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February 2023
2023 AAHA Senior Care Guidelines for Dogs and Cats
Executive Summary of the latest guidance from AAHA
Executive Summary
These guidelines were prepared by a task force of experts convened by the American Animal Hospital Association. This document is intended as a guideline only, not an AAHA standard of care. These guidelines and recommendations should not be construed as dictating an exclusive protocol, course of treatment, or procedure. Variations in practice may be warranted based on the needs of the individual patient, resources, and limitations unique to each individual practice setting. Evidence-guided support for specific recommendations has been cited whenever possible and appropriate. Other recommendations are based on practical clinical experience and a consensus of expert opinion. Further research is needed to document some of these recommendations. Drug approvals and labeling are current at the time of writing but may change over time. Because each case is different, veterinarians must base their decisions on the best available scientific evidence in conjunction with their own knowledge and experience.
This Executive Summary is not a substitute for reading the guidelines in their entirety. The full guidelines are published in the Journal of the American Animal Hospital Association (J Am Anim Hosp Assoc 2023; 59:1-21. DOI 10.5326/JAAHA-MS-7343) and online at aaha.org/senior-care
Senior dogs and cats represent 44% of the pet population, and senior pets have special needs that extend beyond the examination room. A pet’s senior years are distinct from other life stages, but because of variability among species and breeds, no specific age denotes senior status. The 2019 AAHA Canine Life Stage Guidelines define senior dogs as those in the last 25% of their estimated lifespan. The 2021 AAHA/AAFP Feline Life Stage Guidelines and the 2021 AAFP Feline Senior Care Guidelines define senior cats as more than 10 years old.
Healthy senior pets
Set a senior-friendly tone by taking a thorough history and using open-ended questions. Gaining an understanding of the pet’s environment is crucial. This approach may reveal issues not mentioned when the appointment was made. Checklists and chronic pain scales facilitate screening, and videos can aid in assessing pain, mobility, and movement.
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Veterinary professionals are taught to recognize that “old age is not a disease.” However, clients may have the perception that older dogs and cats undergo an unavoidable physical, mental, and behavioral decline attributable simply to old age. The veterinary team’s role includes providing medical care and support to senior pets to maintain their quality of life, as well as supporting and educating clients on proper senior care and addressing misconceptions about the aging process. These guidelines describe a systematic, holistic approach to senior pet care. By using evidence-guided medicine, which may include conventional and integrative approaches as well as environmental management for the senior pet, the patient’s quality of life can be enhanced and potentially extended during this vulnerable life stage. Developing a senior care program requires appropriate training of the entire healthcare team and includes a robust client education program that focuses on the pet’s wellbeing. Palliative and hospice care should be included in the education and information provided to both the veterinary team and the families of senior pets. |
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Establish what pharmaceuticals, supplements, nutraceuticals, creams, oils, or other therapeutics (including cannabis products) the pet receives in order to evaluate the need for additional therapeutics, minimize drug interactions, and build a trusting client-veterinarian relationship.
Following a thorough physical exam (the guidelines describe several factors relevant to senior pets), address other topics, including mobility issues related to osteoarthritis, metabolic issues such as kidney or liver disease, and functional issues such as heart disease or neoplasia. Table 1 lists several diagnostic tests to include in a once- or twice-yearly medical workup.
Anesthetic and surgical considerations. Senior pets can safely undergo multiple anesthetic events. If clients feel anxious, reassure them about the need for and safety of the procedure.
The guidelines discuss several ways to minimize risk and complications before, during, and after anesthesia and surgery, from medication choices to use of checklists and pain management scales. Additional information can be found in the 2022 AAHA Pain Management Guidelines for Dogs and Cats and the 2020 AAHA Anesthesia and Monitoring Guidelines for Dogs and Cats.
Dentistry. Because senior pets may have increased risk for oral cavity issues, the oral cavity should be examined at every veterinary visit. Videos of unusual eating practices can help assess a problem.
Different dental issues affect senior dogs and cats, including periodontal disease, oral tumors, and tooth resorption in cats. To provide adequate care, radiographs are recommended, and anesthesia is required. For advanced or complex disease, if it is not possible to refer to a board-certified veterinary dentist, staging procedures can minimize anesthetic risk. Resolving oral and dental issues can greatly improve quality of life (QOL).
The AAHA 2019 Dental Care Guidelines for Dogs and Cats provide a comprehensive supplement to these guidelines.
Nutrition for the healthy senior. For cats, the effects of age on energy requirements are extremely variable. For dogs, maintenance energy requirements generally decrease over the lifetime. The guidelines discuss the use of muscle and body condition scores to help monitor normal aging and age-related disease changes and needs for nutritional adjustment. Issues related to digestibility of nutrients, protein synthesis, loss of lean body mass, and obesity are briefly discussed, along with some observations on nutritional needs.
Consult the 2021 AAHA Nutrition and Weight Management Guidelines for more information.
Evaluating the unhealthy senior pet
“Clients may not recognize early signs of cognitive dysfunction, but early treatment is more effective.”
Senior pets are at a greater risk for illness in their final years. This section begins with a reminder of the importance of preventing and screening for chronic disease, followed by common signs of chronic disease and recommended diagnostic tests.
Table 2 summarizes diagnostic approaches based on body system. The table is not exhaustive, and additional diagnostic approaches may be warranted.
Senior pets may have several concurrent medical issues and associated clinical signs. Referral to a specialist may be indicated for complex comorbidities. If a client declines diagnostics or treatment, veterinarians should discuss the benefit of symptomatic treatment to improve the pet’s QOL. This may encourage the client to accept palliative care.
Cognitive dysfunction and behavioral anxiety. This section describes clinical signs, guidance for diagnosis, and treatment. Clinical signs of cognitive dysfunction vary between dogs and cats. Clients may not recognize early signs, but prompt recognition is crucial because early treatment is more effective.
Signs in dogs include Disorientation, alterations in social Interactions, changes in Sleep-wake cycles, loss of House training and other learned behaviors, altered Activity levels, and increased Anxiety (DISHAA). Cats experience similar signs, plus increased interaction and vocalization. Anxiety is significant and can be directly treated. Managing pain is important when treating anxiety.
Cognitive dysfunction may be treated with selegiline (for dogs), diet, and environmental enrichment. Some treatments, like acupuncture and certain diets, have not been validated.
Pain management. Clients may not recognize signs of pain in their geriatric pets. Teaching clients to recognize and monitor acute and chronic pain should be paramount. Videos can be used to evaluate changes in movement or to monitor responses to treatment.
The guidelines recommend an integrative and multimodal approach to managing pain and mobility. Options range from pharmaceuticals, nutraceuticals, and herbals to weight management, acupuncture, physical modalities, environmental modifications, and rehabilitation therapies. Counsel clients on home modifications, including helpful pet accessories and ways to address potential hazards.
GOLPP complex. Geriatric Onset Laryngeal Paralysis Polyneuropathy (GOLPP) is increasingly recognized in geriatric large-breed dogs and causes degeneration in the long nerves. A brief note describes clinical signs, possible comorbidities, and possible treatments.
Nutrition in disease management. Changes to nutrition may assist in managing diseases like hypothyroidism in dogs, chronic kidney disease, osteoarthritis, and hyperthyroidism or diabetes mellitus in cats. Different ingredients in a balanced diet may be used to treat or manage a chronic disease, such as cognitive dysfunction syndrome, immunosenescence, osteoarthritis, and heart disease. For cats with diabetes mellitus, treating for obesity and inactivity is beneficial.
For palliative care patients who refuse to eat, the guidelines name several approaches, including feeding tubes, medication, and fluid administration. Offering favorite foods may provide some nutrition and a positive experience for the caregiver and patient.
“Allow adequate time: The initial end-of-life appointment may take up to three hours.”
End of life and euthanasia. The 2016 AAHA/IAAHPC End-of-Life Care Guidelines provide recommendations for maximizing patient comfort and minimizing suffering while providing a collaborative and supportive partnership with the caregiver client.
When there is a chronic, progressive, or terminal diagnosis, palliative care consists of symptom and pain management along with curative treatment. The end stage of palliative care is hospice, which provides planning for the decline of the pet, dealing with a crisis, and how the family would like the animal to die (euthanasia or palliated death from their disease). The guidelines recommend developing a daily and crisis plan to provide patient care and support for the family.
The introductory end-of-life appointment may take up to three hours. Begin with a complete physical examination and a conversation about the pet’s history, diagnosis, and current medications. Then discuss the diagnosis, prognosis, and clinical outcomes, as well as a care plan based on client goals. The discussion may also cover palliative, hospice, or humane euthanasia options.
If a client seems overwhelmed, schedule another time to continue the discussion. Recognize possible limits to what clients can do to provide nursing care, and discuss factors that may affect their decisions about end-of-life care. Although the client is generally the best advocate for the pet, veterinary teams may help guide their decisions.
Senior and end-of-life care involves a range of professionals, including the medical team, grief counselors, respite workers, and more. The guidelines offer suggestions to address compassion fatigue for both clients and staff.
Making Senior Pets a Priority
This section offers valuable details about how to create a senior-friendly practice by:
- Evaluating the physical space
- Planning for the senior pet appointment
- Preparing and providing client information
- Promoting senior pet care
- Managing the caregivers’ burden
- Communicating with families of senior pets
- Using telehealth and telemedicine
- Educating the veterinary team
Unfortunately, an executive summary cannot do justice to the wealth of information the guidelines provide. As always, it is essential to read the guidelines in their entirety. The following are selected highlights.
Create a senior-friendly hospital. Be mindful of senior pets’ needs at every stage of the veterinary visit. A Senior Pet Champion team can develop procedures and identify improvements to create an optimal practice culture.
“Teach clients to recognize and monitor acute and chronic pain.”
Evaluate the physical space. Consider outdoor ramps for curbs and stairs, flooring that provides traction, light and noise dampening, increased padding for recovery beds, and pheromones to control anxiety.
Plan for the senior pet’s appointment. Provide a species-specific questionnaire and, as appropriate, request video or photos; allocate sufficient time for the appointment; and prepare client education materials ranging from appointment-specific information and instructions to educational handouts and a senior pet information kit (similar to new pet kits).
Promoting senior pet care. Emphasize what your practice does differently. Use photos and video to show changes you have made to the building. On your website and social media, be sure 30% of visual content features senior pets. Offer end-of-life resources, like a QOL checklist.
Manage the caregiver burden. Senior care can be emotionally taxing. Supporting the caregiver may involve recognizing the potential for family conflict, providing resources about respite care or coping mechanisms, creating a care plan, and prioritizing client and patient needs.
Communicate with families. Effective communication may involve addressing multiple family members, explaining an array of medical issues, conveying information about a declining condition or serious illness, and answering many questions. Guide discussions with honesty and sensitivity, organizing information into logical “bites.” Give careful attention to issues surrounding medication. Repeat medical recommendations, and check that clients understand and agree with the plan. Schedule a follow-up to evaluate how medications are working and how the client and pet are adjusting to the plan.
Use telehealth and telemedicine. These technologies benefit senior pets by avoiding visits to the practice, which may be difficult and stressful. Moreover, viewing pets at home may provide a truer picture of their behavior. These technologies also allow teleconsultation with specialists. Among other benefits, more frequent high-quality rechecks improve patient outcomes, while access to online patient records facilitates communication and cooperation.
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Educate the team. Train the team to promote senior pet care and to communicate effectively with clients, especially when explaining healthcare recommendations. Formal training should cover the aging process, senior pet–friendly techniques, and modifying the clinic environment. Team members should recognize that senior pets may be frail, understand how common symptoms of aging affect patients, and be competent with low-stress handling and other comfort measures.
The caregiver-pet bond means different things to different people. Work with clients to ensure the animal is not suffering, as sometimes families have difficulty letting go. Educate teams on how to recognize and anticipate bereavement and grief. Provide support for team members who work in emotionally charged situations, and encourage them to seek help when needed.
When both the practice team and clients understand the goals for senior pet care, successfully implementing an effective healthcare program for older pets is all but ensured.
Constance Hardesty is a freelance writer and author currently researching her PhD in Oxford, England. |
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