Senior cat care: treatment options and owner advice

Senior cats – those aged 11 years and older – benefit from closer attention to maintain health.

Regular preventive health care checks are useful in facilitating earlier diagnosis of illness, but attention to general care at home is also important to maintain quality of life. General care tips include advice on litter box provision, grooming, nail trimming and diet.

Routine preventive health care checks

The author follows the CatCareforLife guidelines proposed by the charity International Cat Care (Table 1). These recommend senior cats have a preventive health care check – including blood, urinalysis and blood pressure assessment – every 6 to 12 months.

The author prefers to see super senior cats – those aged 15 years and older – every 3 months, if possible, checking blood pressure and urinalysis every 6 months, and blood profiles every 6 to 12 months.

Health questionnaires are useful in spotting any problems and teaching carers what signs to look out for (Table 2).

Carers should be encouraged to contact the clinic if they notice any change in their cat’s health or behaviour, however trivial they think this is.

Litter box provision

The author is a keen advocate for all senior cats having access to an indoor litter box. Litter boxes are helpful for a number of reasons:

• Many common health problems affecting older cats result in polyuria: if a litter tray/toileting area is not easy to access, toileting accidents are a possible consequence.
• Cats with cognitive dysfunction syndrome may forget where their normal toilet is: providing a litter box in the area of the home they spend time in helps prevent toileting accidents.
• Mobility problems are common in older cats and may make accessing a normal toileting location difficult (for example, if passing through a cat flap is needed); offering a litter box is often helpful to these cats.

The litter box should be roomy (1.5 times the cat’s length from nose to tail base), easy to access (for example, having a low side), and placed in a quiet and private location (Figure 1).

The preferred substrate for most cats is a clumping sandy consistency litter, which is comfortable for them to stand on and easy to keep clean through scooping clumps and faeces at least twice a day. The tray should be completely emptied and cleaned at least once a week.

Carers should be urged to monitor the litter tray for changes in urination and defecation habits. Presence of blood in the urine or stools, altered consistency of stools, malodorous urine or any other changes should be reported to the veterinary clinic, if seen. The quantity and frequency of urination may also indicate a problem if it changes.

Nail maintenance

Carers should be advised to keep an eye on their cat’s nails. Elderly cats are less able to retract their claws and, if less active, may not “strop” their nails as frequently or effectively. This can easily lead to the nails becoming thickened and overgrown.

Overgrown nails can become snagged in furniture/carpets and may cause discomfort. In worst cases, the nails may grow into the food pad (Figure 2). Depending on the individual, regular trimming may be needed.

Grooming

Older cats are less able to groom efficiently and may, therefore, benefit from grooming assistance at home. This may include wiping ocular and nasal discharges, and brushing the coat with a soft brush.

Care needs to be taken to ensure grooming is gentle in cats with poor body condition and those with painful underlying conditions, such as OA. Soft rubber grooming gloves (or even washing up gloves) can be used to massage the skin and coat, and remove loose hairs – elderly cats often love this. Attention to grooming can also help minimise hairball problems.

Dental checks

Dental disease is common, so it is sensible to warn owners about this possibility and advise them on signs that may be associated, such as gingivitis, halitosis, drooling, a “chattering” jaw, loss of appetite and pawing at the mouth.

Mobility problems

OA is very common in senior and super senior cats, but can be difficult for a carer to spot since affected cats are not commonly lame and, often, the main changes are in their behaviour or lifestyle.

Mobility questionnaires (Table 3) help identify cats that may be suffering from mobility problems and/or chronic pain, and also serve as a way of educating carers on what signs to look out for. Support of cats with OA may include environmental advice and support in addition to, where indicated, joint supplements, mobility diets and analgesics.

Environmental advice might include:

• advice on flooring in the home: non-slip surfaces where possible
• provision of an easy-to-access litter box (as aforementioned)
• an easy-access bed: for example, a pillow on the floor covered with a fleece blanket can make a nice bed for a cat with OA
• consideration of providing a step or steps to enable access to favoured sleeping places, such as the bed or sofa
• raising food and water bowls (Figure 3) can make it more comfortable to eat and drink if OA is affecting the elbows, shoulders or neck
• regular play and exercise has a positive impact on mental and physical health, so should be encouraged

Dietary advice to carers of senior and super senior cats

Cats aged older than 11 years are vulnerable to losing weight since they have a reduced sense of smell and taste, and a less efficient digestive system. Increasing the amount of food offered, preferably in the form of multiple small meals, may be all that is needed to maintain bodyweight. Offering very palatable diets may also help.

Monitoring of bodyweight and general condition is of enormous value in determining the most appropriate diet for an older cat – the ideal being to find a regime that maintains a healthy bodyweight and good health.

The dietary options available to apparently healthy older cats include:

• Standard commercial cat food. Because of the changes to an elderly cat’s ability to eat and digest food, it is important to ensure enough food is offered to maintain a healthy bodyweight. For example, an increase in appetite by up to 25% might be required in some cases. To achieve this intake increase, more palatable foods might need to be offered.
• Life stage diets: senior diets are formulated with the older cat in mind and, often, phosphate restricted, with supplements aimed at supporting mobility and cognitive function.
• Home-prepared diets: with advice from a veterinary nutritionist.
• Therapeutic diets: for cats with a medical indication for a specially formulated feline food – for example, patients with chronic kidney disease.

How can appetite be encouraged, when needed?

A fall in appetite is common in elderly cats. In those where the ability to digest fat and protein is reduced, this can lead to weight loss. Tips to offer owners to encourage appetite include:

• Offer food little and often – for example, four to six meals per day as a starting point.
• The food should be easy to access at all times. For cats with mobility problems, this might entail having multiple “feeding areas” in the home.
• Food should not be placed close to the water bowl or litter tray, as this may put the cat off eating.
• Consider the type of bowl used to offer food: cats usually prefer wide, shallow bowls (such as saucers) so they are not placing their head into the bowl to eat. They also dislike their whiskers touching the side of the bowl when eating. Cats often prefer to eat out of stainless steel, glass or ceramic bowls, rather than plastic ones, which can absorb some of the food flavours and be off-putting.
• Offer food at room temperature, rather than fridge temperature. Gently warming the food to just below body temperature can increase palatability.
• Experiment with the consistency of the food offered. Some elderly cats – especially those with dental problems – prefer soft food to lumps or dry biscuits. Try adding a small amount of water to the food and mashing with a fork to see if this increases palatability.
• Raise the food bowl: this may offer more comfortable eating to a cat with arthritis affecting the neck. Try placing the food bowl on a box or other raised surface (Figure 3).

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  Avoid leaving uneaten wet food out for more than a couple of hours depending on the ambient temperature. Regularly replenish with fresh food in a clean bowl or saucer.

• Sitting with the cat while talking (and possibly grooming) can increase appetite.
• Catnip can increase palatability of the food.
• Choose a quiet area for offering food – noisy or busy areas may put a cat off eating.
• Some cats like to eat in private and may appreciate a dark, safe area to do so.
• Many cats appreciate being hand-fed, although this is very time-consuming if done regularly.
• Smearing a small amount of food on to the paws or face can stimulate eating.
• Avoid leaving a range of foods out for prolonged periods as this can be overwhelming and off-putting to the cat. If not eaten after an hour or so, this is usually a good indication to take the food away and try again later.
• Tempting treats can be helpful in triggering an interest in food. Examples include cooked chicken or fish, cooked prawns, cheese and some proprietary “cat treats”. Bear in mind some of these will not be ideal if the cat has a medical condition – for example, meat and dairy products are high in phosphate, which is not ideal for a cat with kidney disease.
• Offer foods that are familiar to the cat, as well as different (highly palatable) ones. The form, smell and taste of the food offered are extremely important to cats.
• High-palatability foods for cats include seafood (such as tuna, sardines and prawns), meat (such as ham and bacon), poultry (such as chicken breast) and dairy produce (such as cheese). Seafood, meat and poultry should always be cooked first.
• It is often worth offering dry cat food to reluctant eaters, as many cats will eat this highly palatable food and can swallow the biscuits, even if they have no teeth or a sore mouth.
• For cats receiving medication, try not to associate timing of medication with meal times. Some cats can subsequently start to associate food with unpleasant events and this can put them off eating. For cats that dislike their medication, it can be helpful finding someone less involved with other aspects of their daily care to dose them.
• Avoid offering “human” foods. For example, foods containing onions are very toxic to cats.

How can drinking be encouraged, when needed?

Elderly cats are more vulnerable to becoming dehydrated – especially if suffering from medical conditions such as kidney disease. Tactics to encourage regular/easy water intake are, therefore, encouraged and include:

• Ensuring water supplies are always easily accessible to the cat – for example, on every floor of the house, outside in the garden and never too far away from where the cat may be sitting or sleeping.
• Cats usually prefer to drink from glass, metal or ceramic bowls rather than plastic ones.
• Experimenting with different size and shape water bowls – some cats prefer to drink out of tall jugs or glasses rather than bowls. Some cats prefer a different colour bowl to others. Cats do not usually like their whiskers to touch the side of their water bowl and do not like putting their head inside a bowl to drink. A wide diameter bowl is often popular.
• Cats prefer to drink from bowls that have been filled to the brim – they rarely drink from bowls that are not completely full as this requires them to put their head into the bowl.
• Raise the water bowl: this may offer more comfortable drinking to a cat with arthritis affecting the neck. Try placing the water bowl on a box, upturned bowl or other raised surface.
• Some cats prefer to drink from moving water sources. Examples would include dripping taps, showers and water fountains. A large number of types of water fountains are available through many pet stores and veterinarians.
• Offering flavoured water: this may encourage the cat to drink more, but it should not be a salty liquid as this may increase the risk of systemic hypertension. Examples of ways to do this include:
  • Poaching chicken or fish in unsalted water and offering the liquid (once cooled) to the cat as a drink (this can also be frozen and used over a period of time).
  • Offering juice from a drained can of tuna/salmon in spring water (not brine) or frozen cooked prawns.
  • Liquidising fish or prawns in water to create a fishy broth. Again, this can be frozen for future use. Some carers find freezing the liquid in ice cube trays helpful. A cube of frozen broth added to a bowl of water may be enough to stimulate drinking.

• Experimenting with different types of water – for example, tap water, collected rain water or mineral water to see if the cat prefers water from different sources. Some cats prefer drinking warm water, so experimenting with the temperature might also be worthwhile.
• Make sure the water is clean and replaced regularly.
• Adding water to the food (whether it is wet or dry) – some cats will tolerate a food that resembles soup.
• If the cat has a feeding tube in place then extra fluid can also be given by this route.

Treatment options

Many common illnesses in elderly cats can be successfully managed with a good long-term outcome. Detailed discussion is beyond the scope of this article, but some summary data is presented in Table 4.

Summary

Successful elderly cat care requires attention to detail, but can often be rewarding for cat, clinician and carer alike. Simple home care tips can help maintain quality of life and are easy to adopt. Maintaining contact with elderly cats and their carers helps optimise health care through early detection of illness and appropriate interventions. Many conditions affecting elderly cats can be successfully treated with a good outcome.