Mary Gardner, DVM, and Dani McVety, DVM
Lap of Love Veterinary Hospice, lapoflove.com
The evolution of medicine, technology, and the pet–parent relationship has created an abundance of geriatric pets. As a profession, veterinarians have many opportunities to give our aging companions and their caregivers the additional services and support needed as they navigate the unstable waters of “getting old.”
SENIOR PERSPECTIVES
In the not-too-distant future, both of us will qualify as seniors, and we will kick and scream our way through this realization. However, unless we develop life-limiting disease or chronic illness, our expectation is to make it through our 60s and 70s unscathed.
That said, we know that when we reach our 80s and, hopefully 90s, even without disease present, we are going to start to struggle. We’ll have limited mobility, sleep pattern changes, decreased vision and hearing, thermoregulation issues, and probably some cognition changes. We will rely on family support to help manage care, safety, health, and mental stimulation.
Aging pets experience a similar scenario. How often does a healthy 8-year-old Labrador retriever come trotting into your clinic and, upon your declaration that the patient is a senior, the owner gives you the evil eye? This is often followed by a rant about how this pet is NOT a senior. You may even test a few senior wellness “upselling” techniques on the client, only to be huffed and puffed at.
However, when the same patient returns at the age of 13, his status as a senior pet is more apparent—he is cautious on the tile floor, his eyes are hazier, his hindlimbs shake with lack of strength, and his coat has lost its glow. He actually looks old. Bloodwork may appear normal, and aside from evidence of arthritis on radiographs, everything checks out okay. But the patient’s age is also apparent at home, and the owner knows changes are occurring, even if she doesn’t know how to improve her pet’s quality of life.
GOALS OF GERIATRIC CARE
As veterinarians who limit our practice to in-home hospice and euthanasia, we have a unique view of the family’s home and pet’s surroundings, and we also see the major challenges faced by geriatric pets and their owners.
In our practice, we help approximately 20,000 pets each year, and of those, 22% have not been seen by their regular veterinarians in over a year. Subjectively, we estimate that 43% of those pets would have benefitted from basic medical care, including pain and/or anxiety medications, hygiene support, and mobility support.
These numbers support our industry’s initiative to educate families of senior pets on the importance of annual (preferably, semi-annual) visits. With that said, many families have shared with us why they are hesitant to pursue veterinary care for their pets—they fear “unnecessary” care and treatment (vaccines were most commonly cited) and expensive diagnostics and therapy.
However, with appropriate marketing and education, we can demonstrate that the goal of proper and effective geriatric pet care is to enhance the quality of life for pets and their owners. This care empowers owners to properly attend to their geriatric pets, motivates the veterinary team to embrace geriatric patients, and maintains the strength of the human–animal bond.
WHAT AGE IS “OLD”?
What qualifies a pet for the geriatric, or senior pet, title? For cats and small dogs, many consider 11.5 years of age geriatric, while medium and large dogs are considered the same at 10 and 9 years of age, respectively.
In 2007, the American Veterinary Medical Association reported that 30% of dogs were 6 to 10 years of age and 14% of dogs were over the age of 10. But, as with humans, this is all relative. We strongly believe it is not how old pets are but simply how they ARE.
Veterinarians have a variety of tools to keep puppies and kittens healthy as they grow, and we are well prepared to help our aging patients as they reach their senior years. The care and management of a geriatric pet, however, is very different for the patient and owner alike. There is much to be done by veterinary health care teams to properly recognize this geriatric stage, keep patients comfortable, and help caregivers with their aging family members.
The Senior Pet Wellness Visit
A senior pet wellness examination should include the following:
Complete blood count and serum biochemical profile (including thyroid levels)
Evaluation of vaccination schedule and risk factors and implementation of appropriate preventive care
Orthopedic examination (including conscious proprioception)
Thorough vision assessment
Current body weight and body condition score assessment
Nutrition/diet evaluation (including caloric intake assessment)
Discussion with family regarding sleeping patterns and any change in cognition.
A Geriatric Questionnaire is available for download to use in your practice at tvpjournal.com and lapoflove.com.
IS OLD AGE A DISEASE?
By definition, old age is not a disease, and we do not simply die of advanced age. However, the problems that arise from an aging body do affect quality of life and may lead to death. The aging process is incredibly complicated, and it can be difficult for the veterinary team to distinguish between changes resulting from the aging process and those associated with common medical conditions.
Aging results from an inevitable decline in the body’s resiliency, both mentally and physically. Over time, cell production decreases, leaving fewer total cells, and these cells are less capable of repairing the body. The immune system becomes compromised and, therefore, more susceptible to infections, and it is less proficient at seeking out and destroying mutant cells. As a result, many older pets succumb to conditions they could have resisted in their youth.
WHEN IS A PET AFFECTED BY OLD AGE?
Knowing the most common afflictions that affect our geriatric patients is crucial but, even more important, is educating owners about managing them. The following 5 signs are ones we often see in senior pets, along with some tips on clinical care.
1. Vision Changes
Pets do not always go blind or lose functional vision as they age. However, some aging processes in the eyes can lead to decreased vision, which manifests as hesitation while navigating stairs, difficulty catching treats or toys, getting “stuck” in strange places, falling into swimming pools, or walking into traffic.
The most common change is lenticular/nuclear sclerosis. All geriatric dogs—beginning at 6 to 7 years of age—develop hardening of the lens; however, it may not become noticeable to owners until around age 10. Hardening of lens fibers makes it difficult for the lens to change shape and, therefore, focus, which reduces near vision (the reason why many middle-aged people need reading glasses).
Other conditions that afflict aging eyes and subsequently affect the pet’s ability to see adequately are iris atrophy, retinal changes, and vitreal degeneration.
Since many geriatric pets experience some level of vision loss, their caregivers need to help them cope better in their environments. Educate owners by encouraging them to:
Place night-lights along stairwells, near the doggy door, and next to food and water bowls.
Affix scent markers, such as Tracerz (innovetpet.com), to walls, flooring, and furniture to help pets find important locations.
Put bells on collars of other pets in the household to alert and signal the visually impaired pet of their whereabouts.
Purchase a halo or visor (halosforpaws.com or muffinshalo.com), which acts as a bumper against walls or furniture, for aging pets to wear.
Approach aging pets with caution (particularly children who may startle the pet), especially those in chronic pain, which avoids an adverse response if the pet is startled.
2. Hearing Changes
All too often owners tell us their pets are deaf—unless, of course, the pet hears the food bowl! Age-related hearing loss, called presbycusis, is quite common in our canine and feline patients. Mid to high frequencies are affected first, followed by progressive loss at all frequencies and deafness. Onset is typically in the last third of a breed’s typical lifespan.
Although hearing loss is progressive, owners usually report acute onset because their pets have compensated for hearing loss until deafness is nearly complete. The most crucial tip to give owners is that vision and scent become more important as hearing loss progresses. The owner must make sure the pet learns, and then observes the owner use, visual cues, or simply sees or smells the food bowl.
3. Skin Changes
Besides graying hair on the muzzle, there are often other skin and coat changes in aging pets. A geriatric animal’s skin and hair may look dull and lusterless due to decreased production of natural oils by the sebaceous glands, which may also result in skin that appears dry and flaky. Advise owners to:
Brush the coat to help stimulate the skin to produce more oily secretions
Consider feeding a fatty-acid supplement, which is beneficial for excessively dry coats.
Aging skin also loses elasticity and becomes more susceptible to infections. While chronic infections lead to decreased quality of life, the worst side effect is the smell—the pet is often separated from its human family, which affects the pet–parent bond more than an owner may realize. Medicated shampoos and systemic antibiotics can increase quality of life for both pets and their owners.
4. Mobility Changes
Mobility issues are the most common of all problems reported to us by dog owners. At least 50% of our patients struggle with some level of mobility difficulty.
Mobility can be affected by arthritis, other musculoskeletal changes, and sarcopenia—an under diagnosed condition in which aging animals progressively lose lean body mass in the absence of disease. As muscle tissue mass decreases, so does muscle strength, which is why older humans are less steady or have difficulty catching their balance. Pets may exhibit analogous signs, such as changes in their movements, reflected in difficulty in rising or reluctance to jump. Tile or wood floors can become an unmanageable “ice rink” to these pets.
Mobility problems need to be addressed before the pet becomes immobile, when there is much less that can be done. Encourage owners to:
Place bath or yoga mats around the house where the pet travels most; the stability they provide gives mental relief to pets.
Use ramps, which—even on the smallest number of steps—provide great relief to arthritic dogs. One step can trip a pet; therefore, owners should not overlook single steps out of a doggy door or off the porch.
Use harnesses (helpemup.com), especially for dogs over 40 pounds, to help pets rise from a sitting or lying position, navigate stairs, and during walks.
Use booties with a non-slip surface, which can be very helpful once the pet acclimates to them. Remind owners to remove them twice a day and at night and to avoid putting them on too tight.
Use wagons for walks, which allows dogs with limited mobility to enjoy walks. Once the pet has arrived at a safe spot, he can get out and enjoy “sniff” time; then the wagon is ready for the walk home.
Keep pets moving. Pet owners should continue to exercise their pets within set boundaries. Lack of movement only exacerbates the issues of decline.
Administer medications—the most underutilized method of pain relief in the patients we see—recommended by the veterinary team. Proper client education and patient follow-up are important to ensure that these patients continue to receive the best protocols available to them.
5. Restlessness at Night
Some older dogs may become restless at night and stay awake pacing and panting throughout the house, similar to sundowner’s syndrome seen in human Alzheimer’s and/or dementia patients. This restlessness may keep the entire family awake and lead to the pet’s exile to a faraway part of the house.
There are many reasons an older dog may have difficulty sleeping at night, including both medical and behavior-related reasons. Pain, cognition, and anxiety are the 3 most common causes we encounter. It is important to uncover the cause of nighttime troubles and address those as best we can.
Anti-anxiety medication and/or sedatives are often needed, particularly in pets with cognition issues. Dosing and dose frequency may need to be adjusted as night-time restlessness progresses. Quality of sleep for all involved is important and can be improved with help from the veterinary team.
Geriatric Pets: Additional Resources for Clinicians
Articles on End-of-Life Care
Visit tvpjournal.com to read:
Handling Euthanasia in Your Practice (January/February 2016)
Adding Veterinary Hospice Services to Your Practice (May/June 2016)
Quality of Life Assessment
lapoflove.com: Click Quality of Life tab
pawspice.com: Click Services tab; then select Quality of Life Care and Quality of Life Scale
THE SENIOR PET FRIENDLY PRACTICE
As mentioned earlier, most clinics are well stocked with puppy/kitten literature and giveaways, and they typically do a good job marketing senior wellness and disease prevention.
But what about making your practice more friendly for geriatric pets? Marketing specifically to this group of pet owners shows them that you empathize with the challenges they face and encourages them to come to your clinic with their pets for assistance.
Practice Environment
Create a good environment for geriatric pets at your clinic by:
Providing a dedicated parking spot near the front for “Gray Muzzles”
Using yoga mats as a runway for the geriatric pet from the waiting room to the examination room
Performing tasks and sample collection in the examination room so the pet is not stressed by being removed from the caregiver’s presence
Using careful handling techniques during procedures, because geriatric pets are fragile and the slightest awkward movement can leave them sore the next day
Fast tracking these patients in and out of the clinic.
Remember, there is no place like home for a geriatric pet. If the pet must stay for a procedure or boarding, encourage the owners to bring something from home to help reduce anxiety.
Client Education
Client education is paramount:
Have literature available to hand to clients during the visit.
Include an “information prescription” that refers them to reliable online sources that provide information on disease processes and management.
Consider creating a list of the most common challenges these pet owners face.
Provide in-home evaluations (available at lapoflove.com) or ask owners to take videos that provide insights about how the pet manages at home and how the owner is managing the pet.
Client Conversations
Telling an owner “old age is not a disease” is not the right thing to say when evaluating the geriatric pet. Instead, take the time to listen to the problems the pet and caregiver are facing, and then discuss the causes and possible treatment options.
Find out what is important to the owner and focus on that first. For pet owners, periodontal disease may not be the foremost problem in their minds, but sleepless nights are. Once you fix the sleepless night issue, the teeth can then be addressed. This approach allows pet owners to learn to trust your advice and follow your recommendations.
BUCKET LISTS FOR GERIATRIC PETS
When it comes to the last stages of life, time is precious and limited.
Focus on what is important for both the pet and the family. Encourage pet owners to create bucket lists for their pets and then help them enjoy doing those things with their furry best friends. (Have you seen the Subaru commercial? If not, visit barkpost.com/subaru-bucket-list.)
Keeping the pet’s mind active and alert can make a huge difference in quality of life.
Owners can modify typical pet games to accommodate their geriatric pets. For example, instead of tossing the ball in the back yard, the owner can roll the ball to his dog while the pet is in bed.
Long walks can be replaced with inside activities, such as hide and seek—a game many dogs enjoy.
Simple, short, and frequent walks around the house can help maintain core muscle.
Pets with a high food drive may love a Kong toy (kongcompany.com), filled with favorite treats, or unique bowls (aikiou.com) that encourage pets to seek out food in compartments.
When dealing with an aging pet, the topic of when it is time to euthanize is bound to come up. Providing activities that enhance a pet’s quality of life also gives the client a way to evaluate quality of life (Does the pet still enjoy the activity? Can the pet participate?), which helps them answer the question about when to euthanize.
IN SUMMARY
There is much we can do to help pets live comfortable lives as super seniors. Our ability to recognize and manage pain, anxiety, hygiene, and other signs that may affect quality of life has advanced in recent years.
Our profession continues to seek ways to identify the unique needs of both clients and patients as the end of life approaches, as well as find best methods for communicating effectively, setting realistic expectations, and guiding pet parents in the care and management of their geriatric companion animals.
Embracing this final life stage and helping owners manage their geriatric dogs and cats can be life changing for the pet. It may not only extend pets’ lives, but what time they have left can be lived with less pain, less anxiety, and more fun!
Mary Gardner, DVM, and Dani McVety, DVM, have focused on geriatric medicine, hospice, and in-home euthanasia since 2010 and founded Lap of Love Veterinary Hospice, the nation’s largest group of veterinarians dedicated to end-of-life care. Lap of Love helps over 1500 families per month and has been featured on The Doctors and in the New York Times, USA Today, and the Associated Press, as well as numerous veterinary trade publications. Drs. Gardner and McVety speak frequently at national and international conferences and veterinary schools on many topics, including body language, communication techniques for doctors, and care of geriatric veterinary patients.
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