e cigs might work better than vaping with dementia.. they LOOK like real cigs, and feel real although heavier. The Vapes are quite odd looking and off putting for many. And way more complicated.. you have to add the oil, they have parts.. etc. But really at his age and with dementia I'd go with keeping him safe. My own mom smokes a pack a day,, has burned several bathrobes and the new couch.. SO I really feel for you! May we both have good luck with this! (BTW my mom is a retired rN, and I am a RT.. no judgement zone here) everyone knows "better",, its a never ending battle.
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Lol, I wish we could share pictures, so I could show what I did with the mom's Bic lighter! But basically I took a length of picture wire, wrapped one end a bunch of times around the lighter (just an ordinary sized lighter), then stuck several pieces of duct tape around the circumference of the wire-wrapped lighter. I secured the other end of the picture wire to an eyehook (which is screwed into a table) and twisted it a dozen times in both directions. I thought about a table lighter, but mom puts things she can't carry on the seat of her walker and moves them that way! This is something mom can't get loose and can't take anywhere.

I also remove all the matches and other lighters in the apartment from mom's access.

You can also get lighters that have little heating coils (like a tiny toaster) instead of flames. This might be safer for some folks than a regular butane lighter.
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Everyone seems clear about the actual problem, here - namely the fire risk, rather than the health risk.

So it's not so much the cigarettes you need to worry about as the lighting them.

It is reasonable and sensible to remove matches and lighters from your husband's reach. The trouble is that then every time he wants a light he's going to be bothering you for it, and it will become annoying for both of you.

If he has a place to sit outside, you could consider getting a handsome, weather-proof table top lighter that stays out there - just pick one that's far too big for him to put in his pocket absent-mindedly. You could even superglue it to the patio table to be extra sure. There are some under 'Collectables' on eBay that aren't expensive.
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I really don't get the limited number of cigarettes a day. What is that supposed to accomplish?

My mother smoked from age 14 to age 94. We were not at all worried about the health risk. Whatever damage was going to happen was already done. But we were worried about all the cigarette burns we discovered when we emptied her apartment. She lived with my sister and her husband for 14 months. They got her on e-cigarettes. These look like cigarettes, to the point where Mom sometimes tried to light them, but they didn't burn holes in anything! They were a bit of a nuisance and expensive, but by the time Mom needed a nursing home she was no longer smoking. That was wonderful! Residents were allowed to smoke, but it had to be in designated place outside.Those who were a bit confused had to be accompanied, and wore large fire-proof aprons that looked like the dentist was about to take x-rays. Smokes were kept at the nurses station. It was so much easier that Mom did not have that complication in her life.

If this were my husband, I'd let him have as many cigarettes as he wanted per day, but only in designated places and only with me or his son. We could sit in the garage (in our winter coats) and have a chat while he smoked. One of us would inspect the area for ashes when he was done.

Your husband has dementia. That is a fatal condition. He is not going to get better whether he smokes or not. I think my goal would be support him in things that seem important to him while making sure the house doesn't burn down! Sometime in the future, when he is gone, I hope your memories are not filled with conflict over smoking. Life is too short and precious for that.
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Another vote for vaping. Or gum, or lozenges. CONFESSION: I'm trying to use vaping, myself. And ... for me, I've found it to make coughing worse, at first. But coughing seems to lessen over time.
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I like the vaping idea also. You aren't really trying to stop his smoking as much as you are trying to be safe. So if you can't get him to vape controlling access to the lighter seems to be the solution.
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Good suggestion Dorianne, and it would cut out the worry about burning the house down.
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Just to add....electronic cigarettes ("vaping") might also be an option. I never tried this when I quit smoking because Nicorette gum worked, but I have friends who vaped their way out of the smoking habit. It seems to me it would mimic the action of fiddling with something in one's hand and providing that satisfying inhaling action and subsequent nicotine rush.
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Yes, I agree with Sunnygirl1 - ask if there is a reason he has to limit his smoking. My mom is 79 and has end stage renal disease along with dementia. While it would be beneficial for her to quit smoking, it isn't going to help her get better. Her doctors have said it would be more stressful for her to try and quit at this stage, which would actually be bad for her.

Most of the fights happened when mom thought I was trying to control her smoking, or control how much she smokes. Now that she understands she can smoke as much as she wants, she actually smokes less. The battle now is just keeping her in the one spot, because she simply forgets.
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I would discuss this with his doctor. I'd inquire why he is limited in his cigarette smoking. At age 82 and with dementia, what are they trying to accomplish? Expanding his life span? Is he able to make his own decisions as to whether he wants to follow this doctor's advice? If so, then, I would try to work with husband. I'd ask the doctor if he can smoke as much as he wants, ONLY he must ONLY do it under supervision. That way, there's no need for him to hide it. He just has no access to a lighter or matches, except when being supervised for safety reasons.

From what I have observed in Memory Care units, the resident has a right to smoke if they want and they have to be escorted outside and supervised when they request it. I suppose the rules may vary by state.
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JohnDBarry34, you have a lot on your plate with the smoking. Some people will tell us that cigarettes relax them... well, the relaxing comes from the deep inhaling and exhaling... they would get the same affect using a short soda straw.

Others feel like they need to keep their hands busy. Now a days some people use those whirling things that kids are spinning around and around.

Does hubby have a least favorite brand of cigarettes? If he is unable to hop in the car and drive to where he buys his cigarettes, and you are responsible for the buying, get him the least favorite brand. Make up some excuse that his favorite brand had been recalled because of pesticide poisoning on the tobacco leaves, whatever you think he might believe.  He might quit if the cigarettes don't taste as good.
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Smoking is extremely hard to stop and I assume it is a long time habit with your husband. 
Dr Andrew Weil wrote a book on addiction many years ago called 
'Chocolate to Morphine". If I remember correctly cigs were the hardest to quit. 

Yes, I would discuss with his doctor and see if a cease smoking aid would be appropriate.
Perhaps there are extremely sensitive smoke detectors you can look into.

Monitor his buying habits and do some simple math on how soon the cigs are gone to give you a more accurate idea of how many he is smoking per day. 

The smokers I used to know were fairly predictable about when they would light up.
First thing in the morning, after a meal etc.

You might find it necessary to be sure and be with your husband at these times, if not all the time.
You've been given some great ideas already. I can understand that it's a battle you would rather not take on but it's probably one of the more important ones. You might even experience some withdrawals symptoms yourself. 
I'm hoping you dont also smoke. Good luck and let us know how you handle it. 
You might keep a log to track your progress. It might make it seem more manageable. 
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cwillie had a good idea. You keep the cigarettes and dole them out as needed. And I know this will be just one more thing you have to deal with but maybe stay with him as he smokes.
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I am trying to deal with my mom's smoking too, so I feel your pain. Kind of making this up as I go, but so far I have taken the knobs off the stove and hidden them, hidden the toaster, and only have one cigarette lighter available - I used picture wire and layers of duct tape to secure the lighter in place, in the one area she is allowed to smoke, so that she can't take it off into her bedroom (which is the biggest danger at this point). I still have a hard time making her STAY PUT once the cigarette is lit, which has led to many fights. I just keep telling her I will not let her risk my safety or the safety of everyone else in the building, like a broken record. I have no doubt it will reach the point where I have to retain possession of the cigarettes and lighter.

Nicotine addiction is a tough one. Not having it when your body is used to it gives you harsh physical and mental withdrawal symptoms. I have read that it's as hard as heroin to kick, and I believe it, having quit myself (a few times now). You might be able to help him deal with the physical symptoms by letting him chew nicotine gum or suck on nicotine mints in between cigarettes. (Just don't give him the patch, because it's dangerous to smoke while on the patch, and you can't guarantee he won't smoke when you're not looking.)

My dad also smoked and had dementia, but he forgot he smoked, which happens with some. Basically I put the cigarettes and ashtray on the sideboard one night during dinner and he never asked for them afterwards. I never offered them and he never asked for cigarettes again.
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The obvious solution is for you to keep the smokes and dole them out on a schedule like medicine.
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I am so sorry you are in this sad situation! I think he cannot be allowed to smoke unsupervised. To be blunt he could burn the house down and kill you both, I'm afraid. In a home situation, of course it is impossible to watch him every second and the poor man is confused. Could the cigarettes be kept locked up somewhere, or locked up more securely or out of the home? I would call his doctor this week to see what he or she recommends. Seems like the smoking 1-2 cigarettes a day thing isn't working. This is a serious safety issue. Best wishes to you both.
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