Geriatric Cat Care

Old age happens to the best of us – even our cats. And as our cats enter into the golden age, they may have specific needs or problems that must be addressed. The aging process brings about a gradual decline in a cat's physical and sometimes mental abilities. Becoming aware of these issues allows an owner to provide the best possible care.

Not all cats age at the same rate. A cat's biological age depends upon genetic background, the quality of his diet, his general state of health and the quality of his living conditions. Research estimates that old age for cats begins somewhere between the 8th and 9th birthday.

Ideally, caring for the geriatric cat should focus on preventative measures. Whenever possible, it is better to prevent a problem from occurring, rather than to wait for a problem to develop. Detecting diseases in the early stages greatly improves the outcome. Different cats have specific risk factors that influence the diagnostic approach to geriatric medicine. Risk factors are characteristics of the breed, genetics, environment and life-style of your cat that may put him or her at greater risk of developing a particular disease or other age related changes.

Veterinary Care

Within the last few decades, advancements in veterinary medicine have caused a dramatic increase in the longevity of our pets. Today, cats are living longer and healthier lives. If there is a problem with your older cat, don't assume it is just because of old age, and that nothing can be done. With appropriate treatment, many conditions can improve. Your veterinarian may do the following to assess your cat's health and to maintain a healthy condition.

• A thorough and complete medical history. Your veterinarian will note changes in behavior and physical abilities.
• A complete physical examination
• Complete blood count (CBC)
• Biochemical profile
• Urinalysis
• Thyroid level
• Fecal exam for parasites
• Feline Immunodeficiency Virus (FIV) and Feline Leukemia Virus(FELV) testing

Treatment

All cats should receive routine vaccinations as required by law (rabies) and vaccines that are appropriate for individual needs. Specific vaccines and frequency of administration may vary, and should be discussed with your veterinarian. Treating an older cat depends on the individual requirements or problems of your pet. The most common problems of geriatric cats are:

• Nutritional issues – managing obesity or special needs
• Dental disease
• Kidney disease
• Hyperthyroidism
• Diabetes
• Hypertension
• Cardiac disease
• Inflammatory bowel disease
• Skin tumors
• Cancer

Home Care and Prevention

A periodic inspection of your pet, at home, may uncover potential problems. Make sure that your pet has clean, warm and protected living conditions, and provide easy access to clean fresh water.

Feed a good quality cat food that is appropriate for your cat's specific needs, and do not allow your pet to gain excessive weight. Discuss unexpected weight gain with your veterinarian. Based on a complete geriatric work-up, a prescription cat food might be advised. Groom your pet and, if possible, brush your cat's teeth regularly. Finally, follow your veterinarian's recommendations as to exercise, nutrition and any medications that may be needed.

Pets today are living longer and better quality lives than ever before. Many factors are responsible for this increase including improved nutrition, veterinary care and educated owners. This increased longevity means that there are more cats reaching an older age, and that owner's will be faced with the special demands and problems that become apparent with age.

Understanding the aging process and the most common problems that face the geriatric cat is the first step in providing the best possible care to your older animal. The main focus of geriatric health care is owner education and the early detection and prevention of disease.

It is important to realize that aging itself is not a disease; it is simply a stage of life. Increasing age causes a gradual decline in the body's ability to repair itself, maintain normal body functions, and adapt to the stresses and changes in the environment.

Many changes occur in cats as they age.

• Changes in metabolism occur so they require less food. Cats, in general, have a more sedentary lifestyle, and older cats, specifically, are usually less active. Weight gain and obesity are common problems.
• The lack of exercise contributes to reduced muscle tone and strength, further adding to the potential of obesity.
• Changes in a cat's environment or routine may actually contribute to behavioral changes or even illness. Trying to minimize severe or sudden changes in the geriatric animal is always a good practice.
• With time, cats begin to have a gradual decline in their senses (hearing, smelling, vision, and taste). Decreased taste sensation can contribute to anorexia, especially if your cat becomes ill.
• Your pet may not respond to stimuli as rapidly or in the same manner as when he or she was younger. It is not uncommon for older cats to spend more time sleeping and have more difficulty being roused.
• The body's ability to repair itself decreases, and the function of the immune system is compromised with increasing age. Metabolic and endocrine problems, organ dysfunction and cancer are all seen with increased frequency in the aging cat. Some of these problems may be difficult to help, however it is usually possible to improve the quality of your pet's life significantly by educating yourself, and becoming aware of potential problems.

Most veterinarians recommend more frequent veterinary visits and additional diagnostic tests for geriatric animals in an effort to find the early stages of disease, before they become problems. Practicing prevention is always better than treating a disease already present. In the long run, preventive medicine improves quality of life, and is more cost effective than waiting for problems to appear. A well-educated and proactive owner is the first step in optimal senior cat care.

Many of these tests are recommended on geriatric cats even when they are feeling totally normal. The routine geriatric exam and accompanying diagnostic tests are recommended to ensure that the early stages of disease is discovered, and appropriate preventive measures and treatment plans instituted.

The most common diagnostic tests performed by your veterinarian as part of a complete geriatric work-up include:

• A complete medical history. Any problems or concerns that you have about your pet should be discussed; however, it is equally important that the veterinarian ask specific questions that may uncover problems unknown to you. Certain problems that you may simply attribute to old age, and just something that they will have to live with, may be signs of underlying disease and be very treatable. Some veterinarians have specific geriatric health history questionnaires that can be filled out by the owner or a health professional. Asking the right questions is very important in obtaining a thorough geriatric health history.
• A complete physical examination. Your veterinarian will perform a complete physical examination that may uncover specific problems, including an eye and retinal exam. He or she will also check the ears for signs of infection or allergies; evaluate the mouth, gums and teeth for dental disease and gingivitis; palpate the lymph nodes and the thyroid gland for enlargement; observe the skin and quality of the hair coat, noting skin tumors or swellings; listen to the heart and lungs, noting the presence of new heart murmurs; palpate the abdomen for any masses or organ enlargements; and record the general body condition and weight.
• Complete Blood Count (CBC). A CBC evaluates the red and white blood cell lines. A decrease in the red cells indicates anemia, not an uncommon finding in the geriatric animal. Red blood cell morphology (shape) is also assessed, and helps determine if the condition is acute, chronic or related to a neoplastic (cancer) condition. Increases in the total white blood cell count may indicate inflammatory or infectious conditions. The specific types of white cells (neutrophils, lymphocytes, eosinophils, monocytes and basophils) are also counted and are recorded in their relative proportions. Increases or decreases in individual white cell types may provide insight into various disease conditions. Occasionally, the presence of abnormal or immature white blood cells suggest a potential cancerous process.
• Biochemical profile. The biochemical profile is a very valuable test in the geriatric animal as it evaluates multiple organ systems. The liver and kidney function are evaluated, and the blood sugar is checked. Elevations in the blood sugar may indicate diabetes, although, high blood sugars are commonly seen in cats that are just stressed due to the veterinary visit alone or other illnesses. Electrolytes are also checked and abnormalities may indicate the need for further diagnostics. Plasma protein and albumin level are also reported, and decreases might indicate kidney, liver or gastrointestinal disease.
• Thyroid testing. Increased production of thyroid hormone by an overactive thyroid gland (hyperthyroid) is a very common problem in older cats. The most common signs of hyperthyroidism are increased appetite and weight loss.
• Urinalysis. A sterile urine sample is obtained by inserting a needle through the skin into the bladder (cystocentesis) by the veterinarian. The urine sample helps in diagnosing kidney problems, bladder infections or diabetes. If indicated either by clinical signs or by the microscopic evaluation of the urine, the urine is cultured for bacteria.
• Fecal examination for parasites. Since gastrointestinal parasites may be more debilitating in geriatric animals, a yearly fecal exam is recommended. Additionally, some parasites have zoonotic (spread to people) potential, re-enforcing the value of yearly fecal exams. Routine fecal floatation, and specific tests for Giardia are recommended.
• FIV and FELV testing. Both of these viral diseases may cause suppression of the immune system and contribute to many other systemic illnesses. In cats that are at risk of exposure to these viral diseases (i.e. outdoor cats or cats that have contact with other cats) routine blood testing is recommended. If the viral status of a cat is unknown, testing is also advised.

The above represents the most routine diagnostic tests that your veterinarian may advise for your senior pet. Based on the history and physical examination findings, common additional testing might include:

• Blood pressure measurement. Hypertension, or high blood pressure, is being increasingly identified in the geriatric cat. In fact, some veterinarians include the test as part of the geriatric cat's initial diagnostic work-up. Usually, hypertension is associated with other disease conditions such as kidney disease and hyperthyroidism. Ideally, the blood pressure should be measured before other diagnostic testing, since stress and excitement may falsely elevate the measurement.
• Aspiration of skin masses. Small masses or lumps are commonly found on or under the skin. Many times these are benign tumors or cysts that grow slowly and rarely cause problems. However, cats do have a higher incidence of malignant skin tumors than do dogs. Because of this, it is usually recommended that all skin tumors on cats be aspirated and the recovered cells evaluated microscopically for evidence of malignancy. Sometimes the number or location of the masses makes sampling impractical. In these cases, your veterinarian can help determine if aspiration is worthwhile. The size and location of all masses should be recorded in the medical record, so that changes in previous masses or the development of new masses can be noted.
• Radiographs. X-rays may be advised based on the initial tests or physical exam findings. Chest X-rays are part of a heart work-up. They are also needed for evaluating the lungs and as a screening test for cancer. Abdominal radiographs might be needed if organ dysfunction is suspected or organ enlargement or masses are palpated.
• Cardiac evaluation. If there is indication of potential heart disease (i.e. a newly discovered or a worsening murmur) a more complete cardiac evaluation is indicated. Chest radiographs, an EKG and an echocardiogram will help better define the extent and cause of potential cardiac disease and whether treatment is necessary.
• Abdominal ultrasound. Abdominal ultrasounds offer a non-invasive method of visualizing masses and organs within the abdomen. Generally, more detail and structure can be obtained with an ultrasound than with radiographs.
• Endoscopy. Evaluating the stomach and initial part of the small intestines through the use of endoscopy is a valuable diagnostic tool. A common problem that some older cats have is a bowel disorder called inflammatory bowel disease (IBD). Cats with IBD usually have vomiting or diarrhea as symptoms, but sometimes present with weight loss as the only complaint. Endoscopy offers a relatively non-invasive method of obtaining gastrointestinal biopsies for establishing a diagnosis.

At the end of the geriatric visit, a geriatric wellness assessment may be completed and given to the owner.

The treatment of the geriatric cat varies according to individual requirements and the problems found. The following is a list of the most common geriatric problems and their general treatment recommendations:

• Nutritional concerns. The proper diet is very important in the care of a geriatric cat. There is no best food to feed a geriatric cat; this depends on the specific problems or nutritional requirements of the individual animal. For example, obesity is a very common problem of older animals because it directly correlates to a decreased longevity and may contribute to other problems. Overweight cats are more likely to become diabetic, develop liver disease (hepatic lipidosis) or suffer from feline lower urinary tract disease. Your veterinarian can prescribe or recommend special lower calorie, high fiber diets that make weight loss easier.
• Dental disease. A common finding on a geriatric exam is dental disease and gingivitis (inflammation of the gums). Your veterinarian may recommend treatment that requires general anesthesia. You may be reluctant to put your older cat under anesthesia; however, if there is significant dental disease present, your cat will benefit greatly. Untreated dental disease leads to tooth loss, and may serve as a reservoir of infection for the rest of the body. In this manner, severe dental disease may pose a risk to other body systems.
• Kidney disease. Kidney (renal) disease is a very common finding in the older cat. Asymptomatic cats usually have chronic (long standing) disease. Chronic renal disease is managed by feeding special diets that are low in protein and phosphorus. When treating kidney disease, the potassium level is also monitored. Sometimes the level will be low, and supplementation may be required. Other treatments might include Pepcid® (famotidine), phosphate binders and fluids to be given under the skin (subcutaneous) at home.
• Hyperthyroidism. Hyperthyroidism is a very common disease of older cats. There are three treatment options. Generally, the safest and most effective treatment is radioactive iodine therapy, which usually requires referral to a specialized facility where cats usually need to be hospitalized for at least a week. The most common form of treatment is with oral medications (Tapazole® being the most common) that reduce the blood thyroid level. Finally the affected thyroid gland can be surgically removed.
• Diabetes. The first sign an owner usually sees in a diabetic cat is excessive thirst or urination. Diabetes is generally managed by giving insulin injections at home. Dietary changes are also recommended. Occasionally, oral medications and diet alone can improve the blood sugar level, without the need for injections. Additionally some cats are only transient diabetics, and do not require life-long therapy.
• Hypertension. The first aspect of treating hypertension in the cat is to identify and treat any possible underlying disease conditions (most commonly kidney disease and hyperthyroidism). Occasionally cats with hypertension will present with only ocular (eye) signs. Sudden blindness sometimes occurs due to retinal detachment or hemorrhage. Hypertension can also cause secondary cardiac changes and associated heart disease. A common drug used to treat hypertensive cats is amlodipine (Norvasc®).
• Cardiac disease. Newly discovered heart murmurs are a common physical exam finding in the geriatric cat. Many times these murmurs are found before a cat is symptomatic of any cardiac disease. Finding a heart murmur in an older cat does not mean that the cat has cardiac disease, but it is an indication for further diagnostics. The most common cardiac disease in the senior cat is hypertrophic cardiomyopathy. This is often associated with hyperthyroidism or hypertension. Early detection of heart disease, treating underlying disorders and proper therapy may slow its progression.
• Inflammatory bowel disease (IBD). Treatment of IBD includes prednisone and other immunosuppressive drugs, metronidazole, antacids and dietary changes. Sometimes IBD is associated with hepatitis and or pancreatitis.
• Skin tumors. On the basis of the size, location and aspiration results, your veterinarian may recommend removal of one or many skin masses. Sometimes these masses may be removed with only local anesthesia, other times general anesthesia is required. Your veterinarian may also decide not to remove a mass. In this case, the mass should be closely monitored for any changes in size, shape or texture.
• Unfortunately, cancer is a significant problem facing the geriatric cat. Lymphosarcoma is the most common type of cancer in the cat. Not all cancer needs to be fatal. Surgery, chemotherapy, even radiation therapy is available that can significantly extend your pet's quality time or produce a cure. The prognosis depends on the type and location of the cancer.

Optimal treatment for your pet requires a combination of home and professional veterinary care. Follow-up can be critical, especially if your pet does not improve rapidly.

• Administer all medications as directed. Alert your veterinarian if you are experiencing problems treating your pet.
• Giving your pet a periodic home health exam is an excellent way to monitor for potential problems. Check the teeth and mouth for dental problems and note any foul odors. Feel the skin for any lumps, bumps or discharges. Feel the limbs and joints for swellings or pain. Observe for any swelling in the abdomen. Note any sudden weight gain or loss. Watch for any changes in water consumption or appetite. Changes in your pet's behavior, appearance or attitude should be discussed with your veterinarian.
• Provide your senior pet with a clean and warm place to sleep, and limit changes in his or her environment. Soft bedding should be provided. Sudden or prolonged changes in temperature should be minimized, as many geriatric cats are less tolerant of cold or hot weather conditions.
• Good grooming practices promote healthy skin and hair coats. Older cats tend to spend less time grooming, and thus, are more likely to develop a dryer skin or get hair mats. Groom your pet regularly.
• Proper dental care begins at home. Your cat's teeth may be brushed at least a few times a week to decrease the incidence of dental disease. Special flavored toothpaste for cats should be used, as the human products are poorly tolerated.
• Provide a good quality cat food based on your cats individual needs. Make sure your pet does not gain or lose too much weight. If your cat is overweight, avoid a rapid weight loss, as a gradual weight reduction plan is safer. Try not to give table scraps, and stick with a consistent diet.
• Unless directed otherwise by your veterinarian, a small to moderate amount of routine exercise is advisable in the older cat. Provide your cat with stimulation and the opportunity for exercise.
• Routine blood work may be advised. Re-checking blood tests may aid in following the progression of certain diseases, and any potential treatment changes. Additionally, if your pet is on any medications, blood tests may need to be monitored to make sure there are no potential side-affects.
• Most geriatric cats should have routine veterinary exams at least twice a year. Full diagnostics are usually not required this often, but a check-up is recommended.