At what point do I need to stop my husband from smoking?

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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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