Enriching geriatric patients' lives (Proceedings)

An important time for practices to include a behavioral exam is when a pet becomes a senior. This timing is going to vary greatly between species as well as individual breeds of dogs. In many giant breed dogs they can be considered geriatric as early as 6 or 7 years of age. Smaller breed dogs tend to have a longer life span and therefore my not show signs of aging until 11 or 12 years of age. Other effects on the aging process may include long standing health problems, the environment and general care received throughout their lives. When veterinary staff sees signs of a pet becoming aged, they should always question the owners about behavioral changes. This can be a topic owners fail to bring up on their own as they feel it is normal or it's an area they don't realize veterinary staffs are well versed in. It's extra important in this stage of a pet's life to ask about behavioral changes as there is no other time when physical and behavioral problems are more closely linked together. It can also be a time when an owner's bond is the greatest with their pet.

Any behavioral changes in geriatric pets should be followed up with a full medical work up. A physical examination should be performed along with a CBC, blood chemistries, thyroid levels, urinalysis and a neurological exam. In many cases the first sign of disease in a pet is changes in their personality and activity level. You can also have a physically healthy pet who showing signs of cognitive loss by changes involving their behavior. This is where being well versed on management, nutrition, pharmacology and behavior modification is important. By offering support to the client in these areas you may be prolonging the pet's life span as well as improving the quality of life.

Because this is a critical time in a client's relationship with their pet, special consideration should be given in the veterinary practice. The veterinary behavior technician needs to be aware of what behavior problems commonly occur in geriatric pets and be prepared to counsel their owners. It may also be a time to discuss the end of their pet's life including the euthanasia process.

Elimination behaviors

Senior pet owners often note a change in house training habits. This can be extremely frustrating and a behavior most owners have little tolerance of. Assisting clients with management techniques may prevent premature euthanasia of the pet.

One of the first signs of decline in a geriatric dog is house soiling. There can be multiple reasons both physical and behavioral. The first step is to identify and physical problems that may be contributing to the house soiling. In general older dogs need to relieve themselves more frequently. Constipation can cause a dog to eliminate smaller more frequent amounts. Many will benefit with a diet change of one that is more highly digestible. Polyuria can be caused by a variety of old age physical conditions and may need to be accommodated. In the case of cognitive loss, owners may simply have to re-housetrain. 

It's not uncommon for the senior cat to stop using their litter box. In which case, the client may need to add an additional box and step up hygiene. The cat's paws should be checked to make sure clumping litter isn't sticking to them indicating a new to change the substrate used. A change in location may be needed. If the cat is arthritic it may have difficulty going down to the basement and may be more motivated to use a box in a first floor laundry room. The arthritic cat may also have trouble climbing in a box. Cutting down one of the sides may help with this. Like dogs, older cats can also become constipated causing small amounts of stool to drop out at various locations. A change of diet can be helpful in many instances. In the case of lost cognitive dysfunction a cat may not remember the location of the litter box. Confining the cat to one small room with the litter box will make it easier for them to find.

Anxiety disorders

Anxiety disorders are common in geriatric pets. These can manifest themselves in a variety of ways. The dog may have had some mild anxieties throughout their life that greatly increase during old age. Anxieties that were experienced as a young animal that dissipated for many years can resurface. There are also anxieties that seem to come out of no where during the geriatric stage. This is an area where veterinarians should consider the use of pharmacology along with any behavior modification techniques for the most thorough management of the anxieties.

Thunderstorm phobias are common in geriatric dogs. As the dogs TPR increases and owners report panting, hiding, restlessness or hyper attachment to the owner. Veterinary behavior technicians should be welled versed in systematic desensitization using a sound CD of a thunderstorm so they can advice the client. The process is paired with a high value food treat and a settle down obedience command. Some dogs may also benefit from the use of a thundershirt®.

Separation anxiety is another behavior that commonly appears or re-appears during old age. Greatest successes are seen with a combination of behavior and drug therapies. The same recommendations should be given as with younger patients. Geriatric pets are more sensitive to schedule changes which are why this condition tends to be common in older dogs.

Environmental changes can also produce stress in older pets. Cats are especially sensitive to these changes which may trigger anxiety related behaviors. Expression of the anxiety can come in the form of spraying, excess vocalization, compulsive grooming and anorexia. These behaviors may be the result of a move to a new home or with the addition of a new pet.

Aggression

Aggressive behaviors with both family members and other pets can increase in both dogs and cats with old age. Such disease processes as arthritis and disc disease can cause increased pain and discomfort making them more reactive when touched, bumped or played with. Ear infections and dental disease will also add to an older pets discomfort and should also be monitored carefully. Animals with compromised hearing or sight can also be more likely to bite when started and should be managed accordingly.

Young puppies and kittens can be the target of aggression. Other zealous play can cause the older pet physical pain and anxiety. These situations should be closely monitored. A fair correction executed by the older dog can be a great learning opportunity for a young pup. An older dog with a short fuse can also cause a puppy great harm. Older pets should be provided with a safe haven away from new additions for good management.

In the case where a younger dog is approaching social maturity in a household can also be a trigger for aggressive behavior. This is a time where the social dynamics are changing and the younger dog may volley for resources the older dog has traditionally controlled. These conflicts can be life threatening and should involve the guidance of a Veterinary Behaviorist.

Cognitive dysfunction

Cognitive dysfunction can occur in both dogs and cats. It is by definition an impairment of memory and learning. Common symptoms include loss of house training, excess vocalization, abnormal sleep wake cycles, failure to recognize familiar people, standing in corners or going to the hinged side of the door and abnormal motility such as circling and pacing. Dogs are currently being used with the goal of developing canine models of human cognitive aging (Norton W. Milgram and Joseph A. Araujo University of Toronto) as canine cognitive dysfunction resembles Alzheimer's disease in humans.

Selegiline (Anipryl®) is an FDA approved drug for the treatment of Canine Cognitive Dysfunction. The drug increases the concentration of dopamine in the brain. With higher levels of dopamine, many cognitive processes are improved. Two seligiline metabolites, amphetamine and metamphetamine, are also stimulants of brain activity. Most owners note improvement of the condition when on the medication but to what degree vary, perhaps to the multiple symptoms pets can exhibit.

Diet, specifically those which include antioxidants and fatty acids can also have an effect on this condition. Hill's b/d® is a prescription diet developed for dogs with Canine Cognitive Dysfunction. Studies (Milgram, University of Toronto, Scarborough, ON) have shown such dietary changes alone to improve cognition. The study also showed most significant improvement of symptoms was the result of a combination of dietary and mental enrichment.

Mental stimulation for the geriatric dog is an excellent way to improve the quality of their life and slow down or improve cognitive dysfunction. Obedience training, whether it's teaching exercises for the first time or simply refreshing some out of practice commands is a benefit to both the dog and the client. All training is best accomplished using reward based technique. A clicker is an excellent tool for the geriatric dog as it is a more distinct marker than our voices. For deaf dogs a laser light or a vibrating collar should be considered along with the use of hand signals. Food puzzles and food dispensing toys are excellent for problem solving. Low level obstacles and mazes can be beneficial for the more mobile seniors.

Management of Geriatric Behavior Problems

Arthritic pets may have trouble executing stairs, in which case a ramp should be considered. Geriatric dogs can have trouble regulating their body temperature which can be a deterrent to going outdoors in extreme weather conditions. For these dogs a mist on water sprayed in their body in warm temperatures or a coat in cold may increase the amount of time spent outdoors. In the case of owners being absent for long periods a dog door that allows the dog outdoor access at will may be the solution. Managing the situation, by providing the dog with an appropriate substrate such as a litter box or pads to relieve them selves on, may be necessary. This is a time when you may have to advise the client of a senior pet to pull out barriers, reintroduce the crate and close doors. In many cases this is for the protection of the pet, keeping them from falling down stairs or having access to slippery floor surfaces. It may also be the client's preference to limit the access in the house due to increased house soiling or destructive behaviors. Diapers may also be a consideration. With the older dog showing signs of aggression, a basket muzzle will help keep people safe while allowing the dog to breathe without restriction and drink water.

In the case of cognitive dysfunction, senior dogs may wander and become confused. Senior dogs need increased supervision and containment out doors for this reason. A micro chip for identification should be recommended in case they do slip away. Access to swimming pools and pond can pose the danger of drowning to a senior dog as they can lose their ability to swim.

Exercise is important and not just for the physical benefits but it can also ease anxieties. A tired dog is more likely to sleep insead of pacing, circling or digging. The best form of exercise for the older dog is simple leash walking. Owners should move along at a leisurely pace allowing the dog opportunities to sniff and explore for mental stimulation. Because older pets are more sensitive to temperature walks during the heat of the day or during extreme cold should be avoided.

Senior companion class

Another consideration for veterinary staff is to offer a senior companion class, private senior pet therapies or senior animal presentations/parties. The programs should be a combination of educational topics along with hands on work with the dogs. Important areas to emphasize mental stimulation are general training, problem solving, exercise and games. It will also allow staff members the opportunity for discussion on geriatric behaviors, dietary changes and euthanasia. Information on physical conditions common to older animals can also be discussed.

The Senior Companion Class is a rotating format that runs four weeks. Any dog is eligible who's owner considers them senior including dogs that have been diagnosed with Canine Cognitive Syndrome. Class is 50 minutes long and participants bring food treats and bedding for their dogs.

The class begins with stretching exercises with veterinary approval. Targeted areas include; sacrum rub, shoulder and rear leg stretch, belly rub and play bow. The next activity involves engaging the dogs in puzzle games, toys that deliver food treats and nose work. Low level obstacles and mazes are also part of the program for added mental and physical stimulation. Previously learned obedience exercises are reviewed. There is also an emphasis on eye contact as some of these dogs may be or become hearing impaired. The clicker is commonly used as it can be adjusted to the individual animal's abilities. For deaf seniors a pen light or vibrating collar is recommended. for additional exposure social interactions with other polite dogs (including puppies), the variety of people in the class and other species including cats. Relevant educational topics are discussed while owners massage their dogs including diet, common geriatric physical conditions, at home enrichment and management. One of the classes discussion revolves around the topic of euthanasia and grieving.For more information on this sensitive topic consider joining the Association of Pet Loss and Bereavement.

Individual therapies should be considered for geriatric cats or a seminar format for owners only. Older cats will also benefit from clicker training and enrichment toys. Social interactions with people and other animals are also recommended.