Feline senior health clinics are a vital part of providing quality preventative healthcare to our patients and are widely recommended by many veterinary organisations for older cats. What makes a pet senior will vary by species and breed¹ For cats, the ISFM has classified older patients into 3 distinct categories – mature (7-11 years), senior (11-15 years) and super senior (15 years and over)².

Feline senior health screens can often be undervalued by owners and sometimes poorly attended. This is in contrast to preventative health checks and consultations in young patients such as  kitten checks, where owner uptake is high. Why is it that for senior health checks, where the chances of finding significant clinical disease is much higher than in younger patients, that often our owners seem less motivated to attend?

CODCAIn many cases it’s not a true lack of motivation for pet owners, they are just as invested in their pets later in their life; often even more so after years of caring for them. Commonly there’s a lack of awareness of the diseases that affect older cats and as the conditions tend to be insidious in onset they can be hard to detect. In particular, there are some common diseases that have few or no clinical signs until significant organ damage has occurred, for example, feline hypertension. In addition, some clinical signs of common geriatric diseases, such as reduced activity, can be easily overlooked by owners and attributed to being a normal ageing change in their cat.

Raising  Awareness of Common Diseases in Older Cats

As such, one of the most important aspects of running successful feline senior health clinic is to raise awareness of the common senior cat diseases and explain why screening is necessary. There are many ways to do this, including; practice blogs, social media posts and educational leaflets designed for owners. There can be too much information to cover in a single consultation, as feline senior health clinics cover a wide array of potential problems. We know in human medicine that much of what is discussed in a consultation is forgotten. A study showed 40-80% of the medical information shared in a consultation is forgotten immediately^3; this is likely to be true for veterinary consultations as well. Providing key information on disease risks of older pets separate to the appointment will improve both uptake of senior health screening and improve compliance with recommendations made in the consultation.

In this age where owners can research and access information on these topics readily online, it can seem unnecessary to provide additional educational resources. However, research with pet owners tells us many prefer to get their information from their vet; who they feel is a far more trusted resource⁴. It also helps to build the relationship between the pet owner and the practice.  It’s a good idea to send them resources that explain what will happen during the consultation to reduce any concerns they may have about what may happen to their pet on the day of the visit and which common conditions you are screening for. It could also be a good idea to send them a questionnaire which they can complete in advance – this can save time during the consultation and allow the owner to reflect at home in their own time on whether any of the subtle signs of senior diseases are present.

Disease information can be shared directly with the owner but it’s also a good idea to use social media channels to offer bitesize pieces of information too. It’s suggested most people need to hear a message at least three times to remember it (in some cases it may be many more times than this). Don’t be afraid to offer information with the same message in various forms; a combination of social media posts; direct mail (post or email); and dialogue when the client contacts the practice. It’s also worthwhile making sure that everyone in the practice is aware that senior cat health screening is now a focus so they can help consolidate the message whenever clients contact the practice.

Planning Senior Health Clinic Consultations

Once you have decided upon which clients to invite for feline senior health screening and how to contact them, the next step is to plan the consultation itself.  Common conditions we see in our older felines are hypertension, chronic kidney disease, diabetes, thyroid dysfunction, osteoarthritis and periodontal disease. It’s important to be systematic in your history and examination when performing a feline senior health check, as it’s designed to be a holistic assessment of the patient. Even if there are strong clues in the history from the owner that point to a specific condition try not to zero in on this but continue to take a full history and perform a full nose-to-tail clinical examination. An example of a feline specific history questionnaire, with a clinical exam guide is available below to preview and print and can be requested from your Ceva Territory Development Manager. History questionnaires can be completed in the consultation or by the owner at home.

It’s possible that a cat may have more than one condition and some conditions may be linked. For example, feline hypertension  can occur secondary to chronic kidney disease or hyperthyroidism in cats.  It can also be associated with neurological signs in up to 46% of cases⁽⁵⁾ so try to obtain all the information first before drawing conclusions about specific conditions.

Additional tests are often advisable and may be included in your feline senior health check or offered as an add-on where the history or clinical exam indicate it. A recommended baseline for cats is a urine SG and dipstick; a blood panel to include haematology and a kidney and thyroid assessment;  and a blood pressure (BP) measurement. Hypertension is a common condition in older cats affecting 1:5 cats over the age of 9 ⁽⁶⁾ and should always be included in this assessment. 

Once the history, clinical exam and further tests are complete, the next step is to signpost to the owner if there are any abnormalities found in the check and whether further action is needed. Communication is key here. For some owners, as we’ve discussed, there can be no or minimal outward signs that anything is wrong with their cat. If abnormalities are found, it can cause some shock or disbelief for the owner. It is important to make time in the consultation to hear any concerns that they might have and ask any questions.  Have client resources available, as they may not process all the information they are given while they are coming to terms with the fact their cat is not as healthy as they thought. It’s a great idea to write things down and use images if possible to explain what’s been found to help owners remember what has been shared with them in the consultation. Offer clear advice on next steps and how they can get in touch if they have further questions after the consultation. Paying attention to these steps will ensure that they quickly move through their emotional reaction to the news about their cat’s health and are ready to start making plans for further investigation.

Celebrating Good Health

If there are no abnormalities on the check-up, it’s important to communicate to the owner the good news that their cat is currently in great health. However, it’s important to reiterate the need for ongoing annual or 6 monthly health checks for their cat as they remain at increased risk of disease as an older pet. Don’t underestimate the value of a healthy older cat consult, far from being a waste of time it’s a vital opportunity to increase the owner’s awareness of signs of disease to look out for and to strengthen the relationship between practice and pet owner so that they will seek early advice and intervention if anything develops in the future.

It’s also a great opportunity to offer top tips to owners to make their household more suitable for older pets – ideas like adding steps to access points or increasing the availability of  resources (such as litter trays and water bowls) for older cats.  Some great resources to explore for top tips are: The American Association of Feline Practitioners (10 Ways to Care for Your Senior Cat – Cat Friendly Homes) and ISFM (Elderly cats – special considerations | International Cat Care (icatcare.org)).

Summary

In summary feline senior health screening is a vital and often underperformed service in our industry. If we reflect on some of the barriers that prevent owners from attending these clinics and educate on the need for these checks,  it’s possible to markedly increase the uptake of these initiatives. Feline senior health screens can help to build a strong bond between your practice and the pet owner, whether disease is found or not. They are also a great opportunity to detect disease early in older cats before they are too adversely affected. A summary of all the steps discussed is included below.

Feline Senior Health Screen Checklist

1. Identify which conditions you would like to screen for in your practice.
2. Source/produce information resources for owners on why screening is important
3. Identify which clients to invite for screening from the practice database
4. Share information with these clients along with an invitation to the appointment.
5. Consider using a questionnaire sent to the client ahead of the appointment to help them spot the subtle signs of disease in older cats.
6. Define when you will offer the appointments – communicate with the entire practice team about the feline senior pet programme (when they are offered, who with, which cats should come in and why.)
7. Conduct the appointments – allow time to take a full history including an assessment of behaviour changes and signs of cognitive dysfunction.
8. Conduct screening tests – urinalysis, BP measurement, blood tests
9. Ensure there is adequate time to explain findings to owners and hear any concerns they may have
10. If the cat is healthy, offer lifestyle tips to support ageing pets
11. If abnormalities are found, – give adequate support materials to help owners process what has been found in their cat so that they can make an informed decision about the treatment options for their pet.

REFERENCES

1. AAHA Senior Care Guidelines for Dogs and Cats. J Am Anim Hosp Assoc 2005;41:81-91.
2. https://www.catcare4life.org/cat-owners/lifestages/
3. Kessels, R. P. C. (2003). Patients’ Memory for Medical Information. Journal of the Royal Society of Medicine, 96(5), 219–222.
4. Ceva consumer research, March 2020.
5. Taylor S, et al. ISFM Consensus Guidelines on the Diagnosis and Management of Hypertension in Cats. Journal of Feline Medicine and Surgery (2017) 19, 288–303.
6. Conroy et al, Survival after diagnosis of hypertension in cats attending primary care practice in the UK 2018