Implementing AAHA

August 29, 2023

By Michelle Evason, BSc, DVM, DACVIM (SAIM), MRCVS, and Katie Krebs, DVM, MBA, DABVP (Canine and Feline)

Recognizing that a dog or cat is aging is hard. This past summer, when one of our family’s English setters was diagnosed with cancer, we became acutely familiar with senior dog needs and end-of-life conversations, and experienced lots (and lots) of feelings. Everyone reading this can probably relate to the emotions and the need to “lean in” to the help offered by the veterinary team during these times. As veterinary professionals, we are also aware pet owners vary widely in goals and beliefs, sometimes making communication with them challenging.

There is recognition that preparing and counselling clients about senior pet care is tough. It is also a necessary portion of the veterinary day-to-day, in that senior dogs and cats represent 44 percent of the pet population.1 One of the challenges in these conversations is the large variation between pets with respect to the onset of senior life stage (i.e. a cat is not a small dog, nor is a Bernese the same as a Shih Tzu, when it comes to creating a senior pet plan). Further challenges arise from differences in unhealthy versus healthy seniors, along with the spectrum of ways the “golden years” can be enjoyable for pets and their owners.

Helping clients and their pets takes time, patience, and the ability to keep current with evolving veterinary knowledge. Having access to the American Animal Hospital Association (AAHA) Senior Care Guidelines1 assists with staged (or a continuum of) preventive care needs, specifically for pets “aging gracefully.”

The mission of the AAHA guidelines is “to provide actionable guidance to help veterinary professionals face the demands of a continually shifting industry.”1,2 These recent guidelines provide succinct summaries of common senior pet medical issues, current tests, and recommendations for implementation that can be tailored to individual/s, as well as resources for client communication.

Staged senior healthcare plans, with the outcomes of maintaining quality of life (QOL), human-animal bond, and shared decision-making with the pet owner, can allow for proactive strategies for individual senior dog or cat needs. Ideally, these plans will be created with evidence-based and expert recommendations for the healthy and unhealthy senior pet.

Below is a possible five-step approach to these, as guided by AAHA.1

When it comes to aging pets, begin by ensuring all veterinary team members and the pet owner have a good understanding of what “senior” means for the specific cat or dog. The AAHA guidelines define senior for dogs “as the last 25 percent of estimated lifespan through end of life,”2 and for cats, “as greater than 10 years of age.”3,4 It is important to emphasize that senior is a unique life stage and needs to be treated as such. For this reason, an individual healthcare plan (i.e. preventive care, diagnostic testing, therapy) is indicated, and likely differs from what was recommended when the pet was in the adult stage.

Senior pet care decision-making can be multi-faceted and interwoven with unique individual and family needs. Using open-ended questioning in the early stages of planning can incorporate concerns family members have and assure compliance with recommendations on key outcomes (i.e. QOL and the human-animal bond).

Communication, active listening, and addressing questions may require comfortable surroundings and visuals to help circle back and explain challenging concepts or co-morbidities.

Similarly, breaking large blocks of information into chunks/categories can ease understanding. When multiple family members are involved, shared decision-making and open dialogue about outcomes and health priorities may need to be revisited frequently.

As pets age, they are at a higher risk of developing illness that causes significant morbidity or mortality. A thorough history, physical exam, diagnostic testing, and evaluation of mobility and pain can help determine whether a senior pet is healthy or unhealthy, and this identification will guide recommendations for a dog or cat.

For healthy and unhealthy senior pets, sending questionnaires to clients before an appointment can expedite history-taking and encourage clients to consider potential issues that they may have chalked up to “just getting older.”

Additionally, encouraging clients to record home videos of pets can aid in diagnosing changes in movement that may indicate pain or discomfort. For the technology savvy, phone apps and activity monitors can track pet exercise, water intake, and a variety of other factors that indicate changes in pet behavior. These types of trackers can be especially helpful for cats that tend to mask underlying conditions or have subtle, easy-to-miss signs. Using the AAHA Pain Management Guidelines5 and chronic pain scales can also be useful tools to evaluate pain.

This is again where videos of a pet in their home environment can help identify mobility changes. Other considerations for senior pets’ health staging include evaluation of oral health, optimal nutrition, and completing (and updating) a body map for masses.

For healthy pets at this stage, diagnostic testing (CBC, chemistry, urinalysis, blood pressure, and other tests/imaging as deemed appropriate) should be considered every six to 12 months; first, to obtain baselines, and ongoing to monitor trends. This overall senior pet health evaluation, testing and staging, serves to assess in chronic diseases, proactively prepare (and plan) for general anesthesia needs (e.g. dental, mass removal), and track impact of medications.

An unhealthy senior pet may have various comorbidities, progressive chronic diseases, or be on multiple medications. They may exhibit lethargy, weight loss, and other nonspecific signs, and additional testing/imaging may be indicated based on body system, clinical signs, progression, etc. Options for referral and/or palliation can be discussed with pet owners, and care should be taken to alleviate pain, pre-empt cachexia, and other clinical signs. While there are not many validated QOL scales for dogs and cats, provision of these resources can assist care and end-of-life decision-making, dependent on senior stage and pet- and family need.6

These individualized care interventions may include the following, as guided by the AAHA Diagnostic Approaches by Body System for Senior Dogs1

Additional recommendations, such as telemedicine (if appropriate and with no liability concerns for the given area-practice) and end-of-life planning for the pet-patient, along with provision of support and resources for the pet’s family may be indicated based on the specific pet and pet owner.

The entire veterinary team can be trained to recognize, stage, and address senior pet health issues, as well as be empowered to impact pet management and desired outcomes.

Senior-friendly modifications in the clinic can consist of staff-initiated planning for senior pet appointments (e.g. scheduled for a one-hour spot instead of a 30-minute adult wellness appointment, ensuring a calm, reduced noise setting). This type of education and open dialogue about senior pet needs can also lend itself to preparing exam rooms equipped with soft bedding, and yoga mats (or non-slip coverings) to improve mobility.

Clinic team awareness on availability of educational materials and visual aids, such as those on the AAHA Senior Care resource section,1 along with pre- and post-visit questionnaires, can assist with mapping of pet progress and ongoing individual staging. Such visual aids help ensure patient profiles are charted, explored, and discussed. Similarly, clinics may wish to include senior pet representation in online materials.

Optimally, senior pet care education is internal (i.e. veterinary team training) and external (i.e. clients, pet-owners). This means taking some extra time in the clinic for senior pets, along with conversations with pet owners on outcomes and staging of life/disease progression.

Providing veterinary team members with additional end-of-life training and support may assist with this difficult, but extremely important, part ofthe job.

Most clients have a very strong bond with their senior pets. Providing them thorough information, and offering a supportive and individualized senior pet care plan, will undoubtedly be welcomed. I know how very much this time and care meant to my family, our beloved (and still missed) senior English setter, Bramble, and me.

Michelle Evason, BSc, DVM, DACVIM (SAIM), MRCVS, serves as global director of Veterinary Clinical Education for Antech (MARS). Dr. Evason has worked in general practice, academia, specialty clinical practice, and in the animal health industry. She has published on numerous infectious diseases, antimicrobial stewardship, nutrition, spectrum of care, veterinary- and pet-owner education related topics.

Katie Krebs, DVM, MBA, DABVP (Canine and Feline) is an assistant professor in Clinical Primary Care at the University of Pennsylvania’s Ryan Veterinary Hospital. Dr. Krebs graduated from the University of California, Davis, School of Veterinary Medicine, with an emphasis in small animal medicine. She completed a small animal rotating internship at the Atlantic Veterinary College in Prince Edward Island, Canada before completing a residency in Canine/Feline practice, American Board of Veterinary Practitioners (ABVP), and MBA at Virginia Tech. Her research interests include pain management of osteoarthritis in cats and implementing telehealth for improved client communication.