Approaches to caring for senior dogs and cats

Our patients are living longer, thanks to better diets, lifestyles and preventive care. However, in their twilight years, like their human counterparts, they often suffer from chronic disease, regularly have multiple conditions, which can require complex management, and many require surgical procedures.

This is in addition to the fact problems often go undiagnosed because of owners’ assumptions signs of illness are simply old age and their reluctance to authorise investigations or procedures for elderly pets.

So, how can we, in first opinion practice, ensure we are proactive in caring for senior patients – both in the consulting room and the hospital?

The first hurdle to overcome is in persuading owners to bring their pets into the clinic. Many elderly animals haven’t crossed the threshold of their veterinary practice for years – particularly if they have been lost to annual vaccinations. Indeed, it can be a point of pride for clients that their charges have never been to the vets and often only present well into a disease process or, worse, when it is too late to help them.

Hidden conditions

Animals are masters at hiding signs of illness, especially chronic disease, and we can safely assume many senior pets will be suffering from something if they haven’t had a recent veterinary examination. Weight loss can be so insidious it is invisible to those who see them every day; slowing down and resting more due to arthritic pain is mistaken for simple old age; a change in dietary preferences is often not considered significant when, really, it is due to painful dental disease. Often polyuric/polydipsic (pu/pd) patients are only presented when they finally lose toileting control.

Clients also have the very real fear if they do present with an older, sick, pet the vet will simply recommend euthanasia there and then. Additionally, the perception anaesthetics and medications are dangerous to elderly patients exists and, of course, clients may have a simple reluctance to spend money on a senior animal.

However, to counter this attitude, many clients are extremely invested in their pets and would welcome the opportunity to ensure they remain healthy in their twilight years.

Vets are also not totally blameless – they could be far more proactive in suggesting and encouraging treatments and investigations, and also in countering client concerns. Vets must strongly advocate high-quality care for these patients and be actively pursuing surgical procedures if they are necessary.

Senior health check

In general practice, with an extensive client base and practice management systems easily able to pluck out suitable candidates, vets are in an ideal position to contact clients and invite them to some type of senior health check and try to get these patients back under supervision.

Senior clinics can take many forms and be as complex or as simple as you wish to make them – ranging from a simple 10-minute health check and advice in a nurse appointment, to admitting the patient for the day and running a series of tests.

However, all will be most successful if the time is taken to educate clients on why monitoring the health of their geriatric pets is important and how much difference – with only moderate costs and minimal risks – it can make to both their quality and quantity of life.

I have found a more detailed and involved approach is the most successful in terms of owner engagement and positive outcomes for the pet.

In the author’s clinic a scheme was devised where owners were given a sheet to fill in before the check-up – detailing any changes they had seen or concerns they had about their pet – and then, on the day of the clinic, the animal was admitted to hospital. This gave vets time to complete a comprehensive clinical examination, blood tests and urinalysis with no consulting time pressure.

It found the cat’s blood pressure measurements were more accurate and much more easily obtained. A discharge appointment was arranged and time allowed for a full discussion of the results and recommendations for further treatment or medication.

However, whichever approach you choose, consider running some form of senior check-up in your clinic. It will increase client engagement and education, promote bonding, improve animal welfare and could be a substantial income generator.

A proactive and enthusiastic approach, with appropriate client education, with respect to surgical procedures and care of geriatric in-patients, will also pay dividends – both in terms of patient safety and outcomes and also to overcome the understandable anxieties some people will have for their pets.

Hospitalisation and preoperative

First, let us consider hospitalisation and the preoperative period. Many elderly patients will be arthritic and possibly underweight, so deep, conforming bedding is a must. Orthopaedic pads are ideal, or simply double-up on the vet beds. Many are often suffering with senile changes – regardless of whether they have been noted by their owners – so allowing a blanket or comforter from their home can go a long way to ensuring they are more settled and less stressed. As will the liberal use of cat and dog appeasing pheromones in the kennelling area.

Reducing stress is particularly important as older patients often do not have the cardiac reserve or function to adequately cope with increased heart rates and myocardial work. They are also vulnerable to hypothermia, even in the preoperative period, and this can have extremely deleterious effects on the body and how it will cope with an anaesthetic; therefore, work on keeping them warm from the moment they are admitted.

A full pre-anaesthetic physical examination is vital and preoperative blood tests, and, ideally, urinalysis, should be performed on every patient. Most older animals will benefit from fluid therapy and the recommendation for those with any degree of organ function is for drips to be started 12 hours before an anaesthetic¹, or as long as is possible in your practice. This should be continued until the patient is eating and drinking normally. A rate of two to three times maintenance is generally considered appropriate for patients with no detectable organ dysfunction¹.

Preoperatively, geriatric patients should be starved as long as their younger counterparts, but consider allowing access to water up until the point they have their premedication. Many will have some degree of pu/pd, but any level of dehydration will put ageing organs under strain.

The choice and dosage of drugs should be carefully considered. Geriatric patients generally need lower doses of both injectable and inhaled anaesthetics. This is due to many factors including changes in their body composition (reduced fat reserves, lower muscle mass and, therefore, reduced body water content and blood volume), changes in liver, kidney and heart function and, for reasons not fully understood, a greater sensitivity of the CNS. They can also have a slower absorption and elimination of some preparations, which should be taken into account when considering the frequency of dosing.

Pre-oxygenation of older animals for five minutes prior to induction should be a standard procedure, provided they don’t find it stressful. This ensures the functional residual capacity of the lungs is fully oxygenated, which acts as a reservoir for the body if there is any induction apnoea or respiratory depression. It is also important to note the lungs have less elasticity in older patients and the respiratory muscles are often weaker and prone to fatigue – both of which reduce the vital capacity of the lungs. Also, the trachea and larynx are proportionally enlarged in elderly animals – increasing the dead space.

All of this can lead to significantly lower oxygenation levels and increased carbon dioxide concentration in the blood, which increases the risk of tissue hypoxaemia and cell death. Therefore, pulse oximetry is vital for these patients and it should be borne in mind they may need higher levels of inspired oxygen than their younger counterparts.

Vets should make every effort to ensure any surgical procedure in an older patient is completed in as timely a fashion as possible. This means we should be adequately prepared and ensure all the equipment and instruments required are to hand. Consider clipping the surgical site prior to induction if they are relaxed enough with their premedication.

During the operation we need the geriatric patient to stay warm and comfortable. Remember muscle and fat loss can leave them vulnerable to developing pressure sores, which is also a consideration for the recovery period. Arthritic limbs will not take kindly to being pulled into unnatural positions and this can be a significant cause of postoperative discomfort. Shivering massively increases tissue oxygen consumption and the cardiovascular system can struggle to cope with the increased tissue demand.

Geriatric patients have a reduced cardiac reserve, myocardial fibre atrophy and reduced ventricular compliance. All this means they are less able to cope with any extra demand – be this preoperative stress, increased oxygen requirements or changes in the blood volume. Close monitoring of the heart rate and rhythm is vital and perioperative blood pressure monitoring should be used if it is available.

Adequate pain relief is essential in elderly pets. If they are left in postoperative discomfort they are less likely to eat properly, will be less mobile and their healing will, potentially, be compromised. However, the choice of drugs is often complicated by organ dysfunction and the issues already discussed in the potentially slower absorption and elimination. A multimodal approach based on careful monitoring and pain scoring should be followed in every case.

Summary

Pets are considered geriatric when they have reached 75% to 80% of their expected lifespan and the ageing process affects all the organs and body systems. This makes caring for them and ensuring they are kept in the best possible health more challenging, but it shouldn’t stop vets from continually striving to do their best for them.

Barriers are often in the way – from the ability of the animals themselves to mask illness, the reluctance of owners to accept there is a problem or have the will to act, and vets’ concerns about the increased complications in treatment, and, sometimes, a simple lack of proactivity in having these conversations with our clients.

However, vets took an oath to protect the health and welfare of the animals under their care and this includes the golden oldies. With a little extra effort, some client education and a few changes to surgical routines, vets have the ability to make a real difference to the quality of life of elderly patients.