AGING GRACEFULLY: A TEAM APPROACH TO MATURE AND SENIOR PET WELLNESS CARE
Steve Thompson, DVM, dipl ABVP (Canine/Feline)
Lorraine Corriveau, DVM,
Cindy Voglewede, RVT, VTS, Saralyn Sharp, RVT, VTS (Canine/Feline)
Purdue University Pet Wellness Clinic – W. Lafayette, IN 47907
In Pursuit of Wellness Excellence. As a veterinary student in 1989, I recall the publication in
JAVMA from the Council on Biologics supporting, for the first time by a national veterinary organization,
annual vaccination in dogs and cats. I’d worked for practitioners for years who had been giving vaccines
on industry label recommendations but now we had support in writing. Much of the veterinary school
education for pets was focused, and still is, on disease detection and treatment, with the prevention of
diseases, infections and infestations less glamorous. Production medicine has a focus on nutrition,
husbandry and preventive medicine, moving away from “fire truck” runs after hours to manage
problems that could have been prevented. Wellness care is a buzz word again. The Partnership for
Preventive Pet Healthcare has evolved into the Partners for Healthy Pets initiative, www.
partnersforhealthypets.org, with a focus on ways practices and the profession can help pet owners
understand the importance and value of preventive healthcare.
Team building and a common message are necessary components of successful small
businesses. Front office staff, our customer service representatives, with the medical staff,
technologists, technicians and assistants, as well as new associates. The Art of Veterinary Practice
includes finding ways to improve compliance and expand treatment tool boxes. Journal articles and CE
programs provide opportunities to hear how successful practitioners handle the routine and the
problem patients. Published guidelines provide an opportunity for practice owners to focus January and
February team planning meetings on these updates and implementation, many with available toolkits.
Evidence based medicine should support guidelines that keep science and critical thinking at the
forefront. I served on the AAHA task force challenged to produce a concise document with evidence
based life stage guidelines for dogs. There is still a need for additional research in many areas but the
publication was a compilation of 98 references and 19 hyperlinks. The Association of Feline Practitioners
and American Animal Hospital Association have been leaders in providing evidence based guidelines and
practical applications for pets related to Vaccinations, Senior Care, Lifestages, Nutrition, Handling and
Behavior to name only a few that encompass wellness care. Search through multiple guidelines for the
latest updates via AAFP at www.catvets.com under Veterinary Professionals and via AAHA at
www.aahanet.org under Library: Guidelines and Toolkits. These guidelines will list the most recent
publication, task force members and authors as well as attached references and hyperlinks.
Need a review on Rabies vaccines, legalities and quarantine guidelines for strays with bite
wounds prior to considering adoption in areas with a terrestrial rabies reservoir species? Find the Rabies
Compendium from the National Association of State Public Health Veterinarians at www.nasphv.org and
look under Documents for all their Compendia. Want to expand team understanding of noncore
vaccinations presented in the AAFP and AAHA vaccination guidelines? The American College of
Veterinary Internal Medicine, www.acvim.org, lists consensus statements on Leptospirosis and Lyme
disease. Retrovirus guidelines exist as another AAFP update. Canine Influenza Background information
is online from AVMA, www.avma.org under the Knowledge Base icon.
Parasite screening and control are covered well in guidelines from the Companion Animal Parasite
Council at www.capcvet.org , the American Heartworm Society at www.americanheartworm.org (for
both dogs and cats) and the Centers for Disease Control and Prevention, Recommendations for
Veterinarians related to roundworms at www.cdc.gov.
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A renewed focus for wellness guidelines includes breed specific concerns, both for the individual
pet with breed and lifestyle awareness as well as breed improvement guidelines. Genetic disease
hyperlinks are available through the 2012 AAHA Canine Life stage Guidelines. Evidence based guidelines
are currently lacking for the best starting age but eventually may allow more targeted screenings and
baselines that are breed specific. These may include blood pressure baselines, tonometry trending,
ultrasound for bladder cancer screening and early hip radiographs. Awareness of predominant breeds
present in mixed crosses, either from visual characteristics or DNA testing, can permit targeted
awareness of breed specific concerns in all pet dogs. Breed improvement screening has taken some
steps forward under the auspices of AKC/Canine Health Foundation and the Canine Health Information
Center, www.caninehealthinfo.org. Breed specific recommendations are being made to screen prior to
breeding. Regular work with intact strays, rescue and breeding dogs warrants a Brucella canis refresher
available through the Compendia at www.nasphv.org. Wellness guidelines often are modified based on
lifestyle and encompass people and pets. This can relate to concerns with family immunity
(immunocompromised households with diabetics, infants or cancer patients on chemotherapy for
example), animal assisted therapy programs or veterinary staff and personnel. General zoonotic
guidelines are available from CAPC, AAFP, ASPHV, CDC and AVMA .
Senior Pet Wellness is a critical lifestage that has not always been emphasized appropriately as
some practices seek to develop prevention programs for the aging pet population. Just as the 55 year
old person recognizes they are now senior citizens and eligible for their golden years' benefits, they
don’t usually consider themselves geriatric. Many common screening tests begin late adult, early senior
life in people. Some common ones include cholesterol screening, prostate exams, colonic exams and
mammography screening. Previous family histories of some of these health concerns may prompt an
earlier testing cycle or more frequent screenings when warranted. While most people can accept some
initial wellness screening at these senior ages, they may not feel up to a battery of geriatric lab tests or
feel it is appropriate. This has certainly been the case for some practitioners trying to implement
Geriatric programs into their practices. Establishing age 6 or 7 as a magical, perhaps arbitrary, cut off for
beginning these tests, pet owners have sometimes balked at the idea of needing to spend $150 on
testing for their 7 year old dog when nothing was done the previous year. To them, their dog or cat
hasn’t changed much and they are probably right!
We experienced a similar situation to that described above related to pre-anesthetic screening
at Purdue. While a CBC and urinalysis was our comfort level for pre-dental workups prior to age 6, we
added a full chemistry and chest rads at age 7 and owners began to question why the dental costs
increased over $170 in a single year. Once again, to them the dog essentially looked and acted the
same, had dental tartar with mild gingivitis like last year and yet necessitated substantially higher
workup costs. While we have begun doing a good job of educating our top owners to the idea of
wellness care, they ask really good questions. Incidentally, so do our technicians and students! In
consultation with our surgeons and anesthesiologists, we have modified our pre-anesthesia workups to
mimic our phased in approach to pet aging and wellness screening.
Wellness services for mature and senior pets should include the same general categories as
identified for adult pets. Physical examination findings, nutrition assessment, oral health, infectious
disease screening and prevention, parasitic disease screening and prevention, behavior and lifestyle
concerns related to the pet, behavior and lifestyle concerns related to the family, zoonotic and societal
concerns related to public health, reproductive health concerns and genetic health concerns.
Degenerative and aging health concerns are now part of the wellness discussion during these later year
visits with a more aged patient. For continuity sake, we use the same Wellness form as we began using
after the pet turned 4 months old. Introducing a phased in approach to senior pet wellness screening
has been much more successful for us as we work with pet owners, compared to suddenly launching a
geriatric program. Clients seem to feel there are more standard recommendations when we put them
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in black and white and we feel they are now more aware of what services are available to their pets.
What follows are some comments related to wellness visits for the senior pet years.
The Exam. The physical exam remains the most important foundation for overall wellness care
and valuing veterinary expertise and services. I continue to highlight normal parameters during the
physical exam, noting that the pet appears to be “aging gracefully.” When appropriate, I think it is often
helpful to relate an appropriate age conversion for their pet. While we view 7 years as still a young
child, we realize that this is already passing the half way point of the life expectancy for most large or
especially giant breeds. Calculations exist that allow you to determine an actual age based on body
weight and human life expectancy. Often it is just as feasible to use 80 years as a human parameter (for
women a little longer than men…) but we should account for the first two years being about 25 years of
life. That leaves 55 human years to be divided by the life expectancy of that sized breed. Commonly, in
2015, we use 14-16 for cats and small dogs, 12-14 for large breed dogs and 9-10 for giant breed dogs. It
is important to identify minor abnormalities that are abnormal yet may not require intervention.
Common examples in senior pets include lenticular sclerosis (and differentiating it from cataracts), iris
atrophy which may result in poor pupil light responses, missing teeth, and sagging skin folds that may
develop with associated fat deposits or just result from reduced elasticity. Not mentioning these items
during a visit may raise questions related to completeness when they are identified by a relative or
neighbor in the future or discussed later during a sick pet visit … by another veterinarian. It is especially
important to integrate a whole body drawing into the physical exam documents during the senior pet
visits. This allows small skin changes and the presence of small growths, lumps and bumps to be easily
mapped and described. I encourage owners who are regularly bathing or grooming their pets to begin
more closely monitoring the skin for these changes.
Body condition scoring. “Feed to feel” is still the best recommendation that I give to clients.
Lifestyle issues here may not necessitate changing all 7 year old pets onto diets with moderate protein,
less fat and more fiber. Working and hunting dogs, in their prime, will still need higher carbohydrate
foods, especially prior to events. Lower fat diets may occasionally contribute to a worsening of
seborrhea sicca (dry skin), especially during lower humidity months in northern climates. It is still
appropriate to discuss hair coat quality, stool consistency or volume, flatulence or housebreaking
concerns if dietary modifications to premium diets are advisable. We still recommend 40-45 minutes of
daily exercise with their pets so that it promotes trimmer pets and owners. Observations of exercise
intolerance, reduced playfulness, lameness, coughing or respiratory distress are all key discussion items
for owner awareness.
Dental Care. Most pets will need annual or biannual dental prophies between the senior ages
of 7 and 11 years. The economic issues of annual dentistry, more advanced lifestage screening and preanesthetic screening requires figuring out ways to make this economically feasible for most pet owners.
We will continue to phase in the metabolic screening that is age and breed appropriate. Other services
can continue to be accomplished while under anesthesia. Common medical services that can be
considered during this anesthetic event include removal of skin or eyelid tumors, especially those in
readily visible or conspicuous places. Wellness and pre-anesthetic screening of these patients usually
requires running a couple small lab tests. Semiannual wellness exams can be prioritized. All items are
covered on the wellness exam sheet with most of the owner costs going into infectious disease and
parasite detection and control at one visit. The follow-up exam 6 months later allows time and budgets
to better assess oral health, nutrition and behavior issues. This visit is primarily run by our nutrition,
behavior and dentistry technicians, with input from the doctors if medical concerns exist or anesthesia is
necessary. Our hope is that by spreading out the costs of the dental to 6 months later, pet owners will
be more readily able to proceed with the dental cleaning at these times. We hope to more accurately
evaluate weight loss (or gain), and intervene earlier on behavior or lifestyle concerns.
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Pre-anesthestic screening. On top of CBC and Urinalysis needs in the 6-7 year old pet, we add a
mini chemistry panel. Currently this includes liver (ALT, AlkPhos, GGT) and kidney (creatinine)
parameters in addition to Glucose. Between ages 8-9, we do a full chemistry panel. Giant breed dogs
would have this earlier. Baseline T4 levels are being done in cats over age 8 but are no longer routine in
healthy dogs. Thyroid levels in dogs are warranted at any age with increasing weight or lack of weight
loss if already overweight. TSH assays allow us to readily differentiate sick euthyroid cases from
hypothyroid cases in older dogs. Certainly pets with medical concerns would have appropriate workups
done when necessary. The guidelines I am discussing relate to the senior pet with a normal physical
exam preparing for elective anesthesia for dentistry and/or growth removal. Depending on the
presence of heart murmurs, chest rads are not routinely added to our pre-anesthetic workup until the
patients reach age 10. We are not currently utilizing blood pressure screening in our senior pet group
due to the dramatic variation noted in values and low incidence of primary hypertension in dogs and
cats. Electrocardiograms are monitored on all patients under anesthesia, young and old, but screening
ECG’s won’t usually modify our anesthetic protocols unless arrhythmias were ausculted during the initial
physical exam. Recently, it appears that the presence of VPC’s on screening Dilated Cardiomyopathy
occurring within 2 years of the initial identification of rare ventricular beats. Applicability to other
breeds that get DCM may apply and we are looking at utilizing this screening test in appropriate breeds.
Infectious disease screening. It is important to assess heartworm status on an annual basis in
regions where heartworm prevalence is high (over 5%). Even in low prevalence areas where biannual
testing is done, it is critical to screen all one year old dogs as well as all pets acquired through rescue and
shelter environments. The test does not pick up recent infections but assesses any missed doses from 6
months or more prior to the test. Our most common positive dogs are dogs who were negative on an
initial shelter or rescue test, yet currently infected with early stage larva, that the test picks up the next
year once these larva mature. Heartworm preventives are not completely effective once the larvae are
past 45 days. Early detection of infections allows treatment before significant, irreversible cardiac or
respiratory disease develops.
Genetic screening. Risk factors affecting senior pet wellness also include breed related
disorders, particularly in dogs. By this age, we are encouraging even our responsible breeders to decide
on when they will have their last litters. We then have their pet neutered to prevent pyometra and
testicular tumors. I tend to have little tolerance for pet producers still “on the fence” about breeding
when we get into this age group. Genetic screening continues for glaucoma in at risk breeds as before,
on an annual basis. Orthopedic screening of hips that may not have been done at an earlier visit will
often by coincided with a dental anesthesia, esp. if there are any concerns about rear weakness or
slowing down in the hind end. Unique screenings may apply for selected breeds as DNA testing
becomes more readily available and for specific breed concerns. Topics we are actively looking into
relate to breeds prone to cystic calculi (taking an abdominal radiograph) and breeds prone to bladder
cancers (single organ ultrasound) may be warranted since a urinalysis does not always detect disease in
these patients. Other areas include Schirmer tear testing of at risk breeds. Many more options may be
present as we look into specific breed related problems that manifest themselves later in life. Relating
back to eye care however, the question has been raised as to what really qualifies as a wellness eye
exam and is direct ophthalmoscopy providing an appropriate wellness exam of the fundus. With the
fundus serving as a window to the body, it seems prudent to examine how frequently we must dilate a
pet’s eyes and do an appropriate indirect exam. At the least, it would seem that the senior pet years are
a good time to get into this habit since lenticular sclerosis is already obscuring somewhat limited access
through a non-dilated pupil.
Lifestyle and Behavior. Issues related to owner, family and pet lifestyle should still be evaluated
to determine appropriate vaccination strategies. Owners are hopefully now aware of behavior
consultation availability in veterinary practices or affiliated with the practice. Many of the initial playful,
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distracting, annoying and aggressive behaviors have been overcome by this age although aggression
may be attributed to irritability related to dermatologic or orthopedic health concerns. Housebreaking
concerns should never be chalked up to aging function without appropriate work up for conditions
related to either increased appetite and increased stool production or increases in drinking or urination.
As the pet enters its senior years, it still may present with new anxiety and phobic disorders. Initial age
of onset is often biphasic with a juvenile onset and senior/geriatric onset documented. Concurrent
behavior conditions should always be evaluated with appropriate neurologic, cardiac, endocrine and
metabolic assessments. Monthly or quarterly metabolic, cardiac or tonometric monitoring is usually
necessary if pets are maintained on anxiolytics.
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