Have you implemented the AAFP-AAHA Feline Life Stage Guidelines?

Cats currently are the most popular pet in North America and are considered family members by many cat owners.1,2 Despite these facts, cats generally receive less veterinary care than dogs do. For example, a 2006 study by the American Veterinary Medical Association found that owners took dogs to veterinarians more than twice as often as they took cats.3 Reasons for this difference include the stress and fear associated with the carrier, car, and veterinary visit; the misconception that cats can take care of themselves; and the fact that signs of illness can be difficult to detect in cats. Owners also state that they do not know what care is necessary because veterinarians do not recommend it or the need or benefit was not well explained.

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In light of this information, the CATalyst Council (a national initiative to champion the cat), the American Association of Feline Practitioners (AAFP), and the American Animal Hospital Association (AAHA) identified the need for wellness guidelines to improve cat health. The goals of the AAFP-AAHA Feline Life Stage Guidelines, published in the January/February 2010 issue of the Journal of the American Animal Hospital Association and available at http://aahanet.org/PublicDocuments/FelineLifeStageGuidelines.pdf, are to

1. Provide optimal healthcare recommendations for cats throughout the different stages of life.

2. Provide practical suggestions and tools to facilitate improved veterinary visits.

3. Promote more effective client communication and education about the benefits of regular veterinary care.

4. Enhance the client-veterinarian clinical encounter.

LIFE STAGES

The life stages chosen are intended to focus attention on the physical and behavioral changes that occur during a cat's lifespan, recognizing that individual cats and body systems can age at different rates and that any individual can have a condition not common to that life stage. The life stage classification was developed by the Feline Advisory Bureau and adopted in the 2008 AAFP Senior Care Guidelines.4,5 The stages are

• Kitten—birth through 6 months

• Junior—7 months through 2 years

• Adult—3 through 6 years

• Mature—7 through 10 years

• Senior—11 through 14 years

• Geriatric—15 or more years

Client education for owners of cats of any age includes the value of a microchip for the cat; ways to prevent and to recognize early and subtle signs of stress, pain, or illness; consideration of healthcare financial planning; and inclusion of pets in home disaster preparedness and estate plans.

THE WELLNESS VISIT

The guidelines begin by emphasizing the need for the whole healthcare team to provide a consistent message to owners about the importance of regular preventive care for all cats throughout their lives.

A minimum of annual wellness examinations and consultations are recommended for apparently healthy adult cats and semiannually for cats 7 years of age and older. However, semiannual wellness examinations for cats of all ages are often preferred because changes in health status may occur rapidly. Plus, like other animals, ill cats often show no early signs of disease. More frequent evaluation allows earlier detection of illness, including "silent" diseases such as obesity and dental disease, and, thus, earlier intervention.

While some may express concern at this recommended frequency of wellness examinations, the frequency is roughly comparable to recommendations for people. Given relative life expectancies of about 12 to 14 years for cats and 75 to 80 years for people, each year of an adult cat's life might be comparable to about four to six years of an adult human's life. If this is reasonable, then recommending two examinations each year for cats might be analogous to recommending an examination every two to three years for an adult human, which is within currently promulgated guidelines in the United States.6

Another benefit of semiannual examinations is the opportunity to interact with owners more frequently about changes in their cats' behavior and attitude and talk to owners about preventive care—which may allow us to identify illness sooner, improve quality of life, and reduce long-term costs related to their cats' healthcare.

The guidelines suggest how to take a more effective history, including the use of open-ended questioning, reflective listening, and empathic statements7 ; perform a comprehensive physical examination; and collect a minimum database. The panel acknowledges that age and frequency of laboratory tests depend on many factors; for example, the incidence of many diseases increases with age.

The guidelines also provide more specific recommendations in nutrition and weight management, behavior and environmental topics for discussion, parasite control, retrovirus testing, vaccination, and dental care.

Nutrition and weight management

Diet basics. A cat's needs in terms of energy and other nutrients change based on age, activity level, and whether or not it is spayed or neutered. Each cat's food intake will need to be individualized to sustain proper body and muscle condition scores. Canned and dry foods are appropriate for cats of all ages, and a label guarantee that the food has undergone feeding trials demonstrates that the food is suitable.

Some concern has been voiced about carbohydrates in dry food being a factor in obesity or diabetes, but current evidence does not support this concern. As for homemade diets, be sure to emphasize the importance of providing balanced nutrition and the risks of preparing and feeding raw food, and refer curious clients to appropriate internet resources (the guidelines provide a table).

Feeding regimens. Cats can be fed free choice or provided meals at certain times of the day. Providing food balls or puzzles or placing food in small containers scattered throughout an area is a good way to ensure cats don't eat too fast and to enhance cats' physical and mental activity as well. Cat owners should promote water intake by providing bowls, dripping faucets, or fountains. Canned food can also provide increased water. Be sure food and water are kept in a quiet area, particularly if a cat is nervous or fearful.

Obesity most commonly occurs as cats reach middle age. Clients can help avoid weight issues by providing environmental enrichment (see below) and promoting activity in their cats.

Behavior and environment

Behavior and environmental topics for discussion at each life stage are outlined.

Cats of all ages need the following:

• Resources throughout the home—In addition to food, water, and litter boxes, the guidelines suggest scratching posts, hiding places, and elevated resting spots. The more cats in the household, the more resources are needed.

• Appropriate materials for elimination—Most cats prefer unscented clumping litter, larger boxes (about 1.5 times the length of the cat from the tip of the nose to the base of the tail), and clean litter boxes in quiet, accessible locations.8

Litter box rejection can result from a variety of causes including box size, litter type, box cleanliness, box style, and external environmental threats unrelated to the litter box.

• Environmental enrichment—This is important for all cats, especially indoor cats. Boredom can be stressful in cats and may be associated with the development of obesity, while instability can lead to a variety of sickness behaviors (a group of nonspecific clinical and behavioral signs that include variable combinations of vomiting, diarrhea, anorexia or decreased food and water intake, fever, lethargy, somnolence, enhanced painlike behaviors, and decreased general activity, body-care activities, and social interactions.).9 The environment can be enlarged safely with outdoor enclosures or supervised outdoor activity (e.g. walking the cat on a harness and leash or in a stroller).

• Playtime—Opportunities for play also are important and may reflect a cat's hunting preferences, which include birds and small animals (e.g. feather toys, pieces of dry food, fur or plush toys).

Additional information on resources and environmental enrichment for indoor cats is available at The Ohio State University College of Veterinary Medicine website The Indoor Pet Initiative at http://indoorpet.osu.edu/cats.

Kitten. The primary socialization period of cats to people is from 3 to 9 weeks of age. If kittens associate positive experiences with exposure to people during this age, they will be more willing to approach people and be held by people later on in life. Kittens should be handled gently and positively. Expose kittens as early as possible to any stimuli or handling techniques they may encounter during their lifetimes (e.g. children, dogs, nail trims, tooth brushing, car rides). Always reward positive behaviors with food or other appropriate rewards; never punish a kitten, as it may elicit defensive aggression. Kittens have a strong drive to play. Intercat social play peaks at about 12 weeks of age, after which object play becomes more common. So providing toys is a good way to allow kittens to safely practice predatory behavior and may help avoid play biting.

Junior. Relationships between cats in a household may change when a cat reaches 1 to 2 years of age (the age at which free-living offspring leave the family unit) and may lead to intercat aggression. In addition, most intact cats and about 10% of sterilized cats mark territory with urine, and onset of marking can coincide with sexual maturity.

Adult and mature. Cats tend to gain weight as they get older because their play activity levels drop. A recent study showed that playing with cats 10 to 15 minutes three times a day helped cats lose 1% of their body weight in one month without restricting their food intake.10

Senior and geriatric. Behavior changes in senior cats are common (e.g. vocalization, changes in litter box usage) and usually indicate an underlying medical problem.

Parasite control

Controlling parasites both on the animal and in the environment is important during all life stages. All cats, including indoor cats, are at risk for roundworms, hookworms, and heartworms and should receive preventives against these.11-13 Fecal testing is needed despite the use of preventives. Because prenatal infection does not occur in kittens, biweekly roundworm treatment can begin at 3 weeks of age; kittens can start receiving a monthly general endoparasite preventive when they are 8 to 9 weeks old. Links to websites with additional details are provided in the guidelines.

Retrovirus testing

The retrovirus status of cats informs both wellness and illness care. The panel recommends testing all cats for feline leukemia virus (FeLV) and feline immunodeficiency virus (FIV) infections when they are adopted, regardless of age. Retrovirus testing can be performed even on kittens a few days old. Cats with negative test results should be retested a minimum of 30 days later for FeLV and at least 60 days later for FIV. Antibody tests for FIV can detect antibodies passed in colostrum from an infected or vaccinated mother, which can be mistaken for infection in the kitten. Kittens with positive results for FIV antibodies should be retested every 60 days up to 6 months of age because FIV tests can detect antibodies passed from an infected or a vaccinated queen and give a false positive result; if a kitten becomes seronegative, it most likely was not infected. Retrovirus tests can diagnose only infection, not clinical disease, and cats with FeLV or FIV infections may live for many years.

Cats should be retested after exposure to an infected cat or a cat of unknown infection status before vaccination against FeLV or FIV and before entering group housing with cats of unknown retrovirus status. Cats living in households with other cats infected with FeLV or FIV should be tested annually unless they are isolated. Sick cats should be tested even if they have had negative test results in the past.14

Vaccination

The panel recommends that panleukopenia virus, herpesvirus-1, calicivirus, and rabies virus vaccines be given to all cats. Administer panleukopenia virus, herpesvirus-1, and calicivirus vaccines to kittens beginning as early as 6 weeks of age every three to four weeks until they are at least 16 weeks of age. Revaccinate one year later and then every three years. Give rabies virus vaccinations in accordance with local or state statutes.

The FeLV vaccine is highly recommended for all kittens because of unknown future lifestyle and for cats that go outdoors, have direct contact with cats of unknown status or that live in high turnover situations such as foster homes or other group housing, and cats that live with cats infected with FeLV. These cats should be revaccinated annually.15

Dental care

Education about oral healthcare is crucial at all life stages to increase awareness that cats need both home and veterinary dental care, especially since many owners do not know how common dental disease is in cats, how painful it can be, and how it threatens their cats' health and welfare.

Emphasize the value of tooth brushing in cats, particularly to owners of kittens since cats are most receptive at this age. For clients with older cats, show how they can encourage tooth brushing with positive interactions and rewards.

In addition to tooth brushing, a variety of dental products for homecare are available, including diets, treats, and chews. Efficacy of products is not equivalent, and the only dental products known to be effective are those approved by the Veterinary Oral Health Council, which requires extensive standards to be met before certification.

COMMUNICATION AND RESOURCES

Excellent resources are available to facilitate the design of a comprehensive, life-stage-targeted wellness care plan for each cat. Veterinarians, staff, and pet owners must communicate clearly to promote adherence to wellness plans and improve the quality of feline healthcare.16 The AAFP-AAHA Feline Life Stage Guidelines may be used as a concise template for this purpose.

C.A. Tony Buffington, DVM, PhD, DACVN

Department of Veterinary Clinical Sciences

College of Veterinary Medicine

The Ohio State University

Columbus, OH 43210

REFERENCES

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3. Lue TW, Pantenburg DP, Crawford PM. Impact of the owner-pet and client-veterinarian bond on the care that pets receive. J Am Vet Med Assoc 2008;232:531–540.

4. Feline Advisory Board. WellCat for life veterinary handbook. Tisbury, Wiltshire, UK: Feline Advisory Bureau, 2008: 5. Available at www.fatcats.org/wellcat/publications/index.php.

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9. Stella JL, Lord LK, Buffington CAT. Sickness behaviors in response to unusual external events in healthy cats and cats with feline interstitial cystitis. J Am Vet Med Assoc 2011;238(1):67-73.

10. Clarke DL, Wrigglesworth D, Holmes K, et al. Using environmental and feeding enrichment to facilitate feline weight loss. J Anim Physiol Anim Nutr (Berl) 2005;89:427.

11. Companion Animal Parasite Council. Available at: www.capcvet.org. Accessed Sept. 14, 2011.

12. Centers for Disease Control and Prevention. Animals (Zoonotic). Available at: http://www.cdc.gov/parasites/animals.html. Accessed Sept, 14, 2011.

13. American Heartworm Society. Available at: www.heartwormsociety.org. Accessed Sept. 14, 2011.

14. Levy J, Crawford C, Hartmann K, et al. 2008 American Association of Feline Practitioners' feline retrovirus management guidelines. J Feline Med Surg 2008;10:300-316.

15. Richards JR, Elston TH, Ford RB, et al. The 2006 American Association of Feline Practitioners Feline Vaccine Advisory Panel report. J Am Vet Med Assoc 2006;229(9):1405-1441.

16. Bayer Animal Health Communication Project, Institute for Healthcare Communication. Available at: www.veterinarycommunication.org/practitioner/practitioner.php. Accessed Sept. 14, 2011.