Sidestepping Senior Mobility Issues with Preventive Medicine
By Jessica Tremayne
Posted: June 24, 2008
Although senior care has vastly improved over the past 10 years, senior-health advocates say practices need to focus on education and prevention in all facets of their senior care regimen.
Senior pet mobility is an area that doesn’t need to wait for more scientific improvements. Educating owners on what to look for with their older pets goes beyond that they’re moving slower.
“Clients aren’t typically going to bring their senior pet in for an exam and ask, ‘What more can be done for my pet?’ unless there’s an obvious problem,” says Fred Metzger, DVM, of Metzger Animal Hospital in College Station, Pa. “This is why vets need to intervene earlier by offering preventive testing [and consultation on issues of] arthritis, cognitive dysfunction, diet and exercise.”
According to the American Veterinary Medical Assn., pets are increasingly living longer. In 1987, 31.7 percent of owned U.S. dogs lived past the age of 6. In 2006, 44 percent of the surveyed population lived past age 6. The feline population experienced an increase as well, from 15.3 percent living past age 6 in 1986 to 31.9 percent in 2006.
“Eighty percent of veterinarians expect chronic care to be a primary growth area in practice, and mobility issues arise with an aging population,” says Dr. Metzger, citing a Pfizer/Iams/VMPG survey. The 1998 survey was the most recent comprehensive survey addressing senior health needs.
“When we look at canine demographics, the numbers present veterinary medicine with a tremendous opportunity. Of the approximately 52 million dogs in the United States, more than a third are considered senior,” Metzger says.
Johnny Hoskins, DVM, Ph.D., Dipl. ACVIM, owner of DocuTech Veterinary Consultants in Baton Rouge, La., and co-author of “Geriatrics & Gerontology of the Dog and Cat,” says, “Non-steroidal anti-inflammatory drugs remain a top choice of general practitioners, but orthopedic surgeons say rehabilitative activity remains most important for dogs with arthritis and muscle degeneration, while weight control is the number one factor in helping senior cats.”
Keeping track of client compliance is a way to maximize a practice’s income and also recognize effective tactics for helping senior pets earlier in the disease process.
“As soon as a pet is within senior age, we give clients a questionnaire to focus on that animal’s specific physical issues,” says Tamara Pikulik, DVM, chief of staff at Wignall Animal Hospital in Dracut, Mass. “We run monthly compliance scores and have had great success since we’ve become organized, enabling us to better serve our senior patients while achieving practice success.”
Exercise and weight control are key to averting the onset of chronic disease and mobility issues.
“Exercise remains intricately important,” Hoskins says. “Veterinarians should be able to offer underwater treadmill services or provide clients a reference to a practice that does offer physical therapy.”
Concerns about the deterioration of the human-animal bond arise with behavioral changes, increased urination and mobility problems.
Excess weight significantly affects senior pets’ mobility, says Brent Mayabb, DVM, of Royal Canin.
“Pets over the age of 7 need an increase of protein, more water intake, dietary supplements and detailed testing—before a problem becomes obvious.”
Many compromising mobility issues can be sidestepped by good record keeping, organization and client education, highlighting preventive measures.
“Aging causes a decrease in the basal metabolic rate,” Metzger notes. “Older animals tend to have decreased activity levels resulting in increased body fat percentage. This is especially important because increased body weight results in an increased incidence of diabetes, cardiovascular, respiratory and orthopedic diseases and perhaps neoplasia.”
Canine and feline digestive ability decreases, but dogs’ decreased activity means less energy is needed in food, Dr. Mayabb says.
“Fewer calories in food to prevent obesity means less weight on ailing joints,” Mayabb says. “Cats actually need a caloric
increase because of the problem of muscle mass deterioration.”
Hill’s and Nestlé Purina PetCare also make prescription diets.
“Dogs develop cognitive dysfunction syndrome earlier than cats,” says William Fortney, DVM, associate professor of diagnostic medicine at Kansas State University.
“Dogs can get CDS at age 7, whereas cats don’t tend to suffer from the disease until age 15. CDS is very common and devastating when it happens because owners dismiss pets’ behavior changes as just getting old.
“Hill’s Pet Nutrition offers a diet for dogs called Prescription Diet b/d, or brain diet, which is formulated to help fight age-related behavior changes in older dogs,” says Dr. Fortney.
Arnold Plotnick, DVM, Dipl. ACVIM, ABVP, owner of Manhattan Cat Specialists in New York City, says few studies of behavior problems in aging pets, especially cats, have been conducted.
“One unpublished study in 1998 showed that 55 percent of cats aged 11 to 15 years develop at least one behavior problem when considered senior,” Dr. Plotnick says. “That percentage increases to 80 percent for cats aged 16 to 20. Disorientation in particular is seen in 2.5 percent of cats aged 11 to 15, and dramatically increases to 40 percent of cats aged 16 to 20.”
Fortney says veterinarians should inform clients of CDS symptoms, recommending brochures that list signs of the disease.
“There is no decent data on cognitive dysfunction and no reasonable studies in cats on the medications that are supposed to be effective,” says Elizabeth Hodgkins, DVM, Esq., in Yorba Linda, Calif. “No one knows much about CDS and that is the problem. “Cats get no real attention compared to dogs. Everyone just assumes that cats are the same as dogs, or are close enough for government work.”
Plotnick says that a better understanding of a cats’ behavior attributed to CDS may help keep the human-animal bond intact, even if the client opts not to attempt medicating. —J.T.
Clients may believe weight reduction will improve their pets’ mobility, but find breaking routines difficult and they are concerned that a change may be expensive and unhelpful. However, veterinarians who offer incentives to initiate better senior care programs find clients stick to altered-care plans.
“We offer our clients many informative brochures that explain what they can do at home for their pet, what to look for and what the profession has to offer,” Dr. Pikulik says.
“Our practice started ‘The Biggest Loser’ contest, which has attracted mostly owners of senior pets. The program provides an incentive for clients to get their pets’ weight off. We also offer significantly discounted rates for senior wellness exams in September, senior healthy pet month.
“During senior healthy pet month, clients can also enter a sweepstakes for free senior physical exams twice a year, for the lifetime of the pet.”
Glucosamine, chondroitin and omega-3 fatty acids have remained the top choice of veterinarians and nutrition experts because of the supplements’ proven capabilities. But according to Mayabb, green-lipped mussels added to food increases mobility by reducing inflammation in joints.
“This mussel is a natural anti-inflammatory that supports joint and muscle flexibility,” Mayabb says.
Some experts are leery of dietary supplements, noting that the lack of Food and Drug Administration regulation opens the market to anyone.
“There is no research for efficacy or safety on these products before they are released,” says William Fortney, DVM, associate professor of diagnostic medicine at Kansas State University. “There are always new nutraceutical claims for senior dogs, making claims with no evidence to back it up. There are no checks and balances, so veterinarians must be careful with making supplement recommendations.”
Still, owners and veterinarians are always looking for a product that may assist pets effectively.
“Veterinarians need to be cautious of the source supplement companies obtain chondroitin sulfate from,” says Mike Grant, scientific adviser at Los Angeles-based Integrated Pet Solutions. “This product is obtained largely from potentially unhealthy cow tracheas imported from China. The only other source is shark cartilage and that is very costly.”
“Anticipating or early detection of a mobility problem is the best way to maximize the animal’s treatment,” Hoskins says. “This is why veterinarians need to stress the importance of examining senior pets more frequently.”
According to Dr. Fortney, arthritis is the most frequent reason pets’ mobility is affected.
“Arthritis isn’t an acute sharp pain, so owners don’t recognize a problem and vets often miss an opportunity for intervention,” Forney says. “Looking at locomotion is easy, but some arthritis symptoms are not recognized.
“Arthritic cats often have arthritis of the spine, which may prevent them from jumping up into a litter box [and make them] have trouble sleeping, not want to be picked up and groom themselves less. Feline arthritis is less diagnosed than in dogs because the symptoms are missed.”
Owners must learn that their older pets’ behavior isn’t simply a facet of getting old, but that it indicates specific problems that can be addressed. Veterinarians should help clients understand pets’ aging process and inform them of their options.
Cat osteoarthritis is underdiagnosed because of the animals’ abilities to mask pain, Mayabb says.
“Elizabeth Hardie, DVM, Ph.D., Dipl. ACVS, at North Carolina State University, conducted a study in 2002 of 100 cats age 12 and older, finding 90 percent of the animals had osteoarthritis as detected by radiographs.
“These cats can benefit from a diet specifically formulated to meet their changing needs,” Mayabb adds.
Once animals reach a point where mobility is compromised, enrichment aid recommendations can be discussed to work in conjunction with medication, diet and exercise.
“Aids increase a senior pet’s quality of life by reducing unnecessary stress on joints and muscles,” Fortney says. “But veterinarians must stress to clients that the products aren’t actually addressing the pet’s issues.”
Many companies offer an products that help take pressure off of joints, help support a lagging back end and compress ligaments to allow for more fluid movement.
A hock holder brace is designed to fit the natural angle of the hock to prevent it from hyper extending.
A neoprene wrap also supports the joint medially and laterally allowing dogs to move with less strain on the joint.
Wrist wraps, lift and assist harnesses, bottoms-up leashes and in extreme cases wheelchairs can be helpful to senior dogs and cats.
From the Veterinary Practice News magazine archives.
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