14 Sept 2022
Kirsty Cavill
Job Title
Veterinary nurses are ideally placed to be advocates for senior patients, and play a major role in developing and implementing their multi-disciplinary care plans.
As highly skilled professionals, RVNs are instrumental in the provision and integration of patient-centred, nurse-centric, evidence-based care, which is essential for the effective management of all senior pets.
Senior patients will often present with complex conditions and comorbidities, and their status can often change without warning. We should remain mindful that old age is not a disease, it is simply a number. Individuals are affected by this natural process at varying rates and, therefore, patients should be assessed regularly.
For both owner and veterinary professional, supporting a pet through its senior years should be viewed as a marathon and not a sprint. It can be physical and emotionally challenging and, therefore, realistic expectations should be established when forging the client-practice relationship.
Value exists in employing a proactive approach to senior pet health parameters, which starts with appropriate education when the pet is still young, even at the first point of contact with the practice. A safety net of relevant advice can be conveyed in a sympathetic manner to ameliorate mitigating risk factors for the years ahead. Therefore, developing an effective strategy to convey the value of senior pet care to the practice model will encourage a shift in culture towards this proactive approach.
Set up a deep-dive discovery session with your colleagues to consider provision – what can you do and how will you do it?
Develop a toolbox of treatment options and establish a network of interprofessional collaboration within the community. By developing a scaffold of support around the practice provision we establish a multimodal model of care, to support a pet on its journey through life.
Audit your practice provision and share your vision. Promote your practice “senior care” brand and establish links with the practice community: your clients. Define your criteria for identification of patients, and generate appropriate pre-assessment quality of life and pain score questionnaires.
Ask, who is most interested in senior patient care within your practice? Define what your nurse-led consultations and case reviews will look like. What are the non-negotiable parameters you will measure and track to enable the identification of developing trends over time and emergent health issues?
Aim to establish named vet/nurse teams for patients to ensure continuity of care and to generate a bond of trust forged on mutual respect with your clients. Establish appropriate client-specific outcome measures for each patient, designed to track positive improvements in a condition, alongside detecting escalations of a disease process.
What is a multimodal treatment approach and how does it work in relation to senior pet health? Imagine the pieces of a jigsaw – we need them all to be in the right place and the same time to achieve the full picture on our patient’s health profile. We need to be considering the “bigger picture” by incorporating all aspects of the pet’s life into our nurse clinics, to aid in the development of functional and effective models of care. Consider pre-existing health issues, lifestyle, diet, body condition score, nutrition and exercise. The identification of opportunities to refer to rehabilitation or enhanced clinical provision should be reviewed regularly.
Nurses are often the vital conduit between pet, owner, vet, and the wider support network of referral and rehabilitation specialists.
Be proactive in facilitating the highest level of patient care through the engagement of interprofessional collaboration, employed in a timely and relevant manner.
Are you prepared? Can the practice be accessed safely or will the slippery floors pose a risk to a senior dog with mobility related issues?
Patients can become stressed in a practice environment – does the benefit of attending a clinic outweigh the risk or can you set up a video call for a virtual check-in? Allow plenty of time and establish in advance what information you need to elicit from the visit to effectively manage this patient.
Cats can easily slip through the senior pet pathway model because, overall, they are seen in clinic less regularly than dogs and, as we all know, cats are masters of disguise. Emerging signs of developing disease processes can, therefore, often go unnoticed in the initial phases. Therefore, designing a targeted and robust pre-assessment quality of life questionnaire can be hugely beneficial, and helps with use of clinical time efficiently for elusive feline patients.
Emergent health issues commonly seen in senior pets include the following:
We have a duty of care to support owners in helping them to recognise the signs of pain in their pet, remembering that chronic or breakthrough pain is often expressed visually, not vocally. The World Small Animal Veterinary Association Global Pain Council recognises the need to address and eliminate the pain incidence-pain treatment gap. Its vision discusses the development of an empowered, motivated and globally unified veterinary profession that can effectively recognise and minimise pain prevalence and its impact on animals (Matthews et al, 2014).
Pain scoring metrics should be robust and assessed regularly. Employing the use of an owner/pet questionnaire, such as Liverpool Osteoarthritis in Dogs, is a useful addition to any senior pet toolbox.
Common signs of pain expressed by cats and dogs:
The assessment of health-related quality of life (HRQoL) is becoming increasingly important in the management of companion animals. Increasingly, animal welfare expectations have brought about a greater emphasis on the individual. HRQoL should become an integral parameter in the development and provision of pet health treatment plans.
Good senior patient care is about looking after the owner, too.
Be aware of the signs indicating the development of anticipatory grief and caregiver burden in owners of senior pets, and be prepared to support them through this emotional and physical journey.
This unique model of grief can develop following a diagnosis, leading to a feeling of vulnerability and frustration. The emotion can be exacerbated when
owners see their pets in pain or distress. Therefore, having a thorough knowledge of pain pathways, and reducing the occurrence of chronic and breakthrough pain, will aid to improve HRQoL for the pet, and, subsequently, the owner. Supporting an owner in this area will enhance the client-RVN bond.
Remain mindful of burden transfer, and have a robust practice protocol in place to support and protect all practice colleagues. To be able to effectively support owners you must look after yourself, too. Allow time to decompress after a difficult nurse clinic, and allow sufficient time for preparation and reflection.
A recent study concluded that caring for an OA dog can have multi-faceted, negative impacts on owners, which may be sustained over many years – particularly if the dog is young at diagnosis (Belshaw et al, 2020).
