Evaluating the Healthy Senior Pet
The initial intake at an office visit is essential for setting a welcoming and senior-friendly tone. Starting with an open-ended question like “What brings you and Harvey here today?” is a good way to initiate a conversation about the pet’s health and wellbeing. Eliciting a thorough history and gaining an understanding of the senior pet’s environment and background are crucial to establishing a relationship with the client and pet. Often there are issues not mentioned when the appointment was made that are best brought forward early in the visit. Older animals often come with a substantial list of concerns, which the client and veterinarian can mutually discuss and prioritize.8
The client may share additional crucial information about their senior pet if they are supported with empathy. A thorough history can provide important information to assess the pet’s health and may include exploring the patient’s eating and drinking habits, exercise, movement, play behavior, eliminations, attitude, grooming, vision, and hearing. Inquiring about any changes or disruptions in the household may also elicit crucial information.
A critical aspect of a patient’s history is establishing what pharmaceuticals, supplements, nutraceuticals, creams, oils, or other therapeutics are currently being given to the pet. This is important to evaluate the need for additional therapeutics and minimize drug interactions, and it is part of building a trusted relationship between client and veterinarian. Drug interactions may result in serious toxicities, negate the effect of medications, or create a physical change that would be detrimental to the animal (e.g., a nonsteroidal antiinflammatory drug given to an animal currently taking steroids, resulting in gastrointestinal bleeding). Practitioners may need to evaluate any nutraceuticals the pet is currently on for potential interactions (e.g., turmeric, which is touted as an anti-inflammatory aid, yet has been shown to cause gastrointestinal ulceration in humans and mice).9,10 Additional examples include melatonin products made with xylitol and nutraceuticals like St. John’s Wort, turmeric (major component curcumin), ginseng, s-adenosyl-methionine, melatonin, and tryptophan that increase 5-hydroxytryptophan and can contribute to serotonin syndrome. Serotonin syndrome may occur with these nutraceuticals if the animal is also medicated with drugs commonly used in senior patients, including selective serotonin reuptake inhibitors such as fluoxetine, tricyclic antidepressants such as clomipramine and amitriptyline, monoamine oxidase inhibitors such as selegiline or L-deprenyl, azapirones such as buspirone, antidepressants such as trazadone, and phenylpiperidine opioids such as fentanyl and tramadol. Clients using cannabis products or other nontraditional therapies for their pets may be reluctant to disclose this information unless they have built a trusted relationship with the clinician. Clients may believe that some products are safe simply because they are labeled as “natural.” Veterinarians must educate clients about the challenges and risks of using herbal, nutraceutical, or other therapies that may include lack of purity and potency certifications as well as potential toxicity, drug interactions, and potential injury.
A thorough physical examination can elicit more information as the next step in a senior pet appointment. A relaxed animal in a comfortable environment allows for a more accurate examination including detailed attention to the eyes and mouth, as well as palpation of the spine, neck, joints, musculature, digits, abdomen, and thoracic auscultation. When assessing musculoskeletal pain, mobility, and movement, checklists can be used as a screening tool and may provide additional information for both client and veterinarian. Chronic pain scales are a useful tool to assess musculoskeletal pain.11 For additional information on assessing chronic pain, see the 2022 AAHA Pain Management Guidelines for Dogs and Cats.12 Client videos of their animal moving in their environment are additional useful tools to assess musculoskeletal pain, mobility, and movement. Videos of the pet ambulating or jumping can help detect early neuropathic or musculoskeletal disease.
A senior pet appointment may address issues such as decreased mobility from osteoarthritis, metabolic issues such as kidney or liver disease, and functional issues such as heart disease or neoplasia. For mobility issues, older animals may benefit from the use of pet friendly techniques (low-stress handling, softened table examination surfaces or examining the pet off the table), as pain and distress may be more common for senior animals.13,14 Mobility may be reduced owing to arthritic changes, and care must be taken to gently manipulate limbs, joints, musculature, neck, and spine to explore underlying discomfort. Unlike dogs, cats rarely have crepitus in affected joints. However, studies have indicated that more than 60% of cats have osteoarthritis in at least one joint despite absence of this physical examination finding.11–13,15
Neoplasia is more commonly found with senior pets and may be indicated from a thorough physical examination. Cutaneous masses noted on physical examination should be measured in all three dimensions, aspirated, and cytologically examined. Clinically, neoplasms such as mast cell tumors may be indistinguishable from benign growths (e.g., ubiquitous lipomas) and they may coexist, making the “watch and see” approach risky. A thorough, gentle abdominal and rectal palpation may also provide an early indication of abnormalities. Special attention should be given to the oral cavity, eye, and digits as sites of potential neoplasia.
A medical workup is also recommended for senior pets once or twice a year and may include a complete blood count, chemistry, and urinalysis, as well as diagrams or photographs to better track changes and screening biomarkers such as symmetric dimethylarginine assay, N-terminal pro B-type natriuretic peptide, and C-reactive protein. It may also include other tests listed in Table 1, Diagnostic Tests and Recommended Frequencies for Senior Dogs and Cats.