You've probably had a scenario similar to this in your practice: A senior cat is presented for routine examination for the first time in 2 1/2 years. The owners report he has trouble eating, excess salivation, and sure enough, a monster tumor is identified, well seated in and under the tongue. Though these can carry a poor prognosis at any stage, we can't help thinking that it might have been salvageable if picked up at a very early stage. Other times the story has a happy ending for seniors, such as when a routine visit identifies a renal condition that stabilizes with therapy. The human population is undergoing a tremendous shift as baby boomers age; average lifespan tops 78 years. Our pet population has benefited from modern veterinary care and changes in lifestyle and nutrition, and is now also living a much longer average lifespan. Clients expect high quality care for their senior pet once they understand opportunities for preventive intervention, and because of the progressively greater proportion of our patients (~25%) in the senior life phase, it behooves us to develop a sensible senior wellness program. Many practices do not currently offer a comprehensive wellness program for aged pets that integrates appropriate customized "packages" or programs for patient monitoring and client education. This is a missed opportunity for increased income, but most importantly, integrated senior care is an essential component of a modern, progressive practice. This will save the client money and perhaps heartbreak, by intervening either before a problem starts, or in the early phases while the prognosis may remain good for either cure or control. As a note aside, the term "geriatric" is generally not used for client communication since there are some negative connotations to the term. The term "senior" has become the preferred term for the aging pet, though many still apply the term geriatric for seniors of advanced age, or those with chronic health problems. New Developments in Senior Pet Care According to the AVMA, 30 million pets are older than 8 years of age, and we know that their health care needs are much more intensive than a middle-aged healthy adult. New therapies and management approaches for cognitive disorder, cancer, chronic pain, hypertension and other conditions are now available. It is up to us to undertake continuing education to keep up with these new developments to properly serve those in the senior life phase. Client Education—First Step Below is a sample senior pet client education segment from a cat clinic newsletter. Each patient is different, so recommendations for each individual pet may vary, and the program for a particular patient may need to be adjusted frequently over time. A client reading this sort of educational summary will be more likely to comply with the recommended care steps. Repeating these messages at the practice will help to reinforce the message. A similar summary could be generated for the dog. Age is not an illness, but client education about preventive medicine can have a significant impact on quality of life for senior pets. The rate at which an individual cat ages depends on many factors including breed, genetics, lifestyle, body condition, general health, and nutrition. In modern veterinary practice we try to pick up problems when they are mild and (usually) curable, or controllable. Cats are very stoic, and often will not communicate poor health to us until late in the disease process. This means that we must monitor them very carefully. Clients ask: Is there anything I should be doing for my cat during the senior (10+) years? Suggested Steps for Care 1. Physical exam, weight check: this allows us to check for early disease symptoms in many body systems, though sometimes additional testing is needed to identify internal problems. We recommendations checkups every 6-12 months for a typical senior. Those with chronic health problems may need to be seen more frequently. 2. Gradual transition to a senior diet: these diets are formulated to provide adequate but not excessive calories, and adjusted protein and mineral content to reflect the changing needs of an old cat. Additional nutritional supplementation may be prescribed. 3. Nail care: old cats are less efficient at sharpening their nails so they tend to retain sheaths, and nails become very thickened. We suggest a trim every 3 months or as needed, with professional assistance if nails have grown into pads. 4. Water intake: some of the diseases of seniors such as kidney dysfunction can begin with subtle symptoms such as increased water consumption, and resultant increase in urine output. If increasing thirst is suspected, we sometimes measure daily water intake and calculate whether it exceeds the normal range. 5. Database of baseline test findings: each cat is an individual and if they become ill in the future, comparing findings at that time to a previous healthy baseline is very useful. Geriatric wellness blood screen and urinalysis, ECG, and X-rays of chest and/or abdomen are baseline parameters the doctor may wish to establish. Cell counts, liver and kidney function, selected minerals/electrolytes and thyroid hormone levels are routinely checked on a schedule tailored to the individual. 6. Dental health: if the cat allows teeth cleaning at home, continue this regularly since home care is important for maintaining optimal dental health. If the cat will not allow home care, follow recommendations re: booking an appointment for professional cleaning/care. Sometimes extractions or antibiotic treatment may be necessary. Broken teeth should be checked since if there is exposed dental nerve, the teeth may get infected and will cause pain. Cats get cavities too and these are very sensitive. Bacteria from mouth infections enter the bloodstream and can infect internal organs including heart and kidneys. 7. Heart and lungs: heart disease in senior cats is usually heralded by a newly identified heart murmur or changes in heart rate or rhythm. These problems are unlikely to be picked up at home, so stethescope auscultation is important. Lungs are checked for changes in noise pattern and rate as well. Other tests such as ultrasound, ECG, and X-Rays may be needed if problems are identified. 8. Tumors: cancers are progressively more common in cats as they age. Sometimes they are evident at the time of the check up, but often require further testing such as biopsy, X-Rays and ultrasound. Any new bump or lump should be checked. 9. Internal parasites: intestinal worm control is needed if the cat goes outdoors since parasites are a drain on their system. Outdoor cats should have fecal tests performed at least once, and preferably twice yearly. Even an indoor cat should have a stool sample checked for parasites annually. Some parasites are zoonotic (shared with people), so we need to control infestations. 10. External parasites: flea control is important since heavy infestations can be debilitating. Fleas can also transfer tapeworms. Remember indoor cats can get fleas too! It only takes one flea to make an infestation, so prevention is the best plan. 11. Senses: hearing and vision may become reduced with age, so bring any changes to the attention of your health care team. If senses of hearing or sight are reduced, keep your pet indoors for their safety. 12. Vaccines: boosters for major diseases should be continued as long as health status allows. Boosters are prescribed according to each patient's risk. 13. Viruses: screening for FeLV (Feline Leukemia Virus) and FIV (Feline Immunodeficiency Virus) will be recommended if your cat goes outdoors, if they contact untested cats indoors, or as a baseline evaluation. Frequency of testing is customized based on lifestyle risk. 14. Bowels/urine: older cats are less efficient at clearing stool, and therapy is often recommended. Inappropriate urinations can occur. Have a urine sample checked if any problems are noted. 15. Arthritis: it is particularly painful if the cat is also overweight since this places greater stress on aging bones and joints. Sometimes a cat will become cranky, less active, hide, change sleeping places, and inappropriately eliminate if they are afflicted. Mobility and agility can often be reduced also in the senior cat, and providing cushion steps up to a favorite perch may be necessary. 16. Behavior: some senior cats will howl, wander around, and sometimes hide. Changes in activity and attitude should be brought to the attention of the veterinary team. Implementing a Senior Program - Bundled Packages Bundling customized services with a physical examination is an effective way to follow up on the client education process. Each clinic will need to decide how they wish to package services, but a sample tiered package might include: BASIC BASELINE: (annual) Examination, +/-vaccines, fecal, urinalysis, blood pressure, blood screen (including CBC, profile, electrolytes, thyroid, HWT etc.) FULL BASELINE: (every 2 years) BASIC plus X-Ray, ECG. MODERATE and INTENSIVE PROGRAMS for ill patients: customize a subset of the above and add specific diagnostics; frequency also customized. Can be comprehensive, or split by problem or body system. Possible sample programs at moderate or intensive-level: systemic (comprehensive and weight control, behavior), cardio-respiratory, oncology, diabetic, renal, hormonal, dental / periodontal, GI. Tips: Train all staff thoroughly; it is not just about getting "shots" up-to-date. Ensure they are familiar with common senior health conditions. Send newsletters (such as the above sample) to a targeted subset of clients with senior pets. For postcard reminders for vaccines, add a message about importance of wellness for senior pets. Try a "senior pet center" at open house time to promote services and educate clients. Bundle services in a price-reduced package to encourage the client to accept a full workup. Annual "checklists" filled out by owners can help pinpoint problems. Include questions about activity, attitude, appetite, bowels and urine, senses, weight changes, new lumps, haircoat and nails health. Dr. Cavanagh is a feline practitioner in New York and Ontario, Canada. She is lead managing and development editor for www.vetmedcenter.com and is president of her new media production company, Matrix Multimedia. 4-15-2004Senior Pet Wellness ProgramsSenior Pet Wellness ProgramsSenior Pet Wellness ProgramsSenior Pet Wellness ProgramsSenior Wellness Programs Bolster CareOur pet population has benefited from modern veterinary care and changes in lifestyle and nutrition, and is now also living a much longer average lifespan.
