GERIATRIC CARE FOR CATS & DOGS

VetSuite Veterinarians
General Practice & Preventative Medicine

Pets today are living longer and better quality lives than ever before, thanks to improved nutrition, veterinary care and educated owners. This increased longevity means that more cats are reaching an older age, and that owners will be faced with the special demands and problems that become apparent with age. Understanding the aging process and the most common problems that face the geriatric cat and dog is the first step in providing the best possible care to geriatric patients. The main focus of geriatric health care is owner education and the early detection and prevention of disease.

It is important to realize that aging itself is not a disease; it is simply a stage of life. Increasing age causes a gradual decline in the body's ability to repair itself, maintain normal body functions and adapt to the stresses and changes in the environment. Many changes occur in cats and dogs as they age. For example, metabolism changes so less food is required. Cats, in general, have a more sedentary life style, and older cats, specifically, are usually less active so weight gain and obesity are common problems. The lack of exercise contributes to reduced muscle tone and strength, further adding to the potential of obesity. Older dogs are also usually less active and thus, commonly gain weight, making obesity one of the more frequent problems seen in the senior dog.

Changes in a cat's environment or routine may actually contribute to behavioral changes or even illness. With time, cats begin to have a gradual decline in their hearing, smelling, vision and taste. Decreased taste sensation can contribute to anorexia, especially if the cat becomes ill. It is not uncommon for older cats and dogs to spend more time sleeping and have more difficulty being roused. Additionally, the body's ability to repair itself decreases and the function of the immune system is compromised with increasing age. Metabolic and endocrine problems, organ dysfunction, and cancer are all seen with increased frequency in the geriatric. Degenerative changes in the muscles, bones and joints may be manifested as arthritis and muscle weakness.

THE AGING DOG

Dogs age at different rates, depending on their body type. In general, smaller breeds live longer than larger dogs, and mixed breed dogs live longer than pure bred dogs.

A general guideline as to when a dog might be considered geriatric is based on the dog's adult weight.

• Small dogs (< 20 pounds) are considered geriatric between 9 to 13 years of age.
• Medium sized dogs (21 to 50 pounds) are considered geriatric between 9 to 11 years of age.
• Large breed dogs (51 to 90 pounds) are considered geriatric between 7.5 to 10.5 years of age.
• The giant breed dogs (> 90 pounds) are usually considered geriatric between 6 to 9 years of age.  

THE AGING CAT

Proper care, nutrition, medical attention and the cat's environment are all controllable and important factors that can improve a cat's quality of life and longevity dramatically. For example, intact feral male cats have a life expectancy of three years. On the other hand, neutered male, indoor house cats commonly live into their teens. The age when a cat is considered geriatric is not well defined.

Depending on the cat's general condition and the medical evaluation, a cat may be considered geriatric anywhere between 8 and 12 years old. Genetics is an important factor in the aging process. Siamese cats tend to have longer life expectancies. Persian cats usually have shorter life expectancies.

ADVANTAGES OF A GERIATRIC PROGRAM

By developing and following a geriatric health plan, disorders and disease can be detected early enough to provide medical or surgical intervention. Some disorders of the geriatric patient may be difficult to help; however, it is usually possible to make significant improvements in the quality of the pet's life by educating owners and by early intervention.

The goal of any geriatric health program is to prevent or delay the development of disorders associated with aging. Practicing prevention is always better than treating a disease already present. In the long run, preventive medicine improves quality of life and is more cost effective than waiting for problems to appear. A well-educated and proactive owner is the first step in optimal senior cat care.

RECOMMENDED DIAGNOSTICS

The routine geriatric exam and accompanying diagnostic tests are recommended to ensure that the early stages of disease is discovered and appropriate preventive measures and treatment plans instituted. The most common diagnostic tests performed as part of a complete geriatric work-up include:

• A complete medical history. Asking the right questions is very important in obtaining a thorough geriatric health history. Some veterinarians have specific geriatric health history questionnaires that can be filled out by the owner or a health professional. In addition, any problems or concerns that owners have about their pet should be discussed; however, it is equally important that the veterinarian ask specific questions that may uncover problems that an owner may simply attribute to "old age" and just something that they will have to live with. Very often these are signs of underlying disease and are very treatable.
• A complete physical examination. A complete physical examination should be performed to attempt to uncover specific problems.The eyes are examined for age-related changes such as lenticular sclerosis or cataracts. Funduscopy also provides valuable information on the systemic status of the dog.The ears are examined for signs of infection or allergies. The mouth, gums and teeth are evaluated, with dental disease and gingivitis being common findings. Lymph nodes and the thyroid gland are palpated for enlargement. The skin and quality of the hair coat are observed. Skin tumors or swellings are noted. A poor hair coat or a lack of grooming may be signs of allergies, parasites, infections or systemic illness. The heart and lungs are ausculted and new cardiac murmurs noted. The abdomen is palpated for any masses or organ enlargements. Finally, the general body condition and weight are recorded. Rectal examination is performed in all male dogs.  
• Complete blood count. In geriatric patients, anemia is not an uncommon finding. Red blood cell morphology can help determine if the anemia is acute, chronic or related to a neoplastic condition. The total white count is also noted, and increases may indicate inflammatory or infectious conditions.
• Biochemical profile. The biochemical profile is a very valuable test in the geriatric animal. Results can indicate renal or hepatic dysfunction, diabetes and hyperthyroidism in cats, alterations in electrolytes and cholesterol, and suspicious evidence of hypothyroidism in dogs and adrenal disorders.
• Thyroid testing. Hyperthyroidism is a very common problem in older cats. The most common signs of hyperthyroidism are increased appetite and weight loss.
• Urinalysis. Analysis of the urine can help detect underlying urinary tract infection, renal insufficiency and diabetes. If indicated, a urine culture may be recommended. Determining whether a dog or cat has polydipsia, polyuria, or incontinence is one diagnostic dilemma when taking a history on urinary patterns. The treatment for such signs varies greatly, depending upon the actual condition and its cause. Careful history taking and a complete medical work-up are often needed to differentiate these conditions.
• Fecal examination. Since gastrointestinal parasites may be more debilitating in geriatric animals, a yearly fecal exam is recommended. Additionally, some parasites have zoonotic potential, re-enforcing the value of yearly fecal exams. Routine fecal flotation and specific tests for Giardia are recommended.
• FIV and FELV testing. Both of these viral diseases may cause suppression of the immune system and can contribute to many other systemic illnesses. In cats that are at risk of exposure to these viral diseases (i.e. outdoor cats or cats that have contact with other cats) routine blood testing is recommended. If the viral status of a cat is unknown, testing is also advised.
• Heartworm test - Heartworm tests are performed on an annual basis in animals that are not on year round prophylaxis and are recommended at least every other year for animals that receive continuous prophylaxis.

The above represents the most routine diagnostic tests that are recommended for the senior pet. Based on the history and physical examination findings, common additional testing might include:

• Blood pressure measurement. Hypertension is being increasingly identified in the geriatric cat and dog. Usually, hypertension is associated with other disease conditions such as renal disease and hyperthyroidism.
• Aspiration of skin masses. A common finding on the physical examination of older cats and dogs is small dermal masses. Many times these are benign tumors or cysts that grow slowly and rarely cause problems. However, cats do have a higher incidence of malignant skin tumors than do dogs. Because of this, it is usually recommended that all skin tumors on cats be aspirated and the recovered cells evaluated microscopically for evidence of malignancy. The size and location of all masses should be recorded in the medical record, so that changes in previous masses or the development new masses can be noted.
• Radiographs. Radiographs may be advised based on the initial tests or physical exam findings. Chest radiographs are part of a cardiac work-up if a new murmur is found and as a screening test for cancer. Abdominal radiographs might be needed if organ dysfunction is suspected or organ enlargement or masses are palpated.   
• Cardiac evaluation. If there is indication of potential heart disease such as a newly discovered or a worsening murmur, an arrhythmia or gallop rhythm, muffled heart sounds, or episodes of weakness or collapse, a more complete cardiac evaluation is indicated. Chest radiographs, an electrocardiogram (ECG), and an echocardiogram define the extent and potential cause of the cardiac disease. They also define whether treatment is required at the time and what therapies are appropriate.
• Abdominal ultrasound. Abdominal ultrasonography offers a non-invasive method of visualizing the abdominal organs and any associated parenchymal changes. It provides valuable information that compliments the information obtained with plain radiography.
• Endoscopy. Evaluating the stomach and initial part of the small intestines through the use of endoscopy is a valuable diagnostic tool. A common problem that some older cats have is inflammatory bowel disease (IBD). Cats with IBD usually have vomiting and or diarrhea as symptoms, but sometimes present with weight loss as the only complaint. Endoscopy offers a relatively non-invasive method of obtaining gastrointestinal biopsies for establishing a diagnosis.
• Endocrine function tests - Common endocrine problems of older dogs are hypothyroidism and hyperadrenocorticism. A thyroid panel (T4, free T4, canine TSH assay) is done to search for hypothyroidism. Tests to diagnose adrenal disorders include an ACTH stimulation test and a low dose dexamethasone suppression test.

RECOMMENDED TREATMENTS

• Vaccinations - All cats and dogs should receive routine vaccinations as required by law (rabies) and vaccines that are appropriate for individual needs. Specific vaccines and frequency of administration may vary depending on veterinarian and/or clinic preference or policies.

 Treating an older cat or dog depends on the individual requirements or problems of the pet. The most common problems of geriatric pets include:

• Behavioral and cognitive dysfunction - As dogs age they may experience deterioration of their mental cognitive functions, similar to aging people. They may become more "set in their ways," more inflexible, less patient and more irritable. They may forget learned behaviors such as normal urinary and defecation habits. They may sleep more and be less responsive to external stimuli. It is important to differentiate whether these signs are related to an underlying disease process, or are due to a decline in their sensory awareness and cognitive behavior. If no underling systemic causes of the deterioration can be identified, medications that treat cognitive dysfunction, such as L-deprenyl, may be considered.
• Nutritional concerns. The proper diet is very important in the care of a geriatric cat and dog. There is no “best” food to feed a geriatric cat or dog. The best food depends on the specific problems or nutritional requirements of the individual animal.

Ø                   For example, obesity is a very common problem of older animals. Obesity is a serious concern in the geriatric animal because it directly correlates to a decreased longevity and may contribute to other problems. Cats that are overweight are more likely to develop diabetes, hepatic lipidosis or feline lower urinary tract disease. For some animals, low calorie, high fiber diets make weight loss easier.

Ø                   Additionally, through the geriatric work-up, special nutritional requirements or restrictions may be recommended. These diets attempt either to slow the development of the disease process or improve specific organ function. Special diets for many diseases (even in the early stages) including kidney, liver, gastrointestinal, heart, dental and skin disease are available. Even diets for diabetes and cancer may be recommended.

• Dental disease. A very common finding on a geriatric exam is dental disease and gingivitis. Left untreated, dental disease usually leads to tooth loss and may serve as a reservoir of infection for the rest of the body.
• Degenerative joint disease (DJD) - DJD is also common in older dogs. Signs of arthritis include lameness, stiffness, difficulty rising, trouble navigating stairs or jumping, falling on slippery floors, difficulty getting comfortable or being restless at night. Within the past few years there have been many developments in the treatment of DJD, and many new pharmaceutical and neutraceutical products are now commercially available.
• Kidney disease. Renal disease is a very common finding in the older cat. Asymptomatic cats usually have chronic disease. Chronic renal disease is managed through diet and supplemental fluids. Other treatments might include famotidine, phosphate binders and potassium.
• Hyperthyroidism. Hyperthyroidism is a very common disease of older cats. There are three treatment options. Generally, the safest and most effective treatment is radioactive iodine therapy. The most common form of treatment is with oral medications (Tapazole being the most common) that reduce the blood thyroid level. Finally the affected thyroid gland can be surgically removed.
• Diabetes. The first sign owners usually see when their cat or dog develops diabetes is excessive thirst or urination. Diabetes is generally managed by giving insulin injections at home. Dietary changes are also recommended. Occasionally, oral medications and diet alone can improve the blood glucose level, without the need for injections. Additionally some cats are only transient diabetics, not requiring life-long therapy.
• Hypertension. The first aspect of treating hypertension in the cat is to identify and treat any possible underlying disease conditions such as renal disease or hyperthyroidism. Occasionally cats with hypertension will present with only ocular signs. Sudden blindness is sometimes seen due to retinal detachment or hemorrhage. Hypertension can also cause secondary cardiac changes and associated heart disease. A common drug used to treat hypertensive cats is amlodipine (Norvasc).
• Cardiac disease. Newly discovered heart murmurs are a common physical exam finding in the geriatric cat and dog. Many times these murmurs are found before a cat or dog is symptomatic of any cardiac disease. Accurate auscultation and recording of the intensity, type, and character of the murmur is important at each examination. Further diagnostics are warranted for all significant murmurs or for mild murmurs that are progressing in intensity. Finding a heart murmur in an older cat does not mean that the cat has cardiac disease, but it is an indication for further diagnostics. The most common cardiac disease in the senior cat is hypertrophic cardiomyopathy, which is often associated with hyperthyroidism or hypertension. Early detection of heart disease, treating underlying disorders and proper therapy may slow its progression.
• Inflammatory bowel disease (IBD). Treatment of IBD includes prednisone and other immunosuppressive drugs, metronidazole, antacids and dietary changes. Sometimes IBD is associated with hepatitis and/or pancreatitis.
• Prostate problems - If the dog is an intact male, he is at significant risk of prostatic disease as he ages. Prostatic infections, hyperplasia, abscesses, cysts, and neoplasia are all potential problems in the intact male. A rectal examination to evaluate the prostate is an important component of each examination of the geriatric male dog
• Neoplasia - Cancer is a significant problem in the geriatric dog. Some breeds such as the golden retriever and boxer are at increased risk for the development of cancer, and some cancers show a predilection for various dog breeds. Major advances in veterinary oncology now provide many different avenues of diagnosis and treatment of many forms of cancer.
• Skin tumors. On the basis of the size, location and aspiration results, removal of certain skin masses may be recommended. If not removed and submitted for histopathology, the owner should be instructed to monitor the mass for changes in size, shape or texture.
• Metabolic problems - A major benefit of routine geriatric laboratory testing is the early detection of a variety of metabolic conditions. Examples include finding evidence of mild, asymptomatic kidney disease, liver disease, hypercalcemia, lipemia, hypo- or hyperproteinemia. When marginal changes are found in laboratory tests, it is advisable to repeat the test to verify the existence of a true alteration. Once a definite change is documented, then further work-up is indicated to investigate the cause and the significance of the abnormality
• Neoplasia. Unfortunately, cancer is a significant problem facing the geriatric cat and dog. Lymphosarcoma is the most common type of cancer in the cat. Not all cancer needs to be fatal. Surgery, chemotherapy, even radiation therapy is available that can significantly extend the pet's quality time, or produce a cure. The prognosis depends on the type and location of the cancer.

SUGGESTED GERIATRIC HEALTH PROGRAM

It is advisable to perform complete physical examinations at least twice a year in geriatric dogs and cats. During each exam, the owners should be educated on nutrition, skin care, ears and teeth care. Obese patients should be placed on a weight control program. In addition, a complete blood count, biochemical profile, fecal, FELV and FIV test, thyroid function tests and urinalysis should be performed at least annually.

For patients with significant health concerns, physical examination may be recommended every 2 to 3 months. In addition, a CBC, biochemical profile and urinalysis may be recommended twice a year. FELV and FIV test, thyroid function tests, ECG, fecal and thoracic radiographs should be considered. Depending on the patient, an abdominal ultrasound, blood pressure and echocardiography may be indicated.