AAFP, American Association of Feline Practitioners, published guidelines to assist the veterinarian in managing the visit of the elderly patient providing high quality care to senior cats and increasing life expectancy.
The recommended controls were focused on health risk factors health risk factors; facilitating and promoting early detection of disease and improving or maintaining residual organ function.
The inevitable biological changes associated with aging result in a progressive reduction in the ability to cope with physiologic, immunologic and environmental stresses and along with “normal” aging, the incidence of certain diseases gradually increases.
One the main obstacles to owner compliance is the lack of a clear recommendation by the veterinary team. Guidelines can help veterinarians to minimize this obstacles, strengthen the human –pet-veterinary bond,and improve the quality of life of cats.
The age of cats can be classified into three categories:
- Middle-aged: 7-10 years
- Senior : 11-14 years
- Geriatric : >15 years
In the clinical examination detailed anamnestic collection is recommended with particular attention to the vaccination status,weight control, evaluating the body condition score (BCS) and an in-depth investigation of changes in the cat’s usual behaviors and routines.
We should carry out diagnostic tests at least once a year which must include: complete blood count ,serum creatinine, potassium, alanine aminotransferase, alkaline Phosphatase ,T4, urynalisis, blood pressure,test for the detection of Feline Leukemia Virus antigen (FeLV) and of antibodies to Feline Immunodeficiency Virus(FIV).
Nutrition and weight management
Dietary recommendations must be individualized and will vary depending on the BCS and any concomitant diseases.
Feeding small meals frequently increases digestive availability. Equally important Increased water intake is important since older cats are prone to conditions that predispose to dehydration.
Diet changes can alter the intestinal flora, leading to diarrhea, vomiting or loss of appetite. Cyproheptadine may increase appetite. Mirtazapine both stimulates appetite and reduces nausea. The vitamins B are not stored, so a diminished appetite or intestinal disease can lead to deficiencies. Oral and/or parenteral supplements should always be carried out.
Dental care
Oral cavity disease is an often overlooked cause of significant morbidity in the older cat and can contribute to a general decline in attitude and overall health. Cats with oral pain may be thin, drop their food or may have sialorrhea.
Avoiding treatment of painful dental conditions such as odontoclastic resorptive lesions, periodontal disease or broken teeth contributes to diminished quality of life.
Hypertension
Hypertension is potentially damaging to the eyes, brain, heart, kidneys and central nervous system. Hypertension may be idiopathic or secondary (ie, associated withkidney disease,Hyperthyroidism, Primary aldosteronism ,drugs, etc) and it should always be treated when the BP is 180/120 mmHg( in cats with CKD, when the BP is 160/100 mmHg) .A reasonable treatment goal is to reduce BP to below 150/95 mm
Chronic kidney disease
Kidney disease is often diagnosed late even if it has already been present in a sub-clinical form for some time. Routine MDB screening may reveal early disease before symptoms detected by owners (pu / pd) typical of CKD. Indirect and early clinical signs are often ignored(constipation,inappetence, nausea and muscle wasting or weight loss).
Evaluating urine concentrating ability is essential even in the absence of high creatinine values always evaluating the urinary pu / cu . Investigate and treat electrolyte abnormalities such as hypokalemia,hyperphosphatemia and acidosis. Monitor BP and urinary tract infections through urine culture. Feeding a ‘renal’ prescription diet has been shown to reduce uremic episodes, decrease phosphorus retention, prevent muscle wasting and increase survival times.
Hyperthyroidism
Approximately 40% of cats with early hyperthyroidism have only mild clinical signs. Early hyperthyroid disease can be diagnosed 1–2 years prior to obvious signs. Thyroid nodules may or may not be functional so diagnosis and The total T4 is the appropriate screening test in the cat. Geriatric cats and especially those with signs of kidney disease and hypertension should always be monitored through creatinine dosage and p.a. measurements serial. Transdermal methimazole is an alternative for cats with vomiting or inappetence.
Diabetes mellitus
Diabetes mellitus is an disease in senior cats, with almost half of all diabetics being 10–15 years old. The home
monitoring by owners can be essential to avoid stress alterations during measurements in veterinary hospital. Although most cats are insulin dependent at the time of diagnosis, early glycemic control may lead to clinical remission.
Recent advances in treatment that can facilitate earlier and/or tighter glycemic control include feeding a canned low carbohydrate,the availability of new insulins formulation; portable blood glucose monitors and increasingly reliable.
Inflammatory bowel disease and associated disease
Inflammatory bowel disease (IBD) begins in adult cats and may require lifelong treatment. The clinical signs of IBD are non-specific and may be confused with many diseases of older cats. Additionally, IBD may influence the diagnostic and/or treatment approach to other diseases when it is present. In addition to the MDB, initial evaluation should include measurement of feline pancreatic lipase immunoreactivity (fPLI), feline trypsin-like immunoreactivity (fTLI), B12 and folate concentration. Because of the close anatomic relationship between the pancreatic and bile ducts in cats, it is important to recognize that IBD, pancreatitis and cholangiohepatitis may occur separately or together.
Osteoarthritis
Osteoarthritis is a common but under-recognized condition in senior cats. Radiographic evidence is not always consistent with clinical signs and Signs are often subtle behavioral and lifestyle changes mistaken for ‘old age’. Palpate for joint thickening, swelling or pain; crepitus or limited range of motion are signs of full-blown disease. Treatment decisions depend on the degree of OA and the existence of concurrent diseases. Diets created for management of OA may improve joint mobility and comfort. Chondroprotective agents may be useful in patients with mild to moderate OA but therapy with analgesics (fans and opioids) becomes essential in the cat with severe signs and with severe pain. Continuous use of low-dose meloxicam has also been shown to be safe and effective in the elderly cat.
Cognitive disorders
According to recent studies at 15 years of age 50% of cats have signs of cognitive dysfunction. Signs of cognitive disorders include altered behavior, spatial or temporal disorientation, altered interaction with the family and changes in sleep/wake cycles. Other diseases should always be excluded before diagnosing a primary cognitive disorder. Diets enriched with antioxidants and other supportive compounds are believed to reduce oxidative damage and amyloid production, and improve cognitive function. Selegiline, propentofylline and nicergoline have all been used with varying degrees of success.
Quality of life
Hand in hand with the management of chronic illness in senior patients comes the responsibility to control pain and distress, assess quality of life, and provide guidance to the owner in end-of-life decisions.
Veterinarians can assist clients in managing home care, changing the environment to ensure comfort and must act as a patient advocate when counseling clients about decisions regarding use and/or continuation of treatment. Hospitalized cats may become depressed; therefore, allow clients to keep cats at home whenever possible. Helping owners prepare for loss and grief is a valuable and memorable service that veterinarians can offer.