Customized Care for Seniors

Just because a medical condition is common or may be a predictable issue by the time we reach a certain age doesn’t mean we don’t need individualized patient care.

GettyImages-1206518788.jpgSenior Pets Deserve Individualized Care Plans

by Mary Gardner, DVM

I was stunned! I was expecting to see a vein specialist at my two-week recheck after having learned I had a blood clot in my calf. I was concerned, I had questions, and I wanted to talk to a doctor. But the nurse simply told me, “Don’t worry, these clots are so common. You’re basically on the conveyor belt of care unless something different happens.” I nearly blurted out: “WHAT? Conveyor Belt of Care?!”

I realize that most physicians are evermore pressured by financial constraints and administrative burdens imposed by various components of the US healthcare system, but I had never felt more like a number at a doctor’s office. Immediately afterward, I scheduled a visit at a different clinic.

Context Matters

Just because a medical condition is common or may be a predictable issue by the time we reach a certain age doesn’t mean we don’t need individualized patient care. Veterinary teams can easily play a “name-that-disease by species/breed/age” trivia game: Middle-age golden retriever? Cancer. Senior Doberman pinscher? Dilated cardiomyopathy. Greying Labrador retriever? Osteoarthritis. Skinny geriatric cat? Chronic kidney disease.

Help Create Senior Pet–Friendly Homes

Veterinarians can easily recommend the best diagnostic tools, medications, and complementary therapies, but we often struggle with how to help a family meet a senior pet’s environmental needs at home. Ask clients to take pictures and short videos of where their pet sleeps, eats, plays, and eliminates. Ask clients about other pets and children in the home and what the family struggles with the most. Maybe their cat can’t jump into their daughter’s bed anymore and she misses that snuggle time, but a simple ramp and a nightlight can preserve that bond. Maybe a family needs to set up a safe zone when they leave for the day to protect their cognitively impaired dog from getting stuck under furniture.

Keep a wealth of product suggestions and home hacks handy that relate to the various ailments a senior dog or cat may have. Here’s a short list of the types of products and services I suggest that every practice research and have ready to recommend to clients who have senior pets:

  • Mobility harnesses
  • Booties
  • Low-entry litter boxes
  • Pheromone products
  • Yoga mats and other options for nonslip flooring
  • Halos for visually impaired pets
  • Cleaning products
  • Pet diapers
  • Soothing sound machines or pet music resources
  • Pet ramps and stairs
  • Cameras to keep an eye out while the pet is home alone
  • Delectable treats and food flavor enhancers
  • Supplemental heat sources
  • Orthopedic beds
  • Food puzzles
  • Pet groomers
  • Pet sitters

But this kind of “cookbook” approach to care is unlikely to consistently produce five-star patient outcomes. Of course it’s essential to follow veterinary practice guidelines, policies, consensus statements, and checklists created by our professional associations, institutions, and societies to help us standardize best practices for patient care. But fine-tuning each “recipe” serves our patients and clients well, and it relies on context.

Each condition is a new problem for each pet and the families who love them. It’s a new issue to manage, a new fear to face, and possibly a reason to say goodbye. The context—various circumstances relevant to each pet’s and pet owner’s situation—influences our ability to provide good, individualized patient care. We must also avoid judging a pet owner’s decisions about their pet’s care.

Sam.pngMy girl Sam had spinal lymphoma and needed an elevated bowl to eat, a yoga mat to stand on, a peanut exercise ball to help support her hind end, and a harness. Having pictures on your website as examples of what a family can do will help them envision the possibilities.

When helping a senior pet, I consider several factors that provide context for each pet’s story: the pet’s ailments, the pet’s personality, and the pet owner’s four budgets: financial, physical, time, and emotional.

The Pet’s Ailments

A senior pet usually has multiple ailments. A wobbly geriatric cat with arthritis may be presented for evaluation of vomiting, but she may also have decreased vision, house-soiling, lack of self-grooming, cognitive impairment, and anxiety. I evaluate every pet holistically and address the pet’s issues in accord with the owner’s abilities. I ask the owner, “What are the two most pressing problems you’re facing with your pet right now?”

So even when my examination reveals that a dog has mild dental disease and is long overdue for a professional dental cleaning, if the owner tells me their dog pants and paces all night and family members are losing sleep, I know we should address that issue first. A dog’s sparkling clean teeth may not stop the family from euthanizing him if he still can’t settle down at night.

The Pet’s Personality

Next, I consider how the pet is handling their ailments and the necessary treatments and environmental adjustments.

For example, an elderly cat with chronic kidney disease may sit quietly on his owner’s lap for daily subcutaneous fluid therapy and chin scratches. But if the owner tells me the cat becomes Satan’s spawn when they try to give him oral medications, I know I’ll need to prescribe a transdermal appetite stimulant when the time comes. Otherwise, the cat will stop getting his oral medication, not consume enough calories, and may develop caregiver aversion—so even the fluid therapy sessions could become a battle. I’ll also begin to talk with the owner about a variety of options to disguise and give oral medications, because giving an oral drug at some point may become unavoidable.

Or a fearful, anxious dog with mobility issues who snaps at every stranger who approaches him will probably need his owner to video chat with a veterinary rehabilitation specialist so he can do his exercises at home.

The Pet Owner’s Four Budgets

I’ve found that evaluating each of these pet owner budgets is crucial in ensuring a senior pet’s optimal care.

Financial. We all know that the amount each pet owner can or will spend for their pet’s healthcare varies widely. An owner may struggle to pay $100 once a year for an examination and rabies vaccination and another may not bat an eye at paying $1,000 a month for a veterinary therapeutic diet and cancer treatments. Some owners have extremely limited finances while others would sell their house for their pet’s care. It’s important to refrain from judgment as you’re constructing a patient’s care plan.

Physical. Consider how well an owner can physically manage their pet. A large dog with mobility issues whose owner can’t lift her in and out of the car to get to their three-times-a-week rehabilitation therapy appointments may jump at the chance to train their dog to use a ramp. A simple suggestion can make the dog’s car trips to medical appointments feasible, and it may also mean that those joyful rides to spend Sunday afternoons at the beach won’t stop.

I once helped a 50-year-old client who had a 20-pound Shetland sheepdog with osteoarthritis. Because the owner had rheumatoid arthritis, she struggled to bend down, pick up her wee dog, and traverse the two porch steps to help her dog get outside to eliminate. I helped her find a sturdy dog mobility harness with a long strap, and that made walks easier for them both.

For various reasons, many older dogs and cats can’t make it to the veterinary clinic as easily as they used to, so consider offering telemedicine or mobile services when possible.

Time. Senior pets take time! They walk slower, eliminate more often, receive multiple medications, need extra rest time, require special attention to comfort care, and need more frequent veterinary visits—the list can be long. A healthy four-year-old dog may stay home alone comfortably for nine hours, receive parasite preventives once a month, and need to see a veterinarian only once a year. A senior dog may house-soil if she can’t get outside every four hours, need medications every six hours, and have veterinary evaluations and rechecks four or more times a year.

Pet owners who have work, travel, or other family commitments may be unable to devote adequate time to their senior pet’s care. Assessing an owner’s needs for different medication options or long-acting formulations (or perhaps decreasing the number of medications or supplements if feasible); recommending reliable pet sitters; and offering telemedicine services, specialized boarding, or even handy cleaning and hygiene tips can be invaluable.

Emotional. Caregiving for a senior pet may have an owner struggling to stay afloat in a sea of emotions: distress, anxiety, fear, sadness, frustration, guilt, or even disgust. Owners of geriatric pets may also be experiencing anticipatory grief when they know their remaining time with their ailing pet is short.

We can help replenish an owner’s emotional budget by carefully explaining the pet’s ailments and what the owner can expect from treatments, providing supplemental educational resources, making specific product recommendations to ease a pet’s activities of daily living, encouraging owners to thoughtfully consider their goals of care for their pet and share them with you, and identifying local resources to help simplify their caregiving.

Closing Thoughts

I hope the veterinary profession can avoid a “conveyor belt of care” system, and that veterinary caregivers will dodge that mindset. As a hospice veterinarian, I have seen my fair share of senior and geriatric pets. Every patient has a unique story and set of circumstances, and every owner has a unique set of goals for their pet’s care. I approach every patient with a fresh perspective and open mind. Over the years I have been amazed at what families have done for their senior pets, and I’m grateful to have learned so much from the families I have helped. 

Mary_Gardner_bio_pic.jpg
Mary Gardner, DVM, is cofounder of Lap of Love Veterinary Hospice, coeditor of a veterinary textbook Treatment and Care of the Geriatric Veterinary Patient, and author of new books for pet parents, including It’s Never Long Enough—A Practical Guide to Caring for Your Geriatric DogGeriatric Dog Health & Care Journal, and Geriatric Cat Health & Care Journal. Gardner’s latest book, Nine Lives Are Not Enough—A Practical Guide to Caring for Your Geriatric Cat, is set to be published in November 2022.

Photo credits: LittleCityLifestylePhotography/iStock via Getty Images; Photos Courtesy of Mary Gardner; LittleCityLifestylePhotography/iStock via Getty Images; Photos courtesy of Kati Nelson, Danielle Richard, Aimee Potter, Karen Loggins, and Garth Jordan

 

Senior Moments

Personal Stories of Older Pets from the AAHA Community

AAHA staff and members shared stories of their senior pets in the AAHA Community. See these and other great posts at community.aaha.org.

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Tipsy’s Long Adventure

Tipsy’s story began the day of my grandfather’s celebration of life in 2007. That was the day my parents gave me Tipsy. She was an 8-week-old dachshund and cute as could be. I immediately fell in love with her. I named her “Tipsy” as a way to honor my grandfather who suffered with alcohol addiction.

Tipsy and I went through everything together. She was with me at the end of high school, she went through college with me, and of course, through many life changes. It was always Tipsy and me against the world! She was the love of my life and my first baby. Coming home to her always made bad days better. She had a personality that wouldn’t quit. She was such a sweet girl.

She made it to the prime age of 14, just four months shy of her 15th birthday. Two years prior to that she was diagnosed with heart disease. I followed through with medications and veterinary visits for those 2 years. Despite our best efforts and her dynamite personality, she eventually developed congestive heart failure. There was nothing I could do to fix it. I kept her as comfortable as I could for as long as I could. She was loved and cared for until the end. In my heart, I know she understood I loved her. Saying goodbye to a senior pet is heartbreaking, but the experience of caretaking, giving unconditional love and compassion, made the effort all worth it.

—Kati Nelson, AAHA Accreditation Specialist

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Angel on Earth

Angel was an amazing kitten wrangler and loved our foster kittens. She would often groom them and let them (attempt to) nurse on her. She let them eat from her bowl without fussing. And she always had lots of cuddles for them.

—Victoria Owens, via Danielle Pitre Richard,
Nursing Manager, Lafayette Veterinary Care Center

 

 

Mo_-_Courtesy_of_Aimee_Potter.jpgZoomie Memories

I have a 16-year-old Chihuahua, Mo, that has a few medical issues, severely collapsing trachea, chronic cough, and has started to lose his sight. This little dog has been a part of our household for 14 years and is the last of four seniors we have had as part of our family.

Seek Out Senior Pets

A study I did with VetSuccess showed that 50% of US pets euthanized at their veterinary clinic had not visited their veterinarian in more than 12 months before they were presented for euthanasia. This breaks my heart because we can give families and pets so much help to ease a pet’s ailments and improve their quality of life and sustain a family’s bond with their pet. A pet owner may simply think, “Rusty is just old, what will Dr. Gardner say that will help?” I can listen, and I can say a lot!

Veterinary practices need to attract clients who have senior pets just as much as, if not more than, they focus on attracting puppy and kitten owners. And reaching owners of senior pets means saying more on our websites and social media than, “Senior pets need biannual blood tests and X-rays so we can uncover your pet’s lurking problems.” (That sounds kind of scary, right?)

Instead, provide senior-pet specific education and practical tips that allow pet owners to bolster their senior pets’ wellbeing and maintain their daily joys of living. This approach will drive more traffic to your website, spark delighted shares of your social media posts, and open more doors into your practice. Show pet owners you know how to help them provide excellent care for their weak and wobbly, crusty and bumpy, most amazing senior pets!

He has some horrible days when he doesn’t want to eat or take his meds, but some days he gets the zoomies and has us all laughing out loud. Senior pets can be a lot of work, but they usually have been with us for so many years that we couldn’t picture life without them. It will be hard to say goodbye when the time comes but we will remember the zoomie days and those memories will last a lifetime.

—Aimee Potter, AAHA Accreditation Specialist

 

Tucker, Adventure Dog

It seems an irony to me that what can be one of the most heartbreaking moments in life can simultaneously be one of its most compassionate and loving as well. I am also blessed to have shared life with several senior dogs and although the dynamics of the relationship change our love and care do not.

Tucker_photo_courtesy_of_Karen_Loggins.jpgI will never forget the day I was sitting across the room from my sweet boy Tucker and noticed, for the first time, the gray strands that seemed to spring up overnight on his face. At first, I could not believe it. It seemed just yesterday he was the mischievous puppy I brought home at just 10 weeks old.

He was such a confident, adventurous pup and a perfect traveler and copilot. We lived in several states, and he enjoyed them all. From surfing in Hawaii to snowmobiling and hiking in Colorado, he lived every moment, in the moment. Even when we were just curled up on the couch for movie night, he was content.

As he reached his senior years, his cognitive function gradually declined, and his body soon followed. It was hard to watch my once energetic pup slow down, but he continued to live every day as best he could. Instead of a hike in the mountains, the daily walk down the driveway to get the mail was a highlight of his day. My dogs have taught me so much about living life and I do my best to emulate that sense of perspective and stop obsessing about the past and worrying about the future.

When it was time to say goodbye, my heart was full, and my only hope was that he felt the same. Tucker lived to be 17, and I am so truly thankful he shared those years with me.

—Karen Loggins, AAHA Practice Consultant

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The Art of Laying Down

As Jem has gotten older, and grey-er, he’s definitely mastered the art of laying down. We used to walk about .6 miles a day together. His front leg is deformed, and it took him a while. With his brace on, he could go at a decent clip and we’d make it in about 20 minutes. Now, with arthritis and the wisdom of age, we go about half that distance and it takes about 40 minutes. There’s a LOT of laying down in the grass along the way disguised as sniffing, then rolling around, then just laying there. The hotter it gets, the better the grass looks at each stop. His record is 22 stops in a 4-block stretch. When the Rimadyl kicks in, he can go 6 blocks in 30 minutes and stop less than 10 times!.

—Garth Jordan, AAHA CEO

 

 

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