Although old age itself is not a disease, the aging process involves changes in physiologic function that the health care team and the client need to understand to ensure the geriatric patient is as comfortable and happy as possible.
Following are the top 5 considerations in caring for older patients.
1. Special Nutritional Needs
As animals age, their metabolic rate and activity decrease, which leads to a decrease in caloric need by as much as 30% to 40%. Older animals also may need specific diets for health reasons (eg, osteoarthritis, kidney or liver disease, neoplasia). Commercial dietary formulas that attempt to address geriatric patients’ needs are available, but finding a single product that addresses all their nutritional needs can be difficult. The veterinary team should ensure an aging patient has proper nutrition, as it can impact quality of life.
2. Early Disease Detection
As animals age, metabolic changes occur and immune competence decreases, despite normal numbers of lymphocytes. Also, phagocytosis and chemotaxis decrease, resulting in less ability to fight infection and allowing for autoantibodies and immune-mediated diseases to develop. Early signs of a disease state may be masked by what the client considers signs of the normal aging process (eg, decreased appetite, lethargy, change in hair coat).Therefore, when taking a patient’s history, team members should focus on any changes that the client has observed, even if the client does not consider the changes problematic. Some conditions can be expected in geriatric patients (eg, arthritis), and early diagnosis allows more treatment options. Identifying diseases earlier also allows the team to manage conditions that come with aging and preserve quality of life for as long as possible.
3. Anesthesia Requirements
Geriatric patients respond differently than younger animals to anesthetic procedures,and the anesthetist must be aware of their special needs.These patients also have a lower tolerance for some medications, possibly the result of the normal aging process or a disease process, which may result in a deeper plane of anesthesia than initially anticipated and a prolonged recovery time. The team should be vigilant when monitoring geriatric patients and adjust the anesthesia protocol based on recent diagnostics and the physical examination.
4. Oral Health
Periodontal disease in animals has been linked to many systemic diseases (eg, kidney and liver disease, heart failure and heart attacks, lung disease, adverse pregnancy effects, cancers, complications of diabetes) because of the consistent bacterial load in the mouth entering the blood stream through bleeding or inflamed gums. Many of these conditions improve with proper dental treatment; therefore, keeping patients’ mouths clean and healthy increases their chances of staying healthy and decreases disease risk throughout their life. All clients should be aware of the importance of good oral health. More than 70% of dogs and cats are estimated to have some form of periodontal disease by 2 years of age, so it is important to educate clients about at-home dental health options(eg, teeth brushing, chews, sprays)and inform them that full anesthetic dental cleanings will likely still be recommended to ensure complete cleaning and decrease future risk for decay and disease.
5. Need for Comfort
Older patients’ comfort is as important as their health. Use a sling while walking a geriatric osteoarthritis patient to increase the patient’s comfort; provide booties to protect thinning paw pads from hot asphalt; provide extra bedding to reduce or eliminate the frequency of pressure sores; and slow down and walk at the patient’s preferred pace.
Geriatric patients present their own unique set of challenges, but with understanding, the veterinary team can help them age gracefully and give them excellent quality of life.