Health Programs for Senior Pets Maureen Revington BVSc, MSc, PhD

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1 Health Programs for Senior Pets Maureen Revington BVSc, MSc, PhD There are many potential benefits of instituting a health program for senior pets in your practice. Senior health programs can help raise awareness amongst pet owners of the special needs of seniors, and educate them that, through regular veterinary visits and appropriate nutrition, they can help their older pets live longer, healthier lives. Providing optimal care for senior pets enhances the human-animal bond and promotes early detection of age-related diseases. With early detection, optimal medical care can be initiated that may increase longevity and enhance quality of life. 1 When are dogs and cats seniors? In humans, the senior years are considered to start between 56 and 60 years of age, and regular health screening for age-related disease is usually recommended from middle-age (42 to 45 years). 1 Cats and small to medium sized dogs reach middle age at approximately 7 to 8 years, while large and giant breed dogs are regarded as middle aged a year or two earlier. 1 The time to start recommending a senior health program is middle-age. Although senior dogs and cats may not outwardly appear old, certain changes are progressively taking place. These include changes in metabolism, special senses, behaviour, the oral cavity and other organs. Metabolism Older animals tend to lose lean body mass and are less active resulting in a decreased basal metabolic rate, although one study failed to show a reduction of lean body mass in older dogs. 2 Their immunity may be altered, making them more prone to infections and cancer. Older animals are less able to metabolise certain drugs such as anaesthetics, and their capacity for body temperature regulation is compromised so they have reduced tolerance to heat and cold. Special Senses There are reductions in smell and taste perception and diminished hearing and visual capabilities with age. Both dogs and cats rely heavily on their sense of smell for palatability. Behaviour Certain behavioural abnormalities may become more evident including disorientation, not recognising family members or the home environment, intolerance to change of routine, sleep disruptions, wandering and pacing and even loss of housetraining with accidents. 3 Dental Disease Oral disease is the most common health problem of mature dogs 4 and cats. 5 Older animals may have fewer teeth or sensitive gums, and they suffer more periodontal disease and increased dental calculus. These changes may make chewing difficult or painful and lead to decreased appetite and weight loss. Digestion/Endocrine Older animals may have decreased liver and pancreatic function leading to reduced nutrient digestion and assimilation, and are more likely to suffer from constipation than younger animals.

2 They are also more likely to suffer endocrine problems such as hypothyroidism, hyperadrenocorticism and diabetes mellitus. 1 Skin Skin changes include loss of elasticity, dry, flaky coat, and brittle nails. Hair follicles may die leading to bald patches, while hairs lose their pigment and go grey. There may also be a loss of sebum (oil) production and increased waxy secretions. Kidney Disease Kidney disease is a leading cause of non-accidental death in older dogs and cats. In a large study of general practices in USA in 1995 the prevalence of renal disease increased with age. 5 Kidney disease is insidious and slowly progressive, and while it is manageable, it is not reversible. Some degree of clinical or subclinical renal insufficiency is often present in older dogs and cats, but the problem is rarely diagnosed before 75% of renal function is lost. Early detection and modification of dietary and non-dietary risk factors are the keys to long-term survival. 6,7 Musculoskeletal Older animals often have decreased lean muscle mass and muscle tone. They are prone to degenerative joint changes such as arthritis, spondylosis and degenerative disc disease. 1 Obesity can exacerbate musculoskeletal disease. Cardiovascular Cardiac output can decrease by up to 30% in older pets, decreasing the heart s efficiency. Increased peripheral resistance in the blood vessels means high blood pressure (i.e. hypertension), which in turn damages end-organs such as the kidneys. Heart murmurs can often be detected in older dogs, and can be caused by thickening and damage to the heart valves. This leads to regurgitation of blood and eventually can lead to signs of heart failure. Urinary Tract Older cats and dogs are more likely to develop calcium oxalate crystals in their urine. 1 High salt diets should be avoided (sodium > 0.6% dry matter). Why is a senior health program important? The health status of senior pets can be very variable, and it is important to evaluate them individually. From the age of 7 years, the prevalence of a number of diseases starts to increase. Some of the diseases that become more common as dogs and cats age include: 1 Cancer Cardiac disease Renal disease Diabetes Thyroid disease Osteoarthritis Ophthalmic diseases Urinary tract disease Neurological diseases Periodontal disease Dermatological conditions Obesity

3 The earlier these diseases are detected, the better the chances of managing them successfully. 1 How often should senior pets have a veterinary examination? The AAHA Senior Care Guidelines Taskforce 1 recommends routine veterinary examinations for seniors every 6 months, bearing in mind that this is roughly equivalent to once every 2 to 3 human years. These twice yearly examinations and laboratory tests will enable earlier diagnosis of diseases, so that therapy can be instituted when it is likely to be of most benefit. Screening apparently healthy senior pets also enables gathering of baseline data for comparison with future examinations and test results. What examinations and diagnostic tests are recommended? For seniors it is especially important that the history obtained extend beyond the owner s main health concern senior pets often have more than one disease, and the course of one disease can be markedly influenced by the presence of another. A senior health check list is helpful, and can be given to pet owners to fill in before they arrive at the clinic, or it can be completed in the waiting room. In the physical examination, extra attention should be given to areas of concern for seniors, such as body condition, hydration status, kidneys and liver, cardiopulmonary assessment, CNS signs and lymph node enlargement. 1 Diseases may be subclinical and not apparent on physical examination, so more diagnostic tools such as blood and urine tests and imaging may be necessary. The minimum laboratory analyses for healthy seeming seniors should include complete blood count and urinalysis, faecal analysis, BUN, creatinine, ALT, ALP, glucose, calcium, total protein, albumin, bilirubin, T4 (cats) and potassium (cats). 1 Any abnormal findings on physical examination will direct the focus of further laboratory tests. Establishing the benefits of senior screening with pet owners Only about 14% of senior companion animals undergo regular health screening. The main obstacle to compliance is the lack of a clear recommendation of the need for senior screening by the veterinary care team. 8 Veterinary professionals are sometimes reluctant to make recommendations that they know are important because they are concerned clients will think they are just trying to sell their services to make more money. However, according to the AAHA Compliance Study, only 10%of pet owners believe that veterinarians recommendations are motivated by the desire to make a profit: client surveys show that cost is the smallest obstacle for pet owners when accepting a recommendation. 8 Identifying your senior patients and establishing a senior protocol In Australia there are 5,690,000 cats and dogs. Dogs over the age of 7 years make up 34% of the dog population, and cats over the age of 7 make up 31% of the cat population. That means there are about 1.9 million senior Australian dogs and cats. 9 Most practice management software can pull up information such as all patients over the age of 6 years. Once you have the information, it is a simple matter to add twice yearly Senior Screening Reminder to your protocols. It should be stressed to clients that a senior screening is part of your health protocol for older pets.

4 Nutrition Nutrition has a profound effect on the wellness of older pets and is an important component of their preventative care. It can help decrease the risk factors for common age-associated diseases. Correct nutrition can ensure good health is maintained and can maximise longevity. 10,11 Nutritional goals in the older pet are to: Maintain ideal body condition and body weight Minimise disease risk Disease management ameliorate the clinical signs of diseases and/or slow their progression Improve the quality and longevity of life There are several specific nutrients of concern for the older pet. These include energy or calories, protein, phosphorus, sodium (salt) and fibre. Nutrition is the 5 th Vital Assessment and is integral to optimal pet care The vital signs temperature, pulse and respiration have been checked by veterinarians for decades. In 2007, Pain became the fourth vital assessment, and in 2010, Nutrition was added as the 5 th vital assessment. 10,11 A nutritional screening evaluation should be part of every patient exam. Current diet and amount fed, activity level, and age should be assessed. An extended evaluation is performed when one or more nutrition related risk factors are found or suspected based on the screening evaluation. Nutrition and the mature pet Clients need to be aware that the dietary requirements of mature dogs differ from those of young and middle aged dogs. They should receive a clear, written recommendation from the veterinary health care team for a premium diet that is specific to the life stage, health status and lifestyle of their dog or cat. Disease specific nutrition While Senior formulations are indicated for healthy older animals, we must appreciate the diversity in health status of older animals. Nutritional needs must be adapted to the specific health needs of each animal. Disorders to which older animals are over-represented when compared with young or young adult pets, where nutritional management is part of therapy include diabetes mellitus in cats and dogs, obesity in dogs, chronic renal disease in dogs and cats, neoplastic disorders, osteoarthritis, dental disease and cognitive dysfunction syndrome in dogs. Moreover, older animals seldom suffer from a single disease and one problem may markedly influence the course of another. In this instance, the most serious or life-threatening disease generally takes priority for nutritional management. How to make a specific nutrition recommendation Be sure to tell the client why you are making this particular recommendation. Conclude your discussion of nutrition by returning to the client s perspective. - What concerns do you have about implementing these changes? - What challenges do you anticipate? - What remaining questions do you have? Follow up Make a chart notation to follow-up with a phone call or a reminder card to ensure the client follows through with the recommendations - 78% of clients want a follow up phone call. 8 Most of

5 dietary changes fail between the first and second bag. This is when it is most important to make that follow up phone call. Tips on achieving compliance 8 Involve all practice staff in achieving compliance Use follow up phone calls to reinforce recommendations Conduct a compliance review on every medical record that is pulled for any reason Send a reminder with a special offer to clients you haven t seen for 12 months Communicate with clients on ageing and the importance of early screening for disease Develop a written protocol for a senior health and screening program for your hospital - guidelines need to be practical so they can be used in your clinic, embraced and carried out by all members of the vet team Nutritional Assessment Protocol Waiting Room Client fills out nutrition history/ update form/weigh the pet Place nutrition history/update form in patient s records Consulting Room Record history using nutrition history form Perform physical exam and nutritional assessment Make specific nutritional recommendation and document the recommendation Ask the client if there are any questions and reinforce the recommendation Discharge Ask client again if there are any questions Dispense food, measuring cup, nutritional literature and reinforce recommendation Schedule a follow up phone call in 3-5 days / Trademarks owned by Hill s Pet Nutrition, Inc. 2010

6 References 1. Epstein M, Kuehn NF, Lascelles BDX et al. AAHA Senior Care Guidelines for Dogs and Cats. J Am Anim Hosp Assoc 2005;41: Williams CC, Cummins KA, Hayek MG, Davenport GM. Effects of dietary protein on whole-body protein turnover and endocrine function in young adult and ageing dogs. J Anim Sci 2001; 71: Head E, McCleary R, Hahn FF, et al. Region-specific age at onset of beta-amyloid in dogs. Neurobiology of Aging 2000; 21: DeBowes LJ, Mosier D, Logan EI. Association of periodontal disease and histologic lesions in multiple organs from 45 dogs. Journal of Veterinary Dentistry 1996; 13: Lund EM, Armstrong PJ, Kirk CA, et al. Health status and population characteristics of dogs and cats examined at private veterinary practices in the United States. Journal of the American Veterinary Medical Association 1999; 214: Jacob F, Polzin DJ, Osborne CA et al. Clinical evaluation of dietary modification for treatment of spontaneous chronic renal failure in dogs. J Am Vet Med Assoc 2002; 220: Ross SJ, Osborne CA, Kirk CA et al. Clinical evaluation of dietary modification for treatment of spontaneous chronic kidney disease in cats, J Am Vet Med Assoc 2006; 229 (6): Wayner CJ, Heinke ML. Compliance: Crafting Quality Care. Vet Clin Small Anim 36, 2006; ACA research 2010 Pet Owners Post GFC 10. Baldwin K, Bartges J, Buffington T et al. AAHA Nutritional Assessment Guidelines for Dogs and Cats. J Am Anim Hosp Assoc 2010; 46: Freeman L, Becvarova I, Cave N et al. WSAVA Global Nutritional Guidelines 2011; 1-25.