I think the dilemma for a lot of veterinarians is the healthy pet,” said Steven Marks, BVSc, MS, MRCVS, Dipl. ACVIM, but he wasn’t trying to be humorous in his assessment. Dr. Marks, clinical professor of critical care and internal medicine, and associate dean and director of veterinary medical services at North Carolina State University Veterinary Hospital, was speaking about the problem posed by apparently healthy senior pets when they are brought into a clinic or hospital. “In the last decade, there’s been a realization that senior pets are different and that we should be looking very carefully for subclinical disease,” said Marks, one of the authors of the American Animal Hospital Association’s (AAHA) “Senior Care Guidelines for Dogs and Cats.” Despite the heightened awareness about senior pet needs, these animals can still fall through the clinical cracks. “A healthy pet burns us,” Marks said, explaining that a senior pet coming into a clinic without any clear signs often does not get diagnosed early enough to eliminate or delay a disease. A great deal of important information for an early diagnosis can be gathered just by talking to pet owners, Marks said. Posing the question “Has anything changed?” is a great way to probe an owner for potential underlying problems in a pet; changes may indicate issues that are “just a little bit below the radar,” he said. “Clients notice there’s something different,” he said. “They can’t put their finger on it, and unless you investigate, you may not know.” Many behavioral changes lie just below the radar, and those are important indicators veterinarians need to know, according to Gary Landsberg, DVM, a veterinary behaviorist at the North Toronto Veterinary Behaviour Specialty Clinic. “One of the most important things we need to do is ask behavioral questions at every visit,” Dr. Landsberg said. Behavioral changes could be the only early signs of organ failure, cognitive dysfunction, pain and arthritis or sensory loss in a pet. “There could be a decline in activity or at the other extreme repetitive pacing aimless activity,” Landsberg said. He advises asking owners questions about altered social patterns—if a pet is more clingy and following than usual, or more aloof and less interested in social interaction, or more fearful or anxious. It’s important to remember to distinguish how a pet behaves in the clinic and how a pet is at home, said Heather B. Loenser, DVM, veterinary advisor in public and professional affairs for AAHA. “Often, as a practitioner, I tend to forget that a senior pet exists outside the walls of my hospital,” Dr. Loenser said. “I find it incredibly helpful to remind myself to ask owners how their pet is doing in their home environment. Learning that a pet struggles with climbing stairs or jumping up on furniture, seems confused either inside or outside their home, makes a mess when eating, or is having urine or fecal accidents in the house, can give me valuable clues to his or her health.” By asking these questions, veterinarians can quickly evaluate whether they should be focusing on screening for arthritis, cognitive dysfunction, visual impairments, dental disease and organ dysfunction, she said. Veterinarians should follow AAHA’s “Senior Care Guidelines for Dogs and Cats” as well as the organization’s “Canine Life Stage Guidelines” and “Feline Life Stage Guidelines,” and perform a minimum laboratory database that is more extensive than that for a younger pet in the hopes of detecting disease as early as possible, Loenser said. What defines a pet as senior? "One of the most important things we need to do is ask behavioral questions at every visit." - Gary Landsberg, DVM Determining just when an animal should be considered a senior pet is crucial—though not always clear, Marks said. “We don’t have a strict definition,” Marks said. “Is a 7-year-old dog a geriatric patient, or is it not a senior until age 10? I would say the definition of senior patient depends on the breed and potentially the size.” Once that determination is made, veterinarian and staff must decide whether an incoming patient is a healthy senior presenting for routine evaluation or a sick senior. “If the senior is sick, things change dramatically because you’re looking for disease,” Marks said. When presented with a healthy senior pet, consider a conversation about screening and how much the pet’s owners are willing to invest in that older dog, he said. The bottom line is that senior pets should not be treated like younger pets when they come in to the clinic, said Mary Gardner, DVM, co-founder of Lap of Love Veterinary Hospice in Orange County, Calif. “A pediatrician, primary physician and geriatrician treat their human patients differently, and so should we,” Dr. Gardner said. “There is a huge opportunity for us to provide even better care for the senior and geriatric pet and their family. It’s not just helping the pet but helping the family manage the aging pet and all the struggles that are associated with it, including anticipatory grief.” Talking to owners Extend that elevated level of care to pet owners—the people who daily face the reality that a beloved family member’s life is winding down. “Many vets and staff focus on the medical issues that may occur with senior pets but tend to overlook the caregiver burden that afflicts these families as well,” Gardner said. “Managing an advanced aged pet can be time consuming, emotionally taxing and physically exhausting to the pet parent, and they could use the guidance from a professional on how best to care for their senior pet.” One veterinarian’s best-practice suggestions during a senior exam * Keep senior pets comfortable and decrease stress as much as possible using Fear Free techniques in the clinic or hospital;* Improve the odds of early detection of geriatric diseases by providing pet owners with reminders for exams every six months as recommended by the American Animal Hospital Association’s “Canine Life Stage Guidelines” and “Feline Life Stage Guidelines”;* Lift a pet’s lip to show the owner any tartar accumulation or gingivitis to more dramatically educate a pet owner about their pet’s dental health in the exam room; and* Encourage pet owners to regularly weigh their pet to help maintain a healthy weight.—Heather B. Loenser, DVM, veterinary advisor in public and professional affairs for the American Animal Hospital Association She believes it’s vital to learn about a pet’s lifestyle, the family dynamics, what symptoms are of most concern to the family and to remember that changes happen quickly in the older population, so keeping in touch with these families is important. Discussions also should incorporate education about topics including common age-related symptoms as well as determining and addressing a family’s priorities. Supplement the education process with informational and marketing materials that outline common problems in aging pets; this demonstrates that a clinic understands the ailments of aging and how they differ from younger pets, Gardner said. “We have created a geriatric questionnaire that pet parents can fill out that helps to guide the conversation with vets as well as possibly uncover some symptoms the family didn’t even consider,” Gardner said. (View the questionnaire at lapoflove.com.) Also urge owners of aging pets to bring them into the clinic more often. Recruit owners as ad hoc diagnostic assistants. Marks shared how he instructs senior pet owners: “If you see your dog or cat do anything at all that you consider abnormal, write it down, put the time of the day and the day of the week, try and ID what the pet was doing that bothers you and what the pet does afterward.” Further, he also encourages owners to take photos or video to share. Another expert who believes in involving pet owners in the diagnostic process is Carlo Siracusa, DVM, MS, Ph.D., Dipl. ACVB, Dipl. ECAWBM, clinical assistant professor of animal behavior and director of Animal Behavior Service at Matthew J. Ryan Veterinary Hospital School of Veterinary Medicine at the University of Pennsylvania. Pet owners should watch for changes in posture, mobility and eating habits, said Dr. Siracusa. It’s also a good idea to suggest to senior pet owners to consider adapting the home environment to suit a geriatric animal’s needs, he added. “Make all the resources available in easily accessible and quiet spaces, and remove physical barriers,” he said. “For example, keep a litterbox in the space where the old cat spends most of his time. Don’t pretend that with his arthritic joints he will climb two ramps of stairs to pee.” Advise owners to provide a safe and quiet haven where an older pet can rest undisturbed. Children in the home also should know how to handle the pet gently and allow it space. “Decrease the intensity of physical exercise if indicated,” Siracusa said. “Keep a predictable schedule and environment, and avoid changes to that environment.” Practitioners also should consider the psychology of the pet owner, said Loenser. “Owners can be reluctant to bring their older pets to the veterinary hospital in fear that they will hear bad news about their pet’s health,” Loenser said. “After spending 10 years as an emergency clinician, I’ve learned that there is a balancing act between alarming an owner about potential diseases lurking around every corner and empowering them with ways to keep their pet as healthy as possible for as long as possible. “Veterinarians should emphasize the importance of semi-annual physical examinations to detect and manage diseases associated with aging,” she added. Best practices Establish best practices for senior pets in the clinic that can ensure safer and happier visits, said Gardner of Lap of Love. Place bath mats in exam rooms for better footing, use Fear-Free techniques, handle senior pets delicately, and send them home as soon as possible. “The most vital thing to keep in mind when you are dealing with a senior pet is to treat them with kid gloves—these pets are fragile,” Gardner said. “Pets heal better and recover faster at home—so they take priority.” Siracusa said practitioners and staff also should carefully observe the behavior of senior pets during appointments to detect signs of poor medical or behavioral health, such as a change in an animal’s gait or posture that may be indicative of chronic pain. “Veterinarians should also be aware of the fact that stressful and painful medical procedure can cause a serious decline in an animal’s welfare,” he said. “For example, surgery could potentially accelerate cognitive decline.” AAHA’s elements of a complete examination Guidelines as outlined by the American Animal Hospital Association’s “Senior Care Guidelines for Dogs and Cats” advise veterinarians to observe a pet prior to handling, while it’s in an open carrier or on the floor, and performing a complete physical examination with special attention to the areas of increasing concern in the senior pet. Such areas include: Risk factor analysis (signalment, breed, lifestyle/use); Physical condition (weight gain/loss, obesity, changes in body condition or conformation); • Presence of lymph node enlargement; Evaluation of skin, coat, claw, nail-bed character; detection and assessment of lumps, bumps; • Presence of thyroid nodule (cats); Hydration status; Abdominal palpation, especially the size and shape of kidneys and liver; Vital signs (temperature, pulse, respirations, pain assessment); Cardiopulmonary evaluation (auscultation of heart sounds; heart rate, rhythm; pulse rate, quality); Evaluation of the central nervous system (mentation; cranial, peripheral nerve reflexes, especially conscious proprioception; vision, hearing); Orthopedic examination (mobility, gait, range of motion, weakness, pain, crepitation, muscle mass); Rectal palpation (dog).
