16 Nov 2015
Kit Sturgess
Job Title
A diabetic Jack Russell terrier undergoing continuous glucose monitoring.
With the elderly pet population increasing and, for some practices, providing up to 60% of their revenue, it is important to focus on specific ways of looking after the health and welfare of senior and geriatric patients.
This should be a practice-wide initiative aimed at developing a clear message to owners on the importance of health and welfare to elderly patients and how this can be delivered. As much focus should be placed on keeping the patients both physically and mentally well as in managing them when disease is identified.
Maximising health and well-being should be based on:
These concepts can be brought together under a single umbrella as a comprehensive senior health care plan (SHCP) with the practice looking to develop some senior and geriatric champions among all levels of care givers and receptionists. Elements important to such a plan would include the following.
A number of quality of life surveys have been published and validated, but it is important any survey links in with the services the practice offers and local population and disease prevalence.
Owners of older pets tend to consider routine vaccination and worming is no longer necessary. While vaccination and worming may not be appropriate for every elderly patient, this has to be a risk/benefit analysis and a conversation with the owner rather than a blanket policy. For example, surveys of older pets demonstrate a significant number have endoparasites.
If the practice does not take a lead in discussing diet with an owner then he or she will look for information elsewhere, undermining the practice’s status as a balanced and specific patient-centric source of advice.
Policies need to be developed on a variety of issues, such as the evidence for feeding senior diets and when they should be started, how to manage obese elderly patients – especially those with osteoarthritis – and what the approach is to the elderly patient whose weight is gradually falling.
Many owners are worried about the risks associated with anaesthesia in elderly patients. In reality, age per se is not a significant factor. Older patients are at risk due to their accumulated health issues and the ability of their major organs to function under stress.
This is an ideal area for a leaflet allowing the practice to explain the way it manages anaesthesia in elderly patients, its policy on pre-anaesthetic blood testing, clinical audit of anaesthesia in this patient group, risk assessment of elderly patients and so on.
Specific attention should be focused on identifying common diseases such as:
Understand the benefits and potential risks of routine monitoring of:
It is vital any routine monitoring is accompanied by a “what if?” response – for example, when measuring creatinine in a cat, how the practice will respond if the creatinine is 180µmol/L – especially if six months ago it was 135µmol/L.
Giving help and advice to owners whose elderly pets have worsening disease, should include what options are available, their costs and their impact on the patient. This could be:
With any SHCP, a major strength is collecting the same data set repeatedly. Within our veterinary species, for a single parameter reference intervals are often relatively wide, but with repeated measurements we can start to develop a more patient-specific expectation.
For example, if on a routine check-up an elderly Labrador retriever has a PCV of 38% that lies within the reference interval, but as part of serial measurements when on the past three occasions it has been 48%, such a change may be significant. It is important to appreciate just because a parameter is inside a reference interval does not necessarily make the value “normal” for a particular patient.
The key challenge for any practice-based SHCP, particularly if the practice is large or has multiple branches, is to deliver a consistent message and provide a consistent response if measured parameters are starting to change (beyond a watching, measuring and waiting approach until the patient is clearly clinically unwell). This is where senior and geriatric champions can deliver real advantage, both as the “go-to people” for advice, as well as to encourage others to deliver the practice-agreed SHCP to as many elderly patients as possible.
Effective delivery of a SHCP can take a variety of forms:
Properly setting up such a plan can be time-consuming and resource-intensive, but it sends out a clear message to local pet owners that the practice actively cares about keeping its senior and geriatric patients fit and well and the practice does not just wait until they become obviously sick to treat them.
As part of any SHCP, it is important to understand the deep bond that has often developed between an aged pet and owner – to you it may look like a slightly smelly, creaky old dog, but to the owner it has been a companion for 15 years. Listening to owners recall stories about their pets may seem a waste of time, but often gives us a clear back story about the owner’s motivation and, on many occasions, helps us understand his or her pet has helped him or her through difficult, emotional times or provides a link to a human family member who has since died.
Ageing is an inevitable biological event, not a disease; there is some evidence nutrition can slow the ageing process (Kealy et al, 2002).
Possibilities exist to positively intervene to identify early signs of age-related disease to maximise patient health and welfare. There is very little evidence such actions will increase longevity other than delaying the decision to euthanise – more research in this area is crucial. There is good reason to believe early intervention will help maximise health and welfare, improving the quality of life of our elderly companions – this is a key role of the SHCP.
