AAFP–AAHA Feline Life Stage Guidelines

Amy Hoyumpa Vogt, DVM, DABVP (Canine and Feline), Background and Goals Guidelines Co-Chair Cats have become the most popular pet in the United States, yet statistics about veterinary care for cats remain troubling.1 Although most owners Ilona Rodan consider their cats to be family members, cats are substantially under- DVM, DABVP (Feline), served, compared with dogs. Guidelines Co-Chair In 2006, owners took their dogs to veterinarians more than twice as often as cats, averaging 2.3 times/year, compared with 1.1 times/year for Marcus Brown, DVM cats, and significantly more dogs (58%) than cats (28%) were seen by a veterinarian one or more times/year.2 Cat owners often express a belief Scott Brown, VMD, PhD, DACVIM that cats ‘do not need medical care’. Two reasons for this misconception are that signs of illness are often difficult to detect, and cats are perceived C A Tony Buffington, DVM, PhD, to be self-sufficient.2 One role of the veterinarian is to develop a partner- DACVN ship with cat owners that will pave the way for a lifelong health care plan. M J LaRue Forman, DVM, DACVIM These guidelines aim to outline an evidence-based life stage wellness program to aid the veterinary medical team in delivering the best com- Jacqui Neilson, DVM, DACVB prehensive care for cats. Specific goals are to provide:

Andrew Sparkes, • Recommendations for optimal health care for cats throughout the dif- BVetMed, PhD, DipECVIM, MRCVS ferent life stages. • Practical suggestions and tools to facilitate improved veterinary visits and to enhance the client–veterinarian clinical encounter. Corresponding authors • A foundation from which to access sources of additional information. (Co-Chairs): A Hoyumpa Vogt, Life Stage Classification [email protected] Distinct life stages (age groups) in cats are not well defined, in part because individual animals and body systems age at different rates, a I Rodan, [email protected] process that is influenced by many factors. These guidelines follow one convenient classification (see box on the next page). These age designa- tions help to focus attention on the physical and behavioral changes that occur at different stages (eg, congenital defects in kittens, obesity pre- vention in the junior cat). It must be recognized, however, that any age groupings are inevitably arbitrary demarcations along a spectrum, and not absolutes.

The AAFP and AAHA welcome endorsement of these guidelines from the European Society of Feline Medicine, and acknowledge the help of the Feline Advisory Bureau’s WellCat for Life programme in helping to formulate the guidance.

70 JOURNAL of the American Animal Hospital Association January/February 2010, Vol. 46 AAFP –AAHA Feline Life Stage Guidelines 71

These guidelines follow a convenient life stage classification developed by the Feline Advisory Bureau and adopt - ed in the recent AAFP Senior Care Guidelines. 4,5 Six age groupings are defined, from kitten through to geriatric.

is justifiable. More frequent examinations may be recom - Evidence-based Health Care Supporting references for specific recommendations are mended for seniors and geriatrics, and cats with medical and supplied where possible, and any previously published behavioral conditions. guidelines on particular topics are referred to where rele - Semi-annual wellness exams are often recommended for vant. Readers should note, however, that the guidelines all feline life stages by veterinarians and veterinary organi - panel was hampered in its efforts by the relative paucity of zations. Their reasoning includes the fact that changes in disease incidence data by age group that is available, and health status may occur in a short period of time; that ill cats there is an urgent need for research to guide the future of often show no signs of disease; and that earlier detection of evidence-based feline health care. 3 ill health, body weight changes, dental disease, and so on, allows for earlier intervention. In addition, semi-annual exams allow for more frequent communication with the Getting Started: The Wellness Exam To achieve optimum feline health care, veterinarians must owner regarding behavioral and attitudinal changes, and help owners to understand and appreciate the importance of education about preventive health care. Further research is regular preventive care for their cats at all ages. A consistent needed to identify the optimal examination schedule to message from the entire health care team is crucial, begin - maximize the health and longevity of the cat. ning with the first kitten visit and reinforced during subse - The panel members concluded that preventive veteri - quent visits. Early detection of clinical abnormalities and nary care can improve quality of life, detect illness earlier behavioral changes can improve disease management and and, therefore, reduce the long term expenses associated quality of life. 5,6 with a cat’s health care. They believe that cat owners are willing to seek more veterinary care when it improves qual - How Frequent? ity of life and detects illnesses earlier, thereby reducing the The panel supports the recommendations of the American long term expenses associated with their cat’s health care. Association of Feline Practitioners (AAFP) and American Improved client communication and education of the bene - Animal Hospital Association (AAHA) that a minimum of fits of regular veterinary care are essential to achieve that annual wellness examinations and consultations for all cats goal (Fig. 1). 72 JOURNAL of the American Animal Hospital Association January/February 2010, Vol. 46

Identification According to one study, 41% of people looking for their lost cats considered them to be indoor-only pets. 9 American Humane Association records reveal that only about 2% of lost cats ever find their way back from shelters, a major reason being the lack of tag or microchip identification. Assuring the identifica - tion of all pet cats, regardless of their lifestyle, is rec - ommended to increase the prospect of lost cats being returned to their owners. The wellness examination is the ideal time to discuss the importance of identifica - tion with owners. The benefits of both visible (eg, col - lar and tag) and permanent (microchip) identification —The benefits of regular wellness exams often should be explained and compliance with identifica - aFriegunroet 1immediately apparent to pet owners and need to tion recorded in the medical records along with other be well explained. Courtesy of Ilona Rodan. elements of the history.

The reasons pet owners have cited for not seeking care were that they did not know it was necessary, the veterinar - Specific recommendations about age and frequency of ian did not recommend it, and the need or benefit was not laboratory testing depend on many factors. 5,18,24 One con - well explained. 7 Other obstacles include the cat’s stress or sideration in determining this frequency is that the incidence fear associated with veterinary visits and the practical diffi - of many diseases increases as cats age. Guidelines for man - culties of transporting cats to receive veterinary care. agement of mature, senior and geriatric cats may be found Suggestions for overcoming such barriers are provided on in the AAFP Senior Guidelines. 5 Retroviral testing is dis - page 77 . cussed in detail in the AAFP Retrovirus Testing Guidelines. 22 Measurement of blood pressure is discussed History-taking in detail in the ACVIM guidelines. 25 Although limited inci - It is not the intent of the panel to reiterate the basics of the dence studies have been performed to identify the age of veterinary visit, but instead to offer a checklist to assist the onset of hyperthyroidism in cats, the panel recommends that veterinarian (see Table 1). Where relevant, aspects of feline veterinarians strongly consider T4 testing in the apparently behavior, nutrition, and various disease prevention and healthy mature cat. More robust incidence data is needed to detection strategies are expanded on in the text. develop firmer recommendations. History-taking includes the use of open-ended question - ing (eg, ‘How has [cat’s name] been doing since the last Nutrition and Weight Management visit?’). 8 This approach is often combined with a template or checklist, such as given in Table 1, to ensure important Diet Basics aspects are not overlooked . Energy and nutrient needs vary with life stage, sterilization status and activity, and so general feeding recommendations Physical Examination provide only a starting point. Individual intakes must then When performing the physical exam, particular attention be adjusted to maintain the desired weight and body condi - should be paid to: tion score (Fig. 2 ).

• Observing the cat from a distance to assess breathing pat - terns, gait, stance, strength, coordination and vision. • Changes in parameters from prior exams (body weight, body condition score [BCS], vital signs). • Other specifics as noted in the discussion/action items in Table 1.

The Minimum Database Although specific data documenting benefits are not avail - able, the panel concluded that regular wellness examina - tions and collection of the minimum database (MDB; Table —Regular assessment of weight and body condi - 2) can be valuable, allowing early detection of disease or Ftioignusrceo2re is important in cats of all ages—and this needs to trends in clinical or laboratory parameters that may be of be stressed to owners. Expressing any changes in weight as concern. Additionally, it provides a baseline for interpreta - a percentage, or in terms of an equivalent weight loss/gain tion of data recorded at subsequent visits. in humans, can be helpful. Courtesy of Deb Givin. January/February 2010, Vol. 46 AAFP –AAHA Feline Life Stage Guidelines 73 ) e g f a o f p s , i e o s t t i d v n i r y x e t t g i h i i / e b l t n s r n a , n y g C a , d t x o u I i ) i o l o e t s i o q n n c R e b a e b b i t o o i r s i n r z T r u s r i e ) s s o s l c o r s o t i o A e s d i y i u s t u / a t I s u f t i e n c e n d c c e i n s l i c n R + s e o o n o d u i e n c a o f 5 v o o u S E i n E M D s a t f ( f l c p i i 1 t • G • ( • A s n t H a o A c A C r ( , d e y s d n d t l s e e h a t s o a s i g b l t : 8 5 u o e n j t ) a t 1 w d / n s f “ t s a s n , d i e e e o t t y n i t l h t l i a g o t y s n i a o e r i c l c l e o i b a , n e h ( C ) r m e g t b u ” x r e i m r o y R t n e d s e o u e i d s i r e t a a o s t v g b g r n s u O r a 4 a o c i I d u a a n u a e r d t e 1 v u G e s o h m a t c e - N o a s d t n d e s n c b e l h f t e 1 o h g i E r E E n c o e a l f a b t o o 1 o a • S ( • t D C n r e r o o f m i e n s s g e e , o f a m t S n d i o n l e e y P t a e t b e i i y l F d E i c d m i , s ) A b n x n e u R s i a c y i s a o A o s e f t G U i i / a b r s m 0 t e c d e T e o e r d 1 h r c r e e o t c p - e A t c o a t a p o c I t 7 / n o n m i C i S I M i g a l ( f n n o i o i s t s c u y l A d c a p t a e o l ) t n t r s t u n e y p t i e i d n t t a a f r o e i h s e v h r e n d t c d e e n a v e g e d g l i m g e n i i v n t m y i u e a r e a u y c e t a r e t c r e i n m s e k q w g g g c i T f t a e ) a u b w o h a g h o n i e r e e n a a n c r n L i o y t r c 1 c i i r e a o s e c d i , n a l h ’ e v r r c t l o a v r j a t e U r f i g c a e r s c t e 6 e n u n i n b s m t e a e e t o - e e s n n D p o l R E s T e h e t i c ( i o a m o v e 3 r s s S w o i f v T • A • ( • b u a c T s d i f h w r y n t o i o o D a a l l l n w : p s e a s o r t i l n e i t n i t a o l d a ) t i a o s t a e c l i e i y r y c t e a R , t e u g u i c o o c d i V r h d p n n 2 i - s O r i t a i i - r u I t r v e t y t n u n i s e d t n e o t e a a a o N t m r a n e o s n r e n I P U i a m d m c t m m f 7 e • J • ( n l l e s s W s t g e i d n v e s i ( i n o t g o i / v t l t a e a n e s i i t r a ) e n y s d t e t n a r e r a s r i w i t i h t e o n : r o t a c e s n a n a a i i c d a t l ) - c p a m r s N t c p l i r , n e r c n t u s i h d i w h e s m a i o a u t r m e E g f i m e a l e q r l c c e c w u d o y s e n n T c d a d n e p a n m m r t e o a c e s y l a l o o 6 r c e r n e d l l p e T o o o a e s - e o o I i C B C C T h p a t g c a r a p a c t c c v A 0 D • • K • • • • ( r e : g e h ) l s e n t r l r i g s g y d ) t l a s t g m d a t o o n i o n n n i f s e b a g i i n s e u o n o s t s v o n s / f o ( i i d d i s n u n h n o c h a m t f i i t i n d a d o v t e n s n c n e l n t s c e a o m c a r p t S g e l : i n e n n a e e n p a ) u t y o y c x e a p a p a l d e e e r e t i r h d o e E i s l s d m r r c o r t i n e u t / c l m m n f p n g n / o ( t i e a h a s - g c a e e i n n e l r m ; a e m o G i u e a o a n a r l t n t c d n e n s t ) s v m i h n s e r o e s a i o r i c r h i t b t s p n a r e m e o s r s l s t A a s , a m a o y s i d u i u y o c u n t i o l r e l a a v a v p l i s o e s o c a u n i c n e r v h e t q e d n r t r s d c t a n p c i s a n c e e L i y i s e i e o u h g a s n e u k n t e h r n r r f a e n o i n e i n l s t e i r i o e m l L s i d R E D H M E H H C E B T c f v ( r m a s i p i p o e f ( p e t p d G E d • a • • • • • A • A • • • • • d t n n a e r l m o i a n r v o e r a i n h v e e n G B e 74 JOURNAL of the American Animal Hospital Association January/February 2010, Vol. 46 ) e g e a c f n p o a t t r w x d o e g i n e p n v a i n C e s m n I i t r s a n n n r R g e e o l o a n i T l i ) c t m u s A d a y I e d g a l c e i n e e R + p r u d r a p 5 E c r e n t u i 1 n o h t I f G m s ( g n i e o h y C , r ( e a z s n i n s o s i n o e s o x c i s s t c o e i u e f a b n i r r c c r g u o s ) f e e o d a t r p y t R , i e p l s s y s O t 4 r t e i I y a l s o i 1 s n / e m - N u i b r n j a d 1 g c o E g d n f i 1 e n I m S a ( o s A r r t s f s s e o h e / o u z g i g m d c i r c , e s n n r i r n o e e e y f f h d o t t a o i t o a h t i x t i e d i f i l e c n h s E i e o h e g s n r e e ) c s e t e s s b s s b r n n y R s a o o g a p i y e i t a o a t a u e n r i o t r i e w d s l p s U e i s t r e h v a e a g y n m m 0 e r e i t r e n t l i c r y n b c s t T c i t o c o c 1 i e g c v e e c n u r n l e u d u s e l i t - A n t n e a M I s s i s d a o d p a s n f a g a I 7 / o • M ( • R a o t c e a n n o i o i s t s c , * t e u ) ) h n A c c i t l g i d s e e i d e o s e t , t d n w a n B ( u a b e a c t D i s n u T a f s ) i e i q M s n s d L t y g s e c , u t o l U s n e n i c e S 6 u s b a - s s D p i o C d s u h 3 s S D a A a s c ( B c ( u e s c a 1 s b i a e t l D a , e s d a : b n , S t e t t t g e o n i a t m a C * n a t z n d ) o u d a i i s i B T e s d ) a c i t t s h h t m s s u , c t e o i y a s e t s R e e V e x i q n n z s y l i i h m g i , s l g o e 2 l m u O t b i g n - r m s I s e s n i b i B r m i c o a f a s t b a e e s o r = s w D N n i m t n s a u h c e w o o f e o t B S D U i e b t s c ( M c r t 7 i D n • J • ( C l a g l l M , e e r o W c s s n d o , f 0 o r i n t n o 1 i p n t r a o d i o x a s u i g t ) n t N g t o n s o o n y a l , n i i n a b r s E o c i m z a v p e i d n c e u r l r n i T y s a i u u c m g 6 r - e e l a d T d e r h r t t f - m s I e c f t i o i e n i g i o e l t u e l 0 b n D s K i a s ( d a L s c n b e = S C B , , y , l s c s t r a n n , a c i e t , e s e e s ) / t g r s u n y z g d d s s r i c m m f n e e q e n n n n m n S n t : s u = a i d e e o e t d - l t e o t r o a a o i e , s i o , i g m i n r i t v E i l i y , / s r e p t s i t u f x t l l : t c , g t a e i a r y i , ( s ) n u e h p d a y o r y t t a o G a s a a n s t i i a g e y r i y o s o b u t o c - n r b t u h h s s c c r t i s i b h n s i i i i n a t t t t i r a A n t t s l l i i n l h u n r o v e o r a u a m d d d t n ) n o e n t a a m r a c a b b a a i u e e c i e c i n g L u e o e c e e a v s t c r e t r l k t i a l e n e a a u u t o l t s s e n e i o L m s i i P M O U E c m h c ( p a m h m e h h h q m l q ( e c l G A d • a A • • D • • = m . n o i s s ; u y r c s o i t d s n n i t o o h x i i / t t e l l t a a a a z e c c n i i i i l e i d g r S m r i e e l * u t M s s E January/February 2010, Vol. 46 AAFP –AAHA Feline Life Stage Guidelines 75 ) e g a p e k t e t t a t x a t l a . h r e e n u n i g f e i n o C o n i d e d t I i t i o o a w y R n d / t o p m i f n T l o S s i ) r o o A e m b C y t c o I d g t o a B i r e d y R + n n f n i e d d u a 5 E o e e o n d h f n 1 i i F b G ( M a c l n t a f n o , o s y r t i C o l ( a m u u t q l d a e r e s o s a a r e ) e o s f r i y R t c d r h O 4 e l o g I t i d a i 1 t - e N n n d 1 w o E e n 1 r d a M S ( . o y f l g r n o i t i d s n r o o m c M e c t . a i n E ) e o n i R s k y t i o a U i d t m 0 t T n n i 1 c e o - A t a c d I 7 / M ( o y n o n d f o i o o y i b f s t i s s d e c s t u o u a ) A c r c m d e s s i i d d d e d d n o n a u d a m c i n s n T f ) o i a e i n t L t y r g c o d U o n n i e 6 t e i a - s D p o e n h 3 s o S F c A ( c ( u M c 1 s i c i e r n l D e s o n y l o s i i e : b t d a a t g i e a a o e C n s r z ( s b o r i T ) a i t l c a . i o h y e r f e e ) n R t d V g r c e d r s o a e t n c 2 i t O i r o e t - s e I s s l n i t h d f i i e d r a d s g e N n d m i d e d e n e t m o o e e U n e f n r o 7 e n M w J ( c a m n a a b f l l e h W t h n d t s t i o e s w d u i t t n t ) w o n y : t i s o s n y e n d r a t a h e n d s i e e e 9 e e o t n g , t e i e l m e r s 1 v e n u n u t i t i a g / g a c : m a t n r e s s a e n o o / a q o a a ) n e n t N t t n u s e s c e d i a o r a g e c i h l s g a u t e ) z i i h l r t r r i h d r t s v i t u h o h n e a l u E n s d a d m d d s h h h y i i i r u m o g o c s p u u o t t t u d n r t r n c i r y e T r a f n c e d d e m v s u u q o t e o o c i x m o a t e i 6 g o e e u n e i a r l r e n o n f T i t a - t s e n e o o s o e l I o d M P F D I h b t a t s ( e d t ( s a i m b r a w m t t f o A 0 • E d • C • • K • ( • e s c n , ) S n l o s e s f l i g r ( r a t C t a t t o a a t n a n s r t a / i B e t e n t i c e d o n d g y n s n e a d m i d S n p e e n d n e m e i r o r d e x = , n e t a d e n i v E r , m d a t i a a l a i a l y m t l r i s s a s o e s e c m i G a s , t e u y s s l n o s s s s r e v t r s h s h g n h i u u t f a e e m t s A a u h l t a u e e g c c e v p t n o o e e c i r m a n d h d s c i r s s n n e o c L o s s i i e t t o i i e r e n r e n f s o s e e L i M D D S c h d d h p d a p b a r o a w m • G • • d a A • = m . n o i s s u * t c d n s * i n e h d t a l t m x a n e e e t t o g i h t h a i e l r g e n t i a a S r u e * N O w m 76 JOURNAL of the American Animal Hospital Association January/February 2010, Vol. 46 e s a b a t a d C m I u d R m i n T n ) s a i r A y t I m o t n = R + c e 5 a E B f m 1 D s G ( e l s M y e , t s e s r s e o f a i . c l s s k e d s n i n n r o i i l a t i e e t d h d t a n i l o u u a l c ) g e a y t y R v h d n E o O 4 n e I . b r o 1 r s - N = u e g 1 E c n n C 1 i i l r S ( S d e e B n d p , i e s u s p r g a a e s t e , d y n d , m r e = e r t e a r t y a e i u , E c y i c / s ) n d h s R s r y t n o e e n i U i m 0 o p t f m T i i 1 c t e m s , - A t a a s I = 2 7 / - M ( e s n 1 m n n e i o . s c i n o n i i c s o c m t i a c s s a c v s a x u u v ) e e A c c r l s e d s o i r a i d c d e c o - d n t c e n x u f a c o e t e i t n n T f ) c u i i e n f L t u y n i e c o t d o U n S i e 6 n n e - * s D p o o o s 3 s C u S C A ( c ( u c 1 s i / e s l D e g e l s : b n n r a i i d t m i o i c c a d n t t l c e s n c a n T ) f a i 4 a , r e a o - g i y i f h v e e R t p V t 1 e , t n v l i / u a e e 2 u e . O w w l a l n s y - n n d I s s n i r i y e e e i p e t i i t t m r e c o s N h i m e v n v t s m n c r a a r s e e o e e U i x n o o a e c e f 7 i n R c c v s C R h s e y o J l ( l l e W g s . n s k i d e e r e k l l e e u r i s f u y t n e n e d i d a t n g n o d m n e e c n s e , w n o w s a u i c h i s s w y e e e t t ) o n f x N e , t 9 a i h e t y m l - a ; t l m n 2 e e u e v w r s E t l . m 3 n k e n m h l r t s y n i i e e o i i m y t l i p e T i t n g f o r . a V t r e f c k o i n 6 i h v w L m c u a l T u e m c n r e - c 4 m r t e o I g e e e o e i v f g - f o a o e 0 e o o u r h F h r f t D f c R v c s e K o f m 6 ( a F 2 o t , t s s n 0 l 2 e e y o . r n o : c i s . t a m l d o i s s o a t 1 n s s e t e / n o g n l e k s e k a d r i , t o d o d s r e r n s n g a i u n r s c s r n o i i m e S i i i i l r n n u s a p o m r r n n u u i r o n c t p s a r i v e r r h c e e e n i i o E o g b v r o d g e t i t t o n c a u l i c i n o e v p t c v i t i i s o k s i e s t n r a e f t t e c m n a t i t i e l v G s a e a s a l a s a i l n t i u w n a d s e n r l f r m a v e e e e r i g d o t i e r y , : l n e l i u u s r t v a e m d e i r A u r t l e c l e g e n n n r u s l n e n s e s o c c a p u v v i i i r o n o b e l i s a l l l a c i n r d n d s o d d e i l a n r a o u k o f c i s n g e e c L r f a i l r r e e v e e e t a a e n v e n i a e r r n n s a i a o u h o i f s e i e o o e i L o i F F V F R E D T c p v h c e a t b c r r a c l c d b g p p H z a r e f a G C • • • d • • T • a • A • 2 2 , 1 2 n o i t e * a t l i n o i s r c t a r c n a a o P V c January/February 2010, Vol. 46 AAFP –AAHA Feline Life Stage Guidelines 77

Overcoming Barriers to Veterinary Visits The panel recommends that the veterinary team endeavours to make the veterinary encounter comfortable for both cat and client. Integral to this is a better understanding of feline behavior. 10,11 Some specific tips to help minimize the challenges associated with bringing a cat to the clinic are given below.

Once the client arrives at the veterinary clinic, the health-care team can take steps to reduce stress for both the client and the cat, as is feasible for their situation. 12 See below for some ideas for the waiting client and cat, and some tips to facilitate examination and treatment.

•RedSuocianlgizethkeittsetnresstso othfetrcaanrsriperoart nd to travelling: – Keep the transport carrier out and accessible in the home. – Create and maintain a positive association with the transport carrier by making it a comfortable resting, feeding or play location. – When feasible, and if the cat is neutral or favorably inclined to car travel, encourage owners to take the cat on periodic car rides paired with positive experiences. • Withholding food prior to travel may prevent motion sickness, increase interest in treats at the clinic, and is beneficial if blood is to be collected. • Apply a calming synthetic pheromone to, and/or place familiar clothing from a favorite person in, the carrier on a routine basis and just prior to transport. 13,14 • Provide cover/hiding options in or over carrier (eg, blanket draped over carrier) during transport.

•MaPkirnogvidtheeacsaetpaanradteclwieanittincgomrofoomrtafobrlecaatts,thoer ecnlisnuicre their immediate placement into an exam room. • Minimize waiting times. • Provide elevated platforms in the waiting area so owners can place cat carriers out of reach of dogs. • Use calming synthetic pheromones in the environment. 14

•FacPirliotvaitdinegatchaet-efrxieanmdilnyaetxioanmarnodomtr: eatment – Keep the room and table warm, with a non-slip surface for the cat. – Avoid loud noises or ambient sounds that may mimic hissing (eg, whispering). – Distract and reward with tasty treats/catnip/play. • Handle using minimal restraint: – See AAFP Feline Behavior Guidelines for tips on handling cats during the veterinary examination. 10 – While gathering historical information, allow the cat time to adjust to the surroundings by removing the top or opening the door of the carrier. The cat should ideally remain in the bottom half of the carrier for as much of the exam as possible; this allows it to adjust to the examiner and the environment. 15,16 – Allow the cat to hide partially under a towel; use towels, rather than scruffing, for handling where additional restraint is needed. – Avoid making eye contact with the cat. – Determine the most comfortable position for the cat during the examination, such as the veterinarian’s lap. – Use sedation, anesthesia or analgesics as indicated to reduce stress and/or pain. • Keep hospitalized cats away from dogs and out of visual range of other cats. 17

SAunpApAleFmP epnotsaitriyonDsattaa tement entitled ‘Respectful handling of cats to prevent fear and pain’ is available at www.catvets.com and included in the online version of this article at doi:10.1016/j.jfms. 2009.12.006 78 JOURNAL of the American Animal Hospital Association January/February 2010, Vol. 46

Satisfactory diets for cats contain all the required nutri - Feeding Regimens ents in proper balance, are palatable and digestible, and are A variety of feeding styles can maintain good health in free of spoilage and contaminants. The specific source of client-owned cats, including free choice or provision of nutrients in feline diets is irrelevant when these criteria are meals. In addition to monitoring intake, considerations 26 satisfied. Both canned and dry food have been found to include: support health during all life stages. 27 The presence of a label guarantee that the food was tested using feeding trials • Providing water via bowls, dripping faucets and/or foun - provides the current best initial evidence that a diet is satis - tains, to promote adequate intake. When increased water factory. intake is desirable, feeding of canned foods may help The panel examined published peer-reviewed evidence- achieve this. based studies in healthy, client-owned cats for any signifi - • Locating food in a quiet area, especially for nervous or cant health effect of: feeding canned versus dry food fearful cats (eg, away from other animals or household (including contribution to dental health); providing a variety items that may make noises intermittently). 34 of foods versus a consistent diet; feeding high protein, low carbohydrate versus lower calorie and high fiber diets; feed - ing raw diets; providing dietary supplements, or access to grass or plants. Based on the available data, specific recom - Factors to Consider When mendations in favor of any of these practices cannot be Changing the Diet made. • Provide amounts of the new diet equivalent to pre - Despite the concern surrounding the effects of carbohy - vious energy (versus volume) intake, adjusting the drate in dry foods, current evidence suggests that housing initial amount as needed to maintain moderate 28 and activity (which may be a marker of welfare) are more body condition. 29–32 significant predictors of health. Evidence does not sup - • Consider offering the new diet as a choice in the port the carbohydrate content of foods as being harmful or presence of the usual diet to enhance acceptabili - an independent risk factor for diseases such as obesity or ty, and make diet changes gradually to minimize diabetes. 29,33 the risk of gastrointestinal upset in cats with a his - With regard to home-made foods, the veterinarian should tory of this response to dietary change. discuss and share evidence about nutritional balance, risks • Warm the food to body temperature; adding associated with preparation and feeding of foods raw, and fish/clam juice may increase palatability for cats advantages of using food formulated for cats, referring with a depressed appetite. clients to additional resources if required (Table 3).

Table 2

The Minimum Database by Age Group

Kitten/junior Adult Mature Senior/Geriatric +/- +/- ++ HCeBmC atocrit, RBC, WBC, differential count, cytology, platelets

+/- +/- ++ ACsHEaMmisncimreuemn include: TP, albumin, globulin, ALP, ALT, glucose, BUN, creatinine, K +, phos, Na +, Ca 2+ +/- +/- ++ SUpriencaifliycsgisra* dient, sediment, glucose, ketones, bilirubin, protein 23

T4* +/- +/- + +/- +/- + Blood pressure* Retroviral testing + +/- +/- +/- ++++ Fecal examination* * See text discussion. CBC = complete blood count, RBC = red blood cells, WBC = white blood cells, CHEM = chemistry, TP = total protein, ALP = alkaline phosphatase, ALT = alanine aminotransferase, BUN = blood urea nitrogen, T4 = thyroxine January/February 2010, Vol. 46 AAFP –AAHA Feline Life Stage Guidelines 79

Table 3 Web Resources for Feline Health Care

Veterinarian/ Clients/ clinic pet owners General wellness information Feline Advisory Bureau (FAB) WellCat for life downloads: Veterinary Handbook www.fabcats.org/wellcat/publications/index.php  Wellcat Log www.fabcats.org/wellcat/owners/index.php  Morris Animal Foundation ‘Happy Healthy Cat Campaign’ www.research4cats.org/  Veterinary Partner www.veterinarypartner.com  CATalyst Council www.catalystcouncil.org/  AAHA Compliance Study 7 www.aahanet.org  Veterinary Information Network www.vin.com 

Behavior, environment and the veterinary encounter Cornell Feline Health Center videos and health information www.vet.cornell.edu/FHC/  The Ohio State University Indoor Cat Initiative www.vet.osu.edu/indoorcat.htm  Humane Society of The United States – indoor cats www.hsus.org/pets/pet_care/cat_care/keeping_ your_cat_happy_indoors.html  AAFP Feline Behavior Guidelines (also includes feeding tips) www.catvets.com/professionals/guidelines/  publications/?Id=177 FAB information and Cat Friendly Practice Scheme: The Cat Friendly Home www.fabcats.org/behaviour/cat_friendly_home/info.html  Bringing Your Cat to the Vet www.fabcats.org/catfriendlypractice/leaflets/vets.pdf  Creating a Cat Friendly Practice, Cat Friendly Practice 2 www.fabcats.org/catfriendlypractice/guides.html  Dumb Friends League ‘Play with Your Cat’ www.ddfl.org/behavior/catplay.pdf 

Nutrition and diet Your Cat’s Nutritional Needs – A Science-Based Guide for Pet Owners http://dels.nas.edu/dels/rpt_briefs/cat_nutrition_final.pdf  American College of Veterinary Nutrition—links to nutrition www.acvn.org/site/view/58669_Links.pml; information websites jsessionid=20s028q8i1ewt 

Medical/dental care AAFP Vaccination Guidelines www.catvets.com/professionals/guidelines/ publications/?Id=176  European Advisory Board on Cat Diseases (ABCD) infectious diseases guidelines www.abcd-vets.org 

(Continued on next page) 80 JOURNAL of the American Animal Hospital Association January/February 2010, Vol. 46

Table 3 (continued) Web Resources for Feline Health Care

Veterinarian/ Clients/ clinic pet owners

Medical/dental care (continued) AAFP Zoonoses Guidelines www.catvets.com/professionals/guidelines/ publications/?Id=181  AAFP Retrovirus Testing Guidelines www.catvets.com/professionals/guidelines/ publications/?Id=178  AAFP Bartonella Panel Report www.catvets.com/professionals/guidelines/ publications/?Id=175  AAFP Senior Care Guidelines www.catvets.com/professionals/guidelines/ publications/?Id=398  AAHA Senior Care Guidelines http://secure.aahanet.org/eweb/dynamicpage. for Dogs and Cats aspx?site=resources&webcode=SeniorCare Guidelines  AAHA Dental Care Guidelines http://secure.aahanet.org/eweb/dynamicpage. for Dogs and Cats aspx?site=resources&webcode=DentalCare Guidelines  Veterinary Oral Health Council www.vohc.org/  AAHA –AAFP Pain Management www.aahanet.org/PublicDocuments/ Guidelines for Dogs & Cats PainManagementGuidelines.pdf  www.catvets.com/professionals/guidelines/ publications/?Id=174  International Veterinary Academy of Pain Management www.ivapm.org  Veterinary Anesthesia & Analgesia Support Group www.vasg.org 

Parasite prevention Companion Animal Parasite Council: Information for veterinary and medical professionals www.capcvet.org  Information for cat owners www.petsandparasites.org/cat-owners/  Centers for Disease Control and Prevention (CDC) zoonoses information www.cdc.gov/ncidod/dpd/animals.htm  American Heartworm Society www.heartwormsociety.org/ 

Supplementary Data Table 3, with hyperlinks to the listed web resources, is available at doi:10.1016/j.jfms.2009.12.006 January/February 2010, Vol. 46 AAFP –AAHA Feline Life Stage Guidelines 81

• Offering dry foods in foraging devices (eg, food balls or Behavior and Environment 35 puzzles), and in multiple small meals in several wide - An outline of behavior and environmental items for discus - ly dispersed bowls to slow intake and increase mental sion at each life stage is presented in Table 1. The following and physical activity. discussion elaborates on those items, where applicable. For detailed recommendations about normal cat behavior and Weight Management management refer to the AAFP Feline Behavior Obesity may occur at any age, but is most commonly Guidelines. 10 encountered in middle age. 32,36 The risk of obesity may be reduced by environmental enrichment, increasing opportu - All Ages nities for activity, and individualizing food intake. The ener - • Provide plentiful resources – hiding spots, elevated rest - gy density of cat foods varies widely, based on the moisture ing spots, food, water, scratching posts and litter boxes – and fat content of the diet. This information should be help - throughout the home, particularly for cats kept indoors ful in determining a guideline of how much to feed. and in multi-cat households (Fig. 3). Tips and items for discussion with clients include: • Controversy exists over whether cats should be kept indoors-only or in an indoor/outdoor environment (see • Slowly (<10% increments and decrements) adjust calorie box on page 82). These debates reflect geographical and intake to life stage and conditions (eg, sterilization, cultural differences, as well as individual owner prefer - indoor housing). ences. 30,37–41 They underline the importance of providing • Provide environmental enrichment to increase activity. 35 an appropriate and stimulating environment for the cat. 35 • Switch to a diet with lower energy density (reduced fat, increased air, fiber and/or moisture). Kitten • Change the feeding strategy. • Play : Kittens have a high play drive; inter-cat social play • Switch to meal feeding, with portion control. peaks at about 12 weeks of age, 45 then object play • Introduce foraging devices (see above). becomes prevalent. Toys offer an outlet for normal • Introduce barriers to food access (eg, baby gates, elevat - predatory sequences as part of play, and help prevent ed feeding stations). play biting.

c

Figure 3 —Environmental needs change with life stage, although environmental enrichment and adequate resource allocation remain important for all cats. While play and play items are a priority for the kitten and junior (a and b), easy access to a soft bed (c) and a comfortable resting spot, such as a sofa (d), assumes more importance in the senior and geriatric cat. Pictures (a), (b) and (d) courtesy of Deb Givin; (c) courtesy of Ilona Rodan.

a b

d 82 JOURNAL of the American Animal Hospital Association January/February 2010, Vol. 46

Lifestyle Choices

• Indoor-only: An indoor-only lifestyle may decrease the risks of trau - ma and certain infectious diseases and increase longevity, but may also increase the risks of compromised welfare and illness due to environmental limitations. Appropriate environmental enrichment is thus essential for maintaining the mental and physical well-being of cats. 10,42–44

• Indoor/outdoor: An indoor/outdoor lifestyle may provide a more nat - ural and stimulating environment for cats, but may also increase the risks of infectious disease and trauma, and result in increased predation on wildlife. Supervised or controlled outdoor access, for example via leashed walks or cat-proof enclosures, may reduce some of the risks otherwise associated with access to the outdoors, and has been recommended by the AAFP and others. 10,40,44

Photo courtesy of Deb Givin.

• Litter boxes : Litter box set-up and cleaning is critical for Senior and Geriatric box usage. Although individual preferences can vary, • Senior and geriatric cats exhibiting behavioral changes 46 most cats prefer clumping litter and a clean box in an (eg, vocalization, changes in litter box usage) should accessible but not busy location. Initially, kittens can be always be evaluated for an underlying medical problem. 5 simultaneously offered a variety of litter box options to permit them to express personal preference through Parasites 47 usage. Some cats may find scented litters aversive. Parasite control is important in cats of all ages. Prevention • Socialization/handling : Kittens should be gradually and includes both animal and environmental control. The positively acclimated as early as possible to any stimuli Companion Animal Parasite Council (CAPC) guidelines or handling techniques that owners plan them to contain recommendations about prevention of ecto- and encounter during their lifetime (eg, children, dogs, nail endoparasites, fecal testing, and more. 20 The United States trims, tooth and coat brushing, car transport). This can be Centers for Disease Control and Prevention website (see accomplished with food or other appropriate rewards, Table 3) also provides information on a variety of zoonoses. avoiding interactive punishment as it may elicit defensive Items for discussion are listed in Table 1, and a few specifics aggression. are expanded on below. Junior • Inter-cat relations : The reduction in social play com - Heartworm: Key Points bined with the dispersal effect (when free-living off - spring leave the family unit at about 1–2 years of age) • Although the incidence in cats is lower than it is in means that inter-cat aggression may develop at this stage dogs (10–15% of the rate in dogs), both indoor and of life. outdoor cats are at risk of heartworm infection. • Litter boxes and elimination : Litter box rejection can • Infection with even a small number of adult worms stem from a variety of causes including litter type, box can cause severe disease. cleaning, box style, and box size. Cats have shown a ten - • Signs differ from those in dogs, tending to be non- specific. dency to prefer larger boxes. 48,49 • A combination of antigen and antibody testing • Urine marking : Most intact cats and about 10% of steril - increases the probability of an accurate diagnosis. 50 ized cats mark their territory with urine. The onset of • Adulticide treatment is currently not recommended this behavior can coincide with sexual maturity. for cats. There is no evidence that it improves sur - vival in infected cats, and the death of adult worms Adult and Mature can be life-threatening. • Play : Declining play activity increases susceptibility to • Monthly prophylaxis is both safe and effective. weight gain. In one study, three 10–15 min exercise ses - Some heartworm preventives also provide control sions per day caused a loss of approximately 1% of body of other parasites. weight in 1 month with no food intake restrictions. 51 January/February 2010, Vol. 46 AAFP –AAHA Feline Life Stage Guidelines 83

Kittens • Because prenatal infection does not occur in kittens, Client Communication and Resources roundworm treatment given every 2 weeks can start at 3 weeks of age. Kittens may begin receiving a monthly Clients face a potentially overwhelming amount of information at each visit to the veterinarian, so effec - general endoparasite preventive at 8–9 weeks of age. 20 tive communication is essential to allow cats to All Life Stages receive optimum health care. In addition to the litera - ture created by veterinarians for their own clients, a • Feces testing allows monitoring of compliance with pre - vast number of other resources are available to assist ventive medication as well as diagnosis of some endopar - veterinarians and their clients. Websites may be ori - asites not treated by broad-spectrum preventives. ented towards pet owners, veterinarians, or both. • Heartworm presents a risk at all life stages in endemic Table 3 is limited to information about wellness, not areas. 52 Some points of note are listed in the box on page disease, and is not intended to be exhaustive. These 82; additional details may be found on the websites of guidelines (which, at a later date, will be supplement - the CAPC and American Heartworm Society (see Table ed with additional links and materials to aid client edu - 3). cation) are available online at www.catvets.com/ professionals/guidelines/publications/ Vaccination Table 1 outlines the vaccination priorities to consider when designing a comprehensive, life stage-targeted wellness plan for a cat. Key Points Dental Care • These Life Stage Guidelines aim to enhance the 53 health, welfare and longevity of cats by providing a Diseases of the oral cavity are extremely common, yet concise template to help veterinarians, their staff most owners are unaware that dental disease can threaten and clients to improve preventive care. the health and welfare of their cat. The AAHA Dental Care Guidelines for Dogs and Cats provide details of dental care • Excellent resources are available to facilitate the and dental charting. 54 Points of note include: design of a comprehensive, life stage-targeted wellness care plan for each cat. • Cats need home and veterinary dental care at all life stages (see Table 1). • Clear communication among veterinarians, sup - • Disease affecting the teeth and/or oral cavity can cause port staff and pet owners should improve adher - pain and may lead to disease elsewhere in the body. ence to the wellness plan, thus improving the quality of health care delivered to cats. • A minimum schedule of annual examinations is recom - 54 mended for cats with healthy dentition. • More robust data about disease incidence by age • Client education is fundamental since cats may not show would assist practitioners in determining the value overt signs of pain and discomfort associated with oral and desired frequency of routine wellness testing. disease: 4 – Discuss owner-usable interventions that will main - tain or improve dental health; 55 for example, condi - ommendations through further research and through coop - tioning at home using treats to allow oral eration and data sharing. More robust data about disease examination by lifting the lips. Although best start - incidence by age would assist practitioners in determining ed with kittens, older cats can be taught to accept the value and desired frequency of routine wellness testing. brushing using positive interactions and rewards. In the meantime, we must rely on the available data, per - – Dental diets, treats and chews exist, but do not all sonal knowledge and experience to help owners maintain have equivalent efficacy and none substitute for vet - their cat’s health during its lifetime. erinary dental care. 56,57 The use of dental treats and chews may be a realistic, practical alternative to Acknowledgements daily tooth brushing, although data about their com - The AAFP and AAHA would like to thank Boehringer parative efficacy is lacking. The Veterinary Oral Ingelheim, Merial Ltd, Pfizer Animal Health and IDEXX Health Council in the USA requires that strict stan - Laboratories for their sponsorship of these guidelines and dards are met before certification of food or treats their commitment to help the veterinary community devel - for oral care. 58 op projects that will improve the lives of cats. Evidence-based Wellness References Although the panel’s objective to provide evidence-based 1. Flanigan J, Shepherd A, Majchrzak S, Kirkpatrick D, San Filippo M. guidelines for health care related to life stage was not fully US pet ownership & demographics sourcebook. Schaumburg, IL: realized, the profession could develop more accurate rec - American Veterinary Medical Association, 2007: 1–3. 84 JOURNAL of the American Animal Hospital Association January/February 2010, Vol. 46

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51. Clarke DL, Wrigglesworth D, Holmes K, Hackett R, Michel K. Using 55. Ray JD, Jr, Eubanks DL. Dental homecare: teaching your clients to environmental enrichment and feeding enrichment to facilitate feline care for their pet’s teeth. J Vet Dent 2009; 26: 57–60. weight loss. J Anim Physiol Anim Nutr (Berl) 2005; 89: 427. 56. Logan EI. Dietary influences on periodontal health in dogs and cats. 52. Nelson CT, Seward RL, McCall JW. Guidelines for the diagnosis, Vet Clin North Am Small Anim Pract 2006; 36: 1385–1401. treatment and prevention of heartworm (Dirofilaria immitis) infection 57. Harvey CE. Management of periodontal disease: understanding the in cats, 2007. www.heartwormsociety.org/veterinary-resources/feline- options. Vet Clin North Am Small Anim Pract 2005; 35: 819–36. guidelines.html 58. Veterinary Oral Health Council. Protocols and submissions. 53. Lommer MJ, Verstraete FJ. Radiographic patterns of periodontitis in http://www.vohc.org/protocol.htm (accessed Aug 17, 2009). cats: 147 cases (1998-1999). J Am Vet Med Assoc 2001; 218: 230–34. 54. Holstrom SE, Bellows J, Colmery B, et al. AAHA dental care guide - lines for dogs and cats. J Am Anim Hosp Assoc 2005; 41: 1–7. http://secure.aahanet.org/eweb/dynamicpage.aspx?site=resources& webcode=DentalCareGuidelines

The need for Feline Life Stage Guidelines was identified by the CATalyst Council, a US initiative comprised of animal health and welfare organizations and corporations to champion the cat in response to statistics that show an increase in the pet cat population coupled with a decline in veterinary visits and increase in shelter population. The guidelines are one part of that effort.

Visit www.catalystcouncil.org for more information, or con - tact: [email protected] CATalyst Council PO Box 5872 Timonium, MD 21093, USA +1-866-979-0222