Senior Cat Care

AMERICANASSOCIATIONOFFELINEPRACTITIONERS SENIOR CARE GUIDELINES Revised December 2008 ©2009 American Association of Feline Practitioners. All rights reserved. AMERICANASSOCIATIONOFFELINEPRACTITIONERS SENIOR CARE GUIDELINES Revised December 2008 Dedicated to our friend, colleague, and co-author of the original AAFP Senior Care Guidelines, Dr. Jim Richards, in memoriam. A passionate cat lover, he was particularly fond of his older “kitty,” Dr. Mew. Two of Dr. Richard’s favorite sayings were: “Cats are masters at hiding illness” and “Age is not a disease.” PANELISTS: TABLE OF CONTENTS Jeanne Pittari, DVM, DABVP Introduction/Aging and the Older Cat . 3 (Feline Practice), Co-Chair The Senior Cat Wellness Visit . 4 ExaminationFrequency...................................4 Ilona Rodan, DVM, DABVP MinimumDatabase......................................5 (Feline Practice), Co-Chair Interpretation of the Urinalysis . 6 RoutineWellnessCare....................................6 Gerard Beekman, DVM Nutrition and Weight Management . 7 Danièlle Gunn-Moore, BVM&S, Obesity ...............................................7 PhD, MACVSc, MRCVS, RCVS Underweight/Loss of Body Mass . 8 Specialist in Feline Medicine DentalCare.............................................8 David Polzin, DVM, PhD, Anesthesia..............................................8 DACVIM-SAIM Monitoring and Managing Disease . 9 BP Monitoring and Hypertension. 10 Joseph Taboada, DVM, Chronic Kidney Disease . 11, 12 DACVIM-SAIM Thyroid Testing and Hyperthyroidism . 11, 13 DiabetesMellitus.......................................13 Helen Tuzio, DVM, DABVP IBD and Associated Disease. 14 (Feline Practice) Cancer...............................................14 Osteoarthritis..........................................15 Debra Zoran, DVM, PhD, Cognitive Disorders. 16, 17 DACVIM-SAIM Complex Disease Management . 17, 18 Quality of Life..........................................18 Conclusion ............................................18 The AAFP Senior Care Guidelines report was reviewed and approved by the Guidelines Committee and the Board of Directors of the American Association of Feline Practitioners. Aging and the Older Cat: What is Senior? There is no specific age at which a cat “becomes senior.” Individual animals and body systems age at different rates, but one convenient way to view older cats is to classify them as “mature or middle aged” (7-10 years), “senior” (11-14 years), and "geriatric” (15+ years). (FAB) This helps to focus on the varying disease risks of the different groups (e.g. obesity in the mature group; cachexia in the geriatric group). In this document, as elsewhere, the word “senior” is used as a broad category for all older cats, unless otherwise noted. Introduction Cats are the most popular pet in the US and much of With good care, many cats live into their late teens and northern Europe. Although 78% of owners consider their some into their twenties; the percentage of older cats is cats to be family members, many cats, particularly seniors, increasing. (Broussard et al 1995, Wolf 1995) The inevitable do not receive appropriate preventive care. (Pew 2006; biological changes associated with aging resultina Cohen 2002; Adams et al 2000) One of the main obstacles progressive reduction in the ability to cope with physiologic, to owner compliance is the lack of a clear recommendation immunologic, and environmental stresses. Along with “normal” by the veterinary team. (AAHA 2003) Guidelines can help aging, the incidence of certain diseases gradually increases. veterinarians to minimize this obstacle, strengthen the Typical changes associated with aging are shown in Figure 1. human-pet-veterinary bond, and improve quality of life There is no clear line between “typical” changes and disease. for cats. For example, many older cats have radiographic evidence The goals of this report are to assist veterinarians to: of osteoarthritis, and it is difficult to determine when I Deliver consistent high-quality care to senior cats. normal aging of the joints actually becomes a pathological I Promote longevity and improve quality of life of senior process; cats with radiographic evidence of OA may or cats by may not have a clinically-evident problem. (Hardie et al • Recognizing and controlling health risk factors. 2002; Clarke and Benett 2006) For the purposes of this • Facilitating and promoting early detection of disease. document, we have included in the “typical changes” • Improving or maintaining residual organ function. diagram those changes which are not surprising or that • Providing guidelines to delay the progression of one might even expect to find as common aging changes common conditions. that would not necessarily result in clinical intervention. I Define aspects of screening, diagnosis, treatment, and anesthesia of senior cats. Reduced stress tolerance Altered social standing Decreased skin elasticity Altered sleep/wake cycle Decreased hearing FIGURE 1 Changes Associated with Aging* Non-neoplastic iris Pigment changes Lenticular sclerosis Iris atrophy *Changes often seen in apparently Decreased digestion/ healthy senior cats. absorption of fat Decreased sense of smell Brittle nails Cat drawing provided by Kerry Goodsall Increased cardiac/sternal contact on films at www.allaboutdrawings.com Redundant aorta Decreased ventricular compliance Decreased lung reserve Costochondral mineralization (decreased chest wall compliance) 3 AMERICAN ASSOCIATION OF FELINE PRACTITIONERS Senior Care Guidelines - Revised December 2008 The Senior Cat Wellness Visit I Joint thickening; muscle atrophy. A comprehensive history helps raise the index of suspicion I Changes in parameters from prior exams (e.g., reduced for early disease by uncovering relevant signs or behavior body temperature; changed weight/BCS or heart rate). changes. Initially, open-ended questions should be asked so that the full range of client concerns is understood. (Kurtz 1998, Frankel 1999) Examples of open ended questions are: “How has Max been doing since his last visit?” “What beh avior changes have you noticed in the last few weeks?” “What else?” Open ended questions can then be followed by more specific questions to ask about: I Changes in the cat’s usual behaviors and routines. (Overall et al 2004) • Changes in interactions with people or other pets. • Grooming. • Activity– sleeping patterns, jumping, wandering, reaction to being handled, and ability to navigate to EXAMINATION FREQUENCY IN SENIOR CATS preferred places. The frequency of exams should increase as cats age. • Vocalization. Although there is controversy regarding frequency of • Litter box habits. exams in younger cats (AAHA 2008), panelists agree that I Eating and drinking (amount and behavior); vomiting apparently healthy senior cats should be examined every or signs of nausea. 6 months. Examining these cats at 6-month intervals is I Stool quality (number, volume, consistency, odor, color). desirable because: I Hearing or vision loss (decreased responsiveness, increased I Many disease conditions begin to develop in cats in vocalization). middle age. I Current diet, medications and supplements. I Health changes occur quickly; cats age faster than humans. I Weight gain or loss can be detected and addressed earlier. The physical exam allows for detection of problems that I Cats may appear well despite underlying disease, may not be obvious to owners or uncovered with laboratory compensating until they can no longer do so, then testing. When performing the physical exam, particular presenting as acutely ill. attention should be paid to: I Owners may not recognize the existence or importance I Observation of the cat from a distance to assess breathing of subtle changes. patterns, gait, stance, strength, coordination, vision. I Early detection of disease often results in easier disease I Weight and body condition score (BCS) comparisons management and better quality of life; it is less costly with previous visits. Both nine-point and five- point and more successful than crisis management. BCS scales are available for use. I The frequency of behavior problems increases with age. http://www.purina.org/cats/health/BodyCondition.aspx One study found 28% of pet cats aged 11–14 years accessed 12/1/2008, www.cvm.tamu.edu/clinicalnutrition/ develop at least one behavior problem, increasing to > bcscat.shtml accessed 1/22/09) 50% for cats > 15 years of age. (Moffatt and Landsberg I Skin and hair coat quality. 2003) I Oral cavity, including gingiva, pharynx, dentition I More frequent owner contact provides opportunity for (Holmstrom et al 2005) and sublingual area. concerns to be discussed. I Retinal exam; vascular changes or “cotton wool spots” as early warning of hypertension or retinal detachment. Exam and lab summary sheets allow for a quick review of I Thyroid gland palpation. trends over time. Once evidence of an age related disease I Heart rate, rhythm, murmur. process is discovered, a more frequent monitoring schedule I Abdominal palpation; pain, masses or thickened bowel, may be needed. kidney and bladder size and shape. 4 AMERICAN ASSOCIATION OF FELINE PRACTITIONERS Senior Care Guidelines - Revised December 2008 THE MINIMUM DATABASE Regular exams and collection of the minimum database (MDB) progressive increases in serum creatinine concentration can help detect preclinical disease. Consider performing over several months (even within the normal range) may the recommended MDB (as indicated in Table 1) at least be significant. annually starting at age 7-10,

Load more