VETERINARY PRACTICE GUIDELINES 2019 AAHA Canine Life Stage Guidelines* Kate E. Creevy, DVM, MS, DACVIM (SAIM), Jesse Grady, DVM, MS, Susan E. Little, DVM, PhD, DACVM (Parasit.), George E. Moore, DVM, PhD, DACVPM, DACVIMy, Beth Groetzinger Strickler, MS, DVM, DACVB, CDBC, Steve Thompson, DVM, DABVP (C/F), Jinelle A. Webb, DVM, MSc, DVSc, DACVIM (SAIM)y ABSTRACT The guidelines are an update and extension of the AAHA Canine Life Stage Guidelines published in 2012. A noteworthy change from the earlier guidelines is the division of the dog’s lifespan into five stages (puppy, young adult, mature adult, senior, and end of life) instead of the previous six. This simplified grouping is consistent with how pet owners generally perceive their dog’s maturation and aging process and provides a readily understood basis for an evolving, lifelong healthcare strategy. The guidelines provide the following recommendations for managing 10 health-related factors at each of the first four canine life stages: lifestyle effect on the patient’s safety, zoonotic and human safety risk, behavior, nutrition, parasite control, vaccination, dental health, reproduction, breed-specific conditions, and a baseline diagnostic profile. (J Am Anim Hosp Assoc 2019; 55:267–290. DOI 10.5326/JAAHA-MS-6999) AFFILIATIONS * These guidelines are supported by a generous educational grant from From the Department of Small Animal Clinical Sciences, Texas A&M Uni- Boehringer Ingelheim Animal Health USA Inc., CareCredit, Elanco Animal versity College of Veterinary Medicine & Biomedical Sciences, College Sta- Health, Hill’s® Pet Nutrition, Inc., IDEXX Laboratories, Inc., Merck Animal tion, Texas (K.E.C.); Department of Clinical Sciences, College of Veterinary Health, and Zoetis Petcare. They were subjected to a formal peer-review Medicine, Mississippi State University, Mississippi State, Mississippi (J.G.); process. These guidelines were prepared by a Task Force of experts Oklahoma State University, Department of Veterinary Pathobiology, Still- convened by the American Animal Hospital Association. This document water, Oklahoma (S.E.L.); Department of Veterinary Administration (G.E. is intended as a guideline only, not an AAHA standard of care. These M.), and Department of Veterinary Clinical Sciences (S.T.), Purdue Univer- guidelines and recommendations should not be construed as dictating sity, West Lafayette, Indiana; Veterinary Behavior Solutions, PLLC, Fall an exclusive protocol, course of treatment, or procedure. Variations in Branch, Tennessee (B.G.S.); and Mississauga-Oakville Veterinary Emergency practice may be warranted based on the needs of the individual patient, Hospital, Ontario, Canada (J.A.W.). resources, and limitations unique to each individual practice setting. Evidence-based support for specific recommendations has been cited CONTRIBUTING REVIEWERS whenever possible and appropriate. Other recommendations are based Lora Rickard Ballweber, DVM, MS, DACVM (Parasit.), (Microbiology, on practical clinical experience and a consensus of expert opinion. Further Immunology, and Pathology Department, College of Veterinary Medicine research is needed to document some of these recommendations. Be- and Biomedical Sciences, Colorado State University, Fort Collins, CO); Joe cause each case is different, veterinarians must base their decisions on the Bartges, DVM, PhD, DACVIM, DACVN (Department of Small Animal best available scientific evidence in conjunction with their own knowledge Medicine and Surgery, College of Veterinary Medicine, The University of and experience. Note: When selecting products, veterinarians have a Georgia, Athens, GA); Mary L. Berg, BS, LATG, RVT, VTS (Dentistry), choice among those formulated for humans and those developed and (Beyond the Crown Veterinary Education, Lawrence, Kansas); Philip A. approved by veterinary use. Manufacturers of veterinary-specific products Bushby, DVM, MS, DACVS (Department of Clinical Sciences, College of spend resources to have their products reviewed and approved by the Veterinary Medicine, Mississippi State University, Starkville, MS); Tracey D. FDA for canine or feline use. These products are specifically designed Jensen, DVM, DABVP (C/F) (Wellington Veterinary Hospital, Wellington, and formulated for dogs and cats and have benefits for their use; they CO); Colleen S. Koch, DVM, DACVB (Mizzou Animal Behavior Clinic, are not human generic products. AAHA suggests that veterinary profes- Mizzou Veterinary Health Services, Wentzville, Missouri); Jason Stull, sionals make every effort to use veterinary FDA-approved products and VMD, MPVM, PhD, DACVPM (Department of Health Management, base their inventory-purchasing decisions on what product is most bene- Atlantic Veterinary College, University of Prince Edward Island, Charlotte, ficial to the patient. PEI); Link Welborn, DVM, DABVP (C/F), CCRT (Tampa Bay Animal Hos- † G. E. Moore and J. A. Webb were cochairs for the Canine Life Stage pitals, Tampa, FL). task force. Correspondence: [email protected] (G.E.M.); [email protected] (J.A.W.) BCS (body condition score); EOL (end of life); MCS (muscle condition score); USMI (urethral sphincter mechanism incompetence) ª 2019 by American Animal Hospital Association JAAHA.ORG 267 Introduction valid. However, categorizing the dog’s lifespan into four segments makes fi The purpose of these guidelines is to provide a comprehensive clinical protocols easier to implement and, very importantly, simpli es structure for both practice teams and pet owners that supports in- the pet healthcare dialog between the practice team and its pet owners. Everyone in the practice, including technicians and support staff, should dividualized recommendations which promote healthy longevity have an understanding of how a dog’slifestageformsthebasisfor throughout a dog’s different life stages. Specific objectives of the patient-specific healthcare recommendations. Thus, there is a dual ra- guidelines include tionaleforthefourlifestageapproachtomanagingthecaninepatient, · Broadening the focus on the individualized approach to the simplifying implementation of and adherence to clinical protocols and veterinary visit. facilitating client communication,whichisthekeytocompliance. · Emphasizing preventive healthcare strategies and recommen- The life stage guidelines represent a framework for the clinician but dations based on age, size, lifestyle, and breed of the dog. are not intended to be all inclusive. The AAHA website (aaha.org/ · Providing a framework and outline on focused areas of health- caninelifestage) contains useful supporting information and resources care that are important during the maturation pathway at each for using life stages to guide preventive healthcare and treatment pro- canine life stage. tocols for the canine patient. · Providing resources and relevant information for practice teams to enable them to develop an individualized preventive Definition of Life Stages healthcare plan for each dog. For practical purposes, rather than attempt to calculate age equiv- · Providing information and communication strategies to “make alents to humans, the task force suggests that life stage be defined compliance easy” by facilitating adherence to recommendations both by age and characteristics (Table 1). Life stage divisions, al- that protect canine and human health. though arbitrary, provide a framework for creating individualized Organizing a canine patient’s lifespan into distinct life stages is a plans for preventive care specific to each dog’s needs at the appro- way of recognizing that a dog’s physiology evolves as he matures, priate time. Table 1 provides broad-based definitions of the four life requiring different approaches to healthcare as the animal prog- stages used in these guidelines. resses from puppy to senior pet. The patient’s life stage becomes a These guidelines focus on life stages that require different ap- clinical tool that guides the clinician’s risk assessment and preventive proaches to preventive care. The spectrum of care within each life stage healthcare and treatment strategies. Equally important, the life is affected by the age, size, lifestyle, health status, and breed of the dog.3–5 stages described in these guidelines also represent a useful frame- Physiological and behavioral developmental periods do not start and work for explaining individualized pet healthcare to the pet owner. end abruptly, but phase in and out gradually. Within each life stage For example, a pet owner who understands why a puppy has dif- category there will also be variation that demands clinical judgement. ferent dietary, vaccination, behavioral, or dental care needs com- Because variation increases toward the latter years, estimates of in- pared with an adult dog is more likely to comply with the practice clusive ages are not uniform and therefore are not proposed for the ’ team s recommendations at each life stage. life stages of mature adults and seniors. Estimation by the practice These guidelines complement earlier canine life stage guide- team of an individual dog’s lifespan, generally predicted by breed 1 lines published in 2012, as well as the more recently released, lifespan, permits more accurate targeting of life stage–specificpre- AAHA/IAAHPC End-of-Life (EOL) Care Guidelines published in ventive care.6 Table 2 provides a checklist of items to discuss with 2016. The EOL Guidelines recommended that the terminal stage of each pet owner based on life stage. Table 3 offers suggestions for ’ a patient s life should be considered a distinct life