Health checks for older cats by Sarah M A Caney

ABSTRACT: Thanks to better diets and care in general, more and more of our cats are living to an advanced age. Seeing and examining apparently healthy mature cats is important, since it can help to identify clinical problems before they reach a crisis point.

Unfortunately, with many feline illnesses, clinical signs are subtle, gradual in onset and progression and, therefore, easy for an owner to miss (Figure 1). Clinical signs can also be confusing – for example, rather than showing lameness, cats with osteoarthritis may show a reluctance to use the catflap. For some of these cats, this may present as an elimination problem, manifested as defecating in the house.

Figure 1: Old cats are masters of disguising illness

Many owners, sadly, are reluctant to present their healthy cats to veterinarians for a variety of reasons. For example, they may feel that it is normal for an older cat to be thin and walk with a stiff gait and that there is nothing constructive that a vet can do about these problems. They may not notice weight loss that is occurring on a gradual basis. They may feel that investigations are likely to be costly, painful or stressful and that ultimately their vet may recommend euthanasia of the cat.

Nurses play a vital role in educating owners that it is worthwhile paying attention to their cat and the clinical signs they may be showing since these may indicate problems that can be readily treated.

When is a cat ‘old'?

The Feline Advisory Bureau, in association with Hill’s Pet Nutrition, recently redefined age ranges. These revised criteria classify older cats as: ‘mature’ when they are seven to 10 years old (equating to a 44-56 year old human)

‘senior’ when they are 11 to 14 years old (equating to a 60-72 year old human)

‘geriatric’ when they are 15 years or older (equating to a human age of 76 years or older).

What are the common health problems in older cats?

There are many common health issues affecting older cats (Table 1). Most of these are amenable to treatment and several are curable with appropriate therapy.

History taking

A thorough history should be taken to identify potential clues of any problems. Particular attention should be paid to: the cat’s weight – has the owner noticed any changes? appetite – any increase or decrease? thirst – any increase? litter tray or toileting behaviour – e.g. inappropriate urination may be seen in cats unable to use a cat flap owing to pain associated with osteoarthritis mental status – any evidence of cognitive dysfunction or behavioural changes?

mobility issues – any stiffness or reduced jumping? energy levels – any hyperactivity or restlessness that could be compatible with hyperthyroidism? gastrointestinal signs – any vomiting or diarrhoea?

urination/defecation problems – e.g. ‘missing’ the litter tray owing to pain when posturing to eliminate? eyesight – any evidence of visual problems, which could indicate systemic hypertension?

Physical examination

The physical examination should aim to identify as many of the common problems as possible. Since many older cats have arthritis, it is important to be gentle when handling and restraining them. Particular attention should be paid to:

observation of posture and gait – e.g. any evidence of pain or stiffness? systolic blood pressure measurement – ideally using Doppler equipment with the cat in a calm state (best performed at the beginning of the physical examination)

oral examination – e.g. any evidence of dental disease? thyroid palpation – any evidence of goitre?

cardiac auscultation – e.g. any evidence of tachycardia which could be consistent with hyperthyroidism? abdominal palpation – e.g. any evidence of masses or constipation? ocular examination – e.g. any evidence of hypertensive damage? neurological examination – if indicated from the history bodyweight and body condition score

– any change since last recorded? Percentage changes are useful in evaluating the significance of any weight changes – for example, a loss of 0.5 kg in a 4 kg cat is greater than a 10 per cent change and is significant (Figure 2).

Figure 2: It is essential to weigh the cat on every visit to the practice

urinalysis – just simple dipstick and specific gravity (using a refractometer) assessment can be helpful in diagnosing conditions such as diabetes mellitus and chronic kidney disease (Figures 3a & 3b). Owners should be encouraged to bring in ‘free catch’ urine samples which are perfectly adequate for these two tests (Figure 4).

Figures 3a and 3b: Annual urinalysis (dipstick and specific gravity) is recommended in cats over the age of seven years

Figure 4: Free catch urine samples brought in by the owner are completely acceptable

Further tests, ideally using cystocentesis- collected urine, should be recommended if an abnormal dipstick or specific gravity (USG) is identified. A USG < 1.040 is considered abnormal in cats and should trigger further investigations for conditions such as hyperthyroidism and chronic kidney disease. For example, urine sediment examination, culture and a urine protein to creatinine ratio are indicated in cats with kidney disease.

Further tests

Blood tests should be done after an eight-hour fast (water intake should not be limited during this period). Mature and geriatric blood profiles ideally should include a complete haematology profile and serum biochemistry with particular attention to proteins, liver enzymes, electrolytes, urea, creatinine and thyroxine.

What health checks are recommended for older cats?

The Feline Advisory Bureau has published guidelines on senior and geriatric health checks (‘WellCat for life’). They advocate that cats of all ages should be assessed at a veterinary practice at least once a year and their weight and body condition score recorded, in addition to a general physical examination and discussion of appropriate preventive health care (Figure 5).

Figure 5: Annual blood pressure checks are recommended in cats over the age of seven years; but once the cat is 11 years old, six-monthly checks are recommended.

In addition to this:

‘mature’ cats – those aged > 7 years – should have their blood pressure (BP) checked once a year and have a urinalysis performed ‘senior’ cats – those aged > 11 years – should have blood tests done (haematology, serum biochemistry, total T4) once a year. Consideration should be given to increasing the frequency of BP and urinalysis check¬ups to every six months in these cats. ‘geriatric’ cats – those aged > 15 years

– should be assessed at a veterinary practice every six months at which time a clinical examination, weight check, body condition score, BP and urinalysis should be performed. Annual blood tests should be continued, unless there is any clinical indication to increase the frequency of these.

The author prefers to see ‘senior’ patients every six months and ‘geriatric’ patients every three months.

What strategies are helpful to encourage owners to bring in their older cats?

From an early age, it is important to educate clients as to the benefits of health checks in their cats. There are a variety of options which can be considered to encourage health checks in older cats.

These include:

extended booster consultations, starting when the cat is seven years old, allowing more time for the additional tests to be done

combined nurse and vet booster consultations – a veterinary nurse can take a thorough history, examine the cat, check BP and perform a urinalysis on a sample brought in by an owner. The veterinarian can then assess the data collected, timetable further tests/treatments, give the booster and advise the client as necessary use of owner questionnaires (asking the sort of questions assessed in a history) can help to shorten the appointment times – they can be posted to clients or given to them on arrival at the surgery running dedicated geriatric clinics, which can be run by nurses and include a thorough history, examination, BP and urinalysis on an owner brought in urine sample – those cats identified with specific problems, such as systemic hypertension, can be referred on for further evaluation by the veterinary surgeon educational literature for owners (such as the FAB WellCat information) can help to explain the benefits of health checks in older cats.

Conclusions

The potential benefits of maintaining contact with the mature healthy feline patient are easy to see. By identifying clinical problems, such as osteoarthritis, we can offer targeted therapy which can benefit the cat’s quality of life immediately.

Diagnosis of some conditions such as systemic hypertension before it has resulted in clinical signs can prevent severe consequences, such as blindness.

Maintaining contact with healthy mature cats is definitely a challenge but hopefully one which is eminently rewarding to the cat, its owner and the practice team.

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