Visiting Vet: Geriatric care

There’s a broad range for pets, as for people.

Senior pets can undergo certain screenings for their older age. —Michael Owen

Next week I am going for my first bone density scan. I think that officially makes me old. This screening is recommended for most women over the age of 65. Although I take after my heavyset father, which reduces my risk of osteoporosis, my tiny, 90-pound, 98-year-old mother recently broke her hip, so I think the bone scan is a good idea for me.

The older I get, the more time I seem to spend at doctors’ offices. The same holds true for senior pets. Although I constantly tell clients, “Old age is not a disease,” the fact of the matter is that as bodies age, things often start to wear out, break down, or go wrong. As medical knowledge and technology evolve, we have more and more options for screening seniors for problems, even before clinical symptoms appear.

Let’s talk about geriatric medicine. According to the American Animal Hospital Association, 44 percent of pet dogs and cats in the U.S. are “seniors.” For humans, 65 years old is generally acknowledged as bestowing senior status (though issues associated with aging may happen earlier). In dogs and cats, defining “senior” is more difficult, as expected lifespan varies widely based on breed, size, and species. For example, small dogs generally live longer than larger ones, and giant breeds, such as Great Danes and Great Pyrennes have even shorter lifespans. Siamese cats are renowned for living a long time (as well for being very vocal, so before you adopt one, make sure you’re ready for 17-plus years of plaintive feline conversation). In general, veterinarians define “senior” as the last quarter of an animal’s estimated lifespan, measured from birth to anticipated natural end of life.

So let’s say you’re bringing Boomer, the beagle, to the vet for his annual physical examination. The American Kennel Club lists the life expectancy of beagles as 10 to 15 years, so by the time Boomer is around 8, he qualifies as a senior. Maybe you are starting to notice changes, some minor, some more concerning, that you want to discuss with your veterinarian. Your first step is to alert your vet’s office when you are making your appointment. Most clinics book a specific amount of time for a routine physical or for a visit to address one ailment, such as an ear infection or case of diarrhea. If you want the doctor to have time for a nose-to-tail senior exam, they may want to book you a longer time slot. Be prepared to pay a little more for an extended exam if there are a multitude of issues discussed.

The goal of geriatric medicine is to give Boomer the best quality of life for the longest possible time. That requires a multifactorial approach, addressing medical, behavioral, and environmental components. Here’s where personal philosophy and finances impact how we proceed. Current guidelines for senior dog and cat medical care include basic blood work every six to 12 months (including thyroid testing, especially in cats), fecal tests to screen for intestinal parasites one to four times annually depending on the pet’s lifestyle, annual tick-borne disease screening, radiographs if indicated by exam, and ECG for dog breeds at high risk of cardiac disease. Screenings for feline leukemia virus and feline immunodeficiency virus are advised annually for cats at high risk. A blood test called NT-proBNP, which looks at heart health, is suggested annually for seniors, and strongly recommended before any anesthetic procedure.

Phew. That’s a lot of tests. When I was a young veterinarian, few owners would go for the expense of such screening in an apparently healthy pet, no matter how old Boomer was. Nowadays, people are more aware of the value of early testing and intervention, as these types of evaluations have become routine in human healthcare. Of course, if Boomer is clearly not feeling well, owners usually agree to diagnostics, but if he’s just “getting old” we have to decide how much workup to do. We have to look at all the comorbidities and make a rational geriatric care plan that works for everyone. It may make sense to remove a tumor on an 8-year-old poodle in otherwise good health, while not in a St. Bernard of the same age who also has arthritis and mobility issues. Anesthetizing one old Chihuahua for much-needed dental work may be an acceptable risk in that patient, but not in another with concurrent kidney and cardiac disease. Geriatric medicine is not “one size fits all.”

Next, behavior. Elderly pets frequently experience behavioral changes, such as anxiety, sleep-cycle disturbances, cognitive dysfunction syndrome, loss of housebreaking, and/or reduced activity. Some may be medically based and medically treatable. Most warrant environmental modifications to make Boomer’s life easier. Just like my mother has a walker, hospital bed, and stair lift, Booner may benefit from ramps, good area rugs for traction, and an orthopedic bed. He may need aids like nightlights to reduce confusion and anxiety after dark, or a baby gate to make sure he doesn’t fall down the stairs.

Then, eventually, we face the end-of-life discussion. When do Boomer’s problems negatively impact his well-being (or yours) so much that it is time to talk about letting him go? It’s a good idea to make an appointment with your veterinarian specifically to discuss quality of life. There may be things we can do to improve and extend his comfortable life that you haven’t explored. This isn’t a conversation for a quick telephone call or email. Let us examine Boomer and take the time to really talk with you. Perhaps you are ready for euthanasia that same day. Perhaps you simply want to have a good heart-to-heart with your veterinarian, then take time to consider your options. Just remember, being elderly is not a disease, and geriatric care is multifactorial. It requires a balance of compassion and realism. As I tell my kids when they make fun of me for my senior Boomer moments, If you are lucky, you too will be old someday.