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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.”
PA NE LI ST S: TABLE OF CONTENTS
Jeanne Pittari, DVM, DABVP Introduction/Aging and the Older Cat . . . . . . . . . . . . . . . . . . . . . . . . 3
(Feline Practice), Co-Chair
The Senior Cat Wellness Visit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Examination Frequency . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Ilona Rodan, DVM, DABVP
Minimum Database. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
(Feline Practice), Co-Chair
Interpretation of the Urinalysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Gerard Beekman, DVM Routine Wellness Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
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
Dental Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 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
Diabetes Mellitus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Helen Tuzio, DVM, DABVP
IBD and Associated Disease. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
(Feline Practice)
Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Debra Zoran, DVM, PhD, Osteoarthritis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
DACVIM-SAIM Cognitive Disorders. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16, 17
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 result in a
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
■ Deliver consistent high-quality care to senior cats. normal aging of the joints actually becomes a pathological
■ 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.
■ Define aspects of screening, diagnosis, treatment, and
Decreased hearing
FIGURE 1
Changes Associated with Aging* Non-neoplastic iris
Pigment changes
Lenticular sclerosis
Iris atrophy
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)
(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
■ 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
■ Stool quality (number, volume, consistency, odor, color). desirable because:
■ Hearing or vision loss (decreased responsiveness, increased ■ Many disease conditions begin to develop in cats in
The physical exam allows for detection of problems that ■ 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: ■ Owners may not recognize the existence or importance
■ 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. ■ 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
■ Skin and hair coat quality. 2003)
■ Oral cavity, including gingiva, pharynx, dentition ■ More frequent owner contact provides opportunity for
early warning of hypertension or retinal detachment. Exam and lab summary sheets allow for a quick review of
■ Thyroid gland palpation.
trends over time. Once evidence of an age related disease
■ Heart rate, rhythm, murmur.
process is discovered, a more frequent monitoring schedule
■ Abdominal palpation; pain, masses or thickened bowel,
may be needed.
kidney and bladder size and shape.
AMERICAN ASSOCIATION OF FELINE PRACTITIONERS
4 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, with the frequency increasing
as cats age. Specific recommendations about age and The incidence of many diseases increases as cats age. More
frequency of testing depend on many factors. (Epstein et robust data about disease incidence by age would assist
al 2005; Richards et al 1998) practitioners in determining the value and desired frequency
of testing, but such data is lacking. Veterinarians must rely
Clearly, there is high value to an individual cat to finding on their clinical judgment and individual client discussions
early disease, even when many tests yield normal results. based on each unique cat. Regardless of the cat’s age, more
However, routine laboratory testing of otherwise apparently frequent or expansive diagnostic evaluation is indicated if:
normal animals increases the statistical likelihood of revealing ■ Any abnormalities are noted in the history or physical
test results that are outside of the normal range but are not exam, even if the MDB appears normal.
clinically significant. Interpretation of these values and ■ Any disease is suspected or revealed at the regular
When in doubt, re-evaluate the patient to establish persist- Interpretation of certain parameters is complex in senior
ence and/or progression of the abnormality. Trends in the cats. Indications for and debates about blood pressure
MDB can be significant, allowing for detection of disease measurement and thyroid testing are discussed later in this
earlier than interpretation of a single sample. For example, document.
TABLE 1
The Minimum Database
“Mature” Cats “Senior / Geriatric” Cats
( 7 – 10 yr) ( > 10 yr)
CHEM screen
At a minimum, include TP, albumin, globulin, ALP, ALT,
glucose, BUN, Creatinine, K+, Phos, Na+, Ca + +
T4* +/- +
BP* +/- +
complete oral exam, plus the owner’s observation of eating every 15 minutes, continuing postoperatively until the cat
behavior, will elucidate dental problems. Cats with oral is ambulatory or normothermic. Support body temperature
pain may be thin, drop their food, chew on one side, eat by using tools such as a heated cage, hot air blankets,
more slowly, eat less, or show less interest in food. Age water-circulating heating pad, and/or booties. (Brodbelt et
or the presence of other chronic conditions should not al 2007)
exclude the treatment of dental disease that can be under- ■ Pain management is essential for all dental and surgical
taken when the cat is stabilized. Avoiding treatment of procedures. Pre-surgical analgesics (e.g., buprenorphine)
painful dental conditions such as odontoclastic resorptive decrease the necessary amount of injectable or inhalation
lesions, periodontal disease, or broken teeth contributes anesthesia thereby lowering the risk of anesthetic or drug
to diminished quality of life. (Richards 2005 Holstrom adverse reactions. Attend to comfort and gentle handling,
2005) AAHA has published comprehensive dental care particularly in cats with OA or muscle wasting.
FIGURE 2
Clinical Conditions in Older Cats*
Retinal hemorrhage
Retinal degeneration
Retinal detachment
Decreased vision/blindness
Dental/periodontal disease
Thyroid nodule
Osteoarthritis
Neoplasia
of a thyroid nodule. (Ferguson and Freedman 2005) due to stress responses in the hospital setting. Introduction
■ The total T4 is the appropriate screening test. An elevated of home monitoring by owners (blood collection via ear
result indicates hyperthyroidism is present, but a normal veins) may help mitigate the problem associated with
result does not rule out hyperthyroidism. (Chastain et al stress. (Reusch et al 2006; Casella and Reusch 2005;
2001) Alt et al 2007)
■ Should total T4 results be equivocal or normal but ■ Although most cats are insulin dependent at the time
hyperthyroidism is suspected, rule out other illness. Then of diagnosis, early glycemic control may lead to clinical
concurrently evaluate a second total T4 plus a free T4 by remission. Recent advances in treatment that can facilitate
equilibrium dialysis. earlier and/or tighter glycemic control include
■ Since free T4 can be elevated in cats with non-thyroidal • Feeding a canned low carbohydrate, high protein diet.
illness, interpret free T4 in conjunction with total T4 (Bennett et al 2006)
and clinical signs. (Peterson et al 2001) • The availability of new insulins such as long acting
■ A high free T4 with total T4 in the upper range of normal insulin glargine, that can help achieve ideal mean blood
supports the diagnosis. glucose concentrations. (Rand and Marshall 2005)
■ Thyroid scintigraphy, if available, is important in treat- • Portable blood glucose monitors that can allow clients
ment planning for I131 therapy, can be used to assess to perform blood glucose curves at home. Choose a
poor response, and is helpful if malignant disease is monitor shown to be accurate with cats, since accuracy
suspected. (Broome 2006; Bruyette 2004) Scintigraphy varies greatly. (Reusch et al 2002; Reusch et al 2006)
is a good test for localizing the source of thyroid hormone ■ Of particular importance for senior cats is the effect of
production and may assist in diagnosing hyperthyroidism. concurrent disease, such as chronic pancreatitis, on their
■ Monitor affected cats for kidney disease and hypertension. health status.
• Hypertension may persist or even develop after treat- ■ Corticosteroids can cause increased insulin resistance,
ment. (Reinsche et al 2008; Becker et al 2000; Graves further complicating disease management. (Rand and
et al 1994) Marshall 2005; Stumpf and Lin 2006)
• Hypertension secondary to hyperthyroidism alone
may self correct when a euthyroid state is achieved.
(Brown et al 2007)
• Monitor renal function. Creatinine levels post treatment
can rise due to unmasking of existing kidney disease.
Even cats with a urine specific gravity >1.035 are at
risk for developing unmasked kidney disease following
treatment.(Riensche et al 2008)
■ Transdermal methimazole is an alternative for cats with
vomiting or inappetance secondary to oral methimazole.
Differences in efficacy and side effects are still being
studied. (Sarto 2004; Lecuyer 2006; Trepanier 2005;
Trepanier 2007)
appears forgetful
■ Feline treatments are extrapolated from studies of humans diseases. (e.g., treatment of hyperthyroidism can unmask
and dogs. Diets enriched with antioxidants and other the severity of kidney disease).
supportive compounds (e.g. vitamin E, beta carotene, ■ The effect of poly-pharmacy or drug interactions.
and essential omega-3 and 6 fatty acids) are believed to ■ The effect of diet on body condition, GI function, kidney
reduce oxidative damage and amyloid production, and function, and overall health
improve cognitive function. (Milgram et al 2004; ■ The cumulative impact of multiple diseases.
Milgram et al 2005) • CKD, OA, DM, and IBD, when present in any
■ Environmental management, particularly surrounding combination, can result in significant inappropriate
litter box issues, can help the cat and owner maintain elimination.
good quality of life. Because these cats are easily stressed, ■ Diagnosing one disease while missing another, or assuming
change should be kept to a minimum or incorporated a single disease is severe when signs are actually due to
gradually. multiple diseases.
■ No drugs are licensed for the treatment of CDS in cats. • When cholangitis, pancreatitis, and/or IBD occur
Anti-anxiety medication may be useful in some cases. together, one or more may be missed. (Mansfield and
(Crowell-Davis 2008) Selegiline, propentofylline and Jones 2001)
nicergoline have all been used with varying degrees of • Chronic pancreatitis may be missed in a diabetic patient.
success. (Landsberg 2006; Landsberg and Araujo 2005; (Forcada et al 2008; Xenoulis et al 2008)
Landsberg et al 2003; Studzinski et al 2005) • Hyperthyroidism may be missed in cats with kidney
or liver disease, or cancer because typical signs are
masked and T4 may be suppressed back into the top
COMPLEX DISEASE MANAGEMENT of the normal range. (Peterson and Gamble 1990;
As cats get older, the likelihood of developing more than Wakeling et al 2008)
one disease increases, often with complex effects on • Hyperthyroidism may also be missed in cats with
diagnosis and treatment. Explore options to help clients diabetes mellitus since signs are usually similar.
manage their pet with multiple diseases. Educate clients
Nestle Purina
Merial Ltd.
Abbott Laboratories
Thank you to Pet Protect Insurance for allowing access to their database in order to generate
UK prevalence data for kidney disease and hyperthyroidism.
Thank you to Dr. Deb Givin for providing photos of our senior friends.
Disclaimers:
Dr. Gunn-Moore, Dr. Polzin, and Dr. Zoran have received funding for previous work from Nestlé Purina.
Dr. Taboada has received funding for previous work from Merial Ltd. and Nutramax Laboratories, Inc.
These guidelines were approved by the American Association of Feline Practitioners (AAFP) Board of Directors and are offered by the AAFP
for use only as a template; each veterinarian needs to adapt the recommendations to fit each situation. The AAFP expressly disclaims any
warranties or guarantees expressed or implied and will not be liable for any damages of any kind in connection with the material, information,
techniques or procedures set forth in these guidelines.