Geriatric cats

In human medicine, the term “geriatric” is now being reserved for when age-related diseases are diagnosed and established (often with additional comorbidities), rather than as a term associated with a specific age range.

Feline age categories have traditionally called cats “senior” from 11 years of age and “geriatric” from 15 years, but in the absence of age-related diseases, this age range could be called “super-senior” and the term geriatric used for cats with age-related morbidities, instead.

Cats aged 7 to 10 years are considered mature. However, if we consider the literature on age-related disease (summarised in Table 1), these diseases do start to occur in cats in the mature age range, and the pathophysiological changes that lead to the development of these diseases will be occurring for some time prior to clinical disease becoming apparent.

Additionally, in a study of 206 cats aged 7 to 10 years of age, 45% were overweight or obese, 29% had a heart murmur, 5% had elevated systolic blood pressure, 54% had dental disease, 58% had abnormalities on orthopaedic examination, 10% were azotaemia, and 3% were hyperthyroid. Only 12% were “healthy” of 176 out of 206 that were completely examined¹.

What are the common conditions?

Table 1 summarises the common diseases seen in ageing cats, their prevalence and the ages they are commonly diagnosed.

Key points for working with and advising caregivers

Getting the most out of your annual appointments

The goal is to encourage cat caregivers to bring their cat into the clinic before the disease becomes clinically apparent, giving us the opportunity to diagnose and manage age-related diseases before they start to have a significant impact on the cat’s welfare.

One way of doing this is by raising awareness of the clinical signs of age-related disease at annual appointments and to provide education on what is involved in screening for these diseases, and when it needs to be considered.

Being consistent with your advice across the team

It should be agreed as a clinical team what advice you are giving, including the frequency of appointments, the age ranges under consideration and what diagnostic tests are advised, in addition to when.

Individualise to the animal

Each cat will age differently, so it is useful to have broad categories for advice, but individual caregiver and cat factors need to be taken into consideration when tailoring advice and care plans.

This includes how comfortable the cat and owner are attending the veterinary clinic, what the financial resources are and, most importantly, what the existing health status of the cat is, what medications are they on and what morbidities and comorbidities are present.

Be upfront about costs 

The individual cat’s disease status should always be taken into account, as this is often the main factor to determine the frequency of visits and the type of diagnostic tests advised, which are the main factors impacting the cost.

It is important to realise that we really do not know how frequently healthy cats should be visiting the clinic. Guidelines produced are based on the best evidence available, and that evidence is poor.

Geriatric or cats with a known age-related disease should probably be visiting the vet every three months. With a healthy geriatric (super-seniors) then a longer visit every six months and a shorter appointment every three months could be considered.

For senior cats, every six months is likely to be the most appropriate; for mature cats, an annual vet visit with potentially a short six-month check should be suitable.

What should we be including?

A thorough clinical examination should be included with every appointment.

Key points for clinical exam

• Weigh the cat at every appointment and record the body condition score.
• Record the muscle condition score. This may be using a formal muscle condition score system or just a descriptive note of what you are seeing.
• Always look in the cat’s mouth; dental disease in cats is very common.
• Palpate for a goitre.
• Listen to the heart on two to three different occasions during the exam, as the presence of a murmur in cats will vary with the heart rate. Listen when the cat first arrives and then later when it is settled, and again if it gets upset during the exam.
• Have a good look at the coat and note any areas of over-grooming or under-grooming. During your history and examination, try to observe the cats walking around the room, too, and perform an orthopaedic examination if indicated.

Diagnostics

Blood pressure

Ideally, blood pressure should be part of an annual exam from seven years of age and at every appointment for cats that are hyperthyroid or have chronic kidney disease (CKD).

Blood pressure will increase with age, so starting from seven will get cats used to the procedure and hopefully reduce white coat effect.

Cats with a reading of more than 140mmHg (if they have CKD) or more than 160mmHg should have their retinas examined for signs of hypertensive retinopathy.

Urine sample

Ideally, collect a urine sample annually in cats older than seven years and more frequently in cats older than 10 years.

Test urine specific gravity, perform a dipstick for blood and bilirubin, and a sediment exam for crystals and inflammatory cells.

Bloods

Blood sampling could be included as part of a standard senior health check package on an annual or bi-annual basis; alternatively, you may choose to do bloods when the indication exists to do so.

Table 2 summarises some of the common clinical indications for running routine biochemistry and haematology (minimum database). 

Summary

Develop a general structure for your clinic, but always be prepared to modify it for the individual. Aim to be consistent across the whole team, so that the caregiver is not receiving mixed messages about the care of their cat.

Regular examinations in practice, monitoring weight and assessing the cat for common conditions that have a large impact on individual welfare, such as dental disease and musculoskeletal disease, can be hugely beneficial.

The caregiver is more likely to undertake further diagnostics if they trust the veterinary team and can understand the individual value for their cat.