2021 AAHA/AAFP Feline Life Stage Guidelines: Executive Summary

by Constance Hardesty, MSc

Note: This executive summary provides highlights of the guidelines. It is not a replacement for reading the guidelines in their entirety.

Overview

The 2021 AAHA/AAFP Feline Life Stage Guidelines provide a comprehensive age-associated framework for promoting health throughout a cat’s lifetime. The guidelines were developed by a task force of experts in feline clinical medicine. Their recommendations are a practical resource to guide individualized risk assessment, preventive healthcare strategies, and treatment pathways that evolve as the cat matures.

The guidelines include a comprehensive table on the key components of a feline wellness visit. This table provides a framework for systematically implementing an individualized life stage approach to feline healthcare. Included are recommendations for managing the most critical health-related factors in relation to a cat’s life stage. The text of the guidelines complements the table with more detailed discussion of specific components and related topics.

Introducing New Life Stage Classifications

The 2021 life stage guidelines divide a cat’s life span into four age-related stages, plus an additional stage for end of life:

• Kitten (birth to 1 year)
• Young adult (1–6 years)
• Mature adult (7–10 years)
• Senior (greater than 10 years)
• End of life

These groupings reflect how pet owners perceive their cats’ life stages and provide a clear rationale for individualized healthcare strategies that evolve over the life of the cat. The grouping makes clinical protocols easier to implement, simplifies communication, and provides structure for client education.

The age designations help to focus attention on the physical and behavioral changes, as well as the evolving medical needs, that occur at different life stages. Examples are proper socialization in kittens, obesity prevention in young adult cats, and increased vigilance for early detection of degenerative diseases in mature adults and seniors.

Age groupings are not absolutes. Although ages have been used to identify life stages, there may be significant variation among individual cats. For example, some senior cats may remain in excellent physical condition and would be best treated as mature adults at the veterinarian’s discretion. The guidelines serve as a starting point to develop individualized care recommendations.

Life stage is the most fundamental presentation factor the practitioner encounters in a regular examination of a feline patient. Most components of a treatment or healthcare plan are guided by the patient’s life stage. Because a cat can transition from one life stage to another quickly, each examination visit should include a life stage assessment.

End of life and its precursor events are considered a separate life stage. This stage is addressed in the 2016 AAHA/IAAHPC End-of-Life Care Guidelines  and the 2021 AAFP End of Life Online Educational Toolkit.

How the Guidelines Are Organized

The guidelines are organized around nine “characteristics” or topics ranging from behavior to zoonoses. A large table (Table 2) lists action items and issues to discuss with clients for each topic.

In effect, Table 2 defines what needs to be done at each life stage. This prescriptive approach is explained and justified in the text of the guidelines.

The text provides additional discussion about some of the items listed in the table, but the discussion is not intended as a comprehensive review. For example, Table 2 recommends, “Discuss elimination habits,” and the text provides information about general litter box considerations, touching briefly on topics ranging from urine marking to special issues with senior cats.

Throughout the guidelines, you will find pointers to resources that can be used to enhance practice team training and client education.

A recurring theme is the importance of feline-friendly handling techniques at home, in the waiting area, and in examination settings. Understanding and responding to feline communication and natural feline behaviors, preserving the cat’s welfare or quality of life, and the quality of the home environment and enrichment also receive consistent attention.

Recommendations for acclimating kittens to carriers, gentle mouth handling, medication administration, and other healthcare tasks are supplemented by practical advice for helping cat owners overcome barriers to examination visits.

Finally, the guidelines offer recommendations for practice team training and client education.

As a whole, the guidelines provide a framework for systematically implementing an individualized life stage approach to feline healthcare.

Selected Highlights

This is a selective overview of the guidelines’ recommendations. It follows the guidelines’ organizing structure, focusing on the recommendations listed in Table 2. This provides a sense of the guidelines’ breadth and depth, but it is not comprehensive. For the full list of recommended action items and discussion points, organized by topic and life stage, see the guidelines themselves.

Recommendations are organized in Table 2 under the following headings: discussion items for all life stages, medical history, issues that merit extra attention during physical exams, nutrition and weight management, behavior and environment, elimination, oral health, parasite control, and vaccination. Recommendations for diagnostics appear in a separate section of the guidelines.

Table 2 begins with a list of recommended action items and discussion points on topics for all life stages. These include recommending a minimum of annual exams for kittens, young adults, and mature adults, increasing to every six months for seniors. Discussion of pet insurance and other financial planning options is also recommended.

There are many recommended topics for client education, including, for example, subtle signs of illness, pain, and anxiety, as well as claw care and alternatives to declawing. In addition, the guidelines recommend collecting information about the patient’s medical history, daily food and water intake, diet and feeding, and so on.

In keeping with the emphasis on reducing stress for cats, the guidelines recommend evaluating the cat’s demeanor to determine the appropriate approach to the physical examination as well as making recommendations for optimal future examinations based on the cat’s personality and temperament. Assessing and discussing the patient’s quality of life is recommended when clinically relevant.

In terms of the patient’s medical history, age-specific topics include but are not limited to breed healthcare predispositions and congenital genetic concerns for kittens; vomiting, hairballs, and diarrhea, or changes in behavior or grooming habits for young adults; and, for senior patients, detecting masses and identifying changes in a variety of behaviors that could indicate cognitive decline or age-associated physical impairments or ailments.

What deserves extra attention during the examination itself? Some examples are: for kittens, congenital or genetic findings; for young adult cats, cardiorespiratory and dermatologic findings; and for mature and senior cats, pain assessment, thyroid gland and kidney palpation, and musculoskeletal examination. Again, this is a partial list.

Reflecting the guidelines’ emphasis on reducing feline stress, the guidelines recommend that veterinary professionals monitor changes in the patient’s usual demeanor and to record successful feline-friendly handling techniques and preferences.

Certain diseases and conditions that require additional focus during the examination by each life stage are listed separately in Table 3. Examples include genetic and congenital conditions and dermatophytosis for kittens; feline bronchial disease, chronic enteropathy, and feline atopic dermatitis for young adult cats; and several chronic diseases or conditions for mature and senior cats, including chronic kidney disease, cognitive dysfunction syndrome, and degenerative joint disease. Again, this is just a sampling; see Table 3 for the full list.

Body condition is an area of focus for all age groups. Obtaining dorsal and lateral photographs is recommended to facilitate monitoring BCS/MCS as the cat ages and to help the owner recognize subtle changes.

Following up on the exam’s focus on body weight and condition, the guidelines include recommendations for nutrition and weight management. Here, the consistent message across life stages is appropriate feeding for body or muscle condition scores.

The guidelines recommend, for example: for kittens, advise clients about what, when, and how much to feed. For young adults, address obesity risks, monitoring weight gain, and advice on play and activity. For seniors, monitor weight loss or gain and discuss diseases associated with changes in appetite or weight.

In the text, a highlighted section on hydration explains how to accommodate some feline preferences.

An extensive section on behavior and environment focuses on enhancing behavior by identifying age-appropriate interventions.

Recommendations for kittens emphasize socializing them to people and other pets and preparing them for normal adult-cat experiences: acclimating the kitten to the carrier, car, and veterinary visits; teaching them to come or sit on cue; and acclimating them to handling, brushing, nail trims, and medication administration. For young adult cats, the guidelines recommend addressing changes in inter-cat or human-cat interactions. With mature and senior cats, address aging-related topics ranging from environmental needs to cognitive function.

Other discussion points and action items address environmental needs and changed or unwanted behaviors.

Understanding the cat’s lifestyle is important for making thorough and accurate preventive healthcare and medical recommendations. The traditional classification of a cat as “indoor” or “outdoor” is oversimplified as there may be additional risk factors. The text of the guidelines discusses lifestyle risk assessment and lifestyle choices.

The text also offers recommendations for incorporating kitten socialization in the examination visit, particularly the first visit. Team members should be trained to use positive reinforcement, gentle handling, and use of food or rewards to desensitize and countercondition kittens to veterinary or handling procedures.

For both team members and clients, the guidelines emphasize gentle handling, discouraging punishment in favor of positive reinforcement. Aversive handling or punishment should always be avoided.

Practitioners should closely observe feline body language postures for even the most subtle signs of anxiety and tension, such as the position of ears or whiskers. The guidelines stress the importance of being aware of signs of distress during the exam—and of respecting them. The cat must have a way to tell people to “please stop” or “I need a break.” When those signals are ignored or disregarded, the cat’s fear increases and the signaling escalates.

Elimination is a persistent theme across all life stages. The guidelines recommend teaching new kitten owners how to set up and clean litter boxes and to recognize normal elimination behaviors, and then to confirm that the litter box size and cleaning regimens continue to accommodate the growing size of young adults and the physical needs of mature and senior cats.

Discussion points across all life stages concern assessing the appearance of stools and size of hairballs and distinguishing between toileting and marking behaviors. The text provides substantial discussion of elimination issues, including lower urinary tract disease, house soiling, and investigating urine marking.

Oral health topics appropriate for all life stages include dental examinations, dental disease and preventive healthcare, dental prophylaxis, and the importance of treatment and home care.

Oral health concerns begin with examining for malocclusion or developmental dental issues and acclimating kittens to mouth handling and toothbrushing/wiping. For young adult cats, the guidelines recommend a dental diet if clinically indicated. And for mature and senior cats, monitor for oral tumors, inability to eat, or decreased quality of life from painful dental disease.

Parasite control and zoonotic risks know no age limits. Action items include assessing the patient’s risk of exposure and educating clients about the risks to indoor cats. Fecal examinations are recommended as appropriate. Zoonotic disease risks should be discussed and mitigated. The guidelines call for veterinary professionals to recommend year-round, broad-spectrum antiparasitics against heartworms, intestinal parasites, and fleas for all patients and recommend tick control based on risk.

Vaccination recommendations specify core vaccines consistent with the 2020 AAHA/AAFP Feline Vaccination Guidelines for each age group and identify factors affecting their administration. For rabies vaccines, AAHA and the AAFP recommend following vaccine label instructions and local laws. The guidelines caution that the risk/benefit of vaccinating senior cats should be carefully considered in light of their overall health status.

Diagnostics are discussed in the text, and recommendations are listed in the accompanying Table 4. The table uses symbols to indicate the strength of the recommendation. Retroviral testing is strongly recommended for kittens, for example, but for senior cats is recommended to be based on each patient’s needs.

Team Training and Client Education

Team training and client education are integral to implementing successful life stage recommendations. These two factors will allow the practice team to appropriately accomplish physical examination and diagnostics, and institute treatment protocols when indicated for the patient.

Every life stage will have specific items that should be discussed in the veterinary visit (as outlined in Table 2), and both veterinary technicians and veterinarians should be familiar with current recommendations and practice protocols in order to educate clients on the most critical health-related factors relevant to each life stage.

Constance Hardesty, MSc, is an award-winning writer specializing in science, technology, and veterinary medicine.

 

Photo credits: Naked King/iStock via Getty Images Plus, Alexsandr Ermolaev/iStock via Getty Images Plus, Vonschonertagen/iStock via Getty Images Plus