Implementing a geriatric wellness program (Proceedings)

Old Age Is not A disease!

It's no surprise to anyone that the number of geriatric feline patients is on the rise. We are doing a better job as veterinarians and as cat owners taking care of our cats and they are living longer and longer. However, many people believe that 'if it ain't broke, don't fix it,' and that means they aren't bringing these older cats in to see us as often as they might. Identifying at risk cats as well as good client education early in the cats' lives can lead to more visits to the hospital, and earlier detection and treatment of senior cat problems.

Geriatric wellness programs start at the client's first visit to your hospital. It starts even if that first visit is with an 8 week old kitten. This is the prime opportunity to establish a relationship and a standard of care that can be followed for the cat's entire life. It is at this time that you can discuss what to expect through the years as the kitten ages. Things to highlight will include:

• Semiannual wellness exams for life will help us prevent disease and detect problems early

• Regular blood and urine testing will help screen for illness

• Preventative care, such as parasite testing and treatment, and possibly dental exams and cleanings, will be undertaken on a routine basis

• Awareness of common things to look for that may be indicators of underlying problems

To start implementing a geriatric wellness program, geriatric should be defined. There is no set standard for when a cat is considered geriatric, and some cats will seem older or younger than they actually are. A general guideline for starting testing programs may be consider senior blood testing to start at age 7-8, with more extensive testing occurring starting around age 10-12, depending on the cat. These are the parameters that you can discuss with your staff and decide what everyone is most comfortable with doing. For a geriatric screening program to be successful, it has to be supported by everyone involved. Input from your staff and technicians is vital, as they are the ones who work with the pets most intimately.

To improve compliance, clients must be continually made aware of what your standard of care is. At each semiannual visit, the client should have to answer a series of health questions, either asked by the technician or in the form of a wellness questionnaire. Having to think about these questions at every visit will solidify these potential symptoms in the client's mind, and hopefully trigger a response and call to action if something is noticed at home. If clients don't know what to look for, they aren't going to see it.

Reminders mailed to clients at predetermined intervals should list the services that the pet is going to need. If the reminder only says that the cat is due for his semiannual exam, and you end up doing $200 worth of labwork, the client may be as agreeable next time around. If, on the other hand, the reminder says that Big Bart is due for his exam, senior blood and urine profile, and blood pressure, the owner can be more prepared and be more mentally ready to be part of the health care team.

Positive reinforcement when blood and urine tests are within normal limits goes a very long way. Sometimes it is hard for clients to appreciate the negative. They wonder what all the fuss is about, why something needed to be done if things are negative. There is merit in observing, for example, renal values that go from a BUN of 21 and creatinine of 1.2 one year, to a BUN of 36 and a creatinine of 2.0 the next. Even though these numbers are still technically within normal limits, a clinician who is paying attention and has a history with that patient would be quick to do a urinalysis to check the concentration of that cat's urine. This could be a prime example of catching chronic kidney disease at a stage that can actually be helped a bit. Emphasizing the things that you will do, the things that you are watching for, will make it much easier for you to achieve compliance. It allows for an opportunity to continue educating the client – these are the things we are seeing on the lab results, these are the things I need for you to watch for at home. Having an effective geriatric program, with all of it's monitoring and testing, is impossible without good communication and a good, trusting relationship with your client.

Each time the client comes in, they should leave with reading material. I joke around that some of my clients have almost made me obsolete in that they have been educated so much, they know the tests that I'm going to want to run. Give handouts on all the things you see regularly – thyroid disease, dental disease, renal disease, arthritis. The more people know, the less scared they are going to be when something happens to their own cat. Education is power!

Finally, be geriatric friendly. So many people switch practices because of the perception that their cat is not being treated correctly. Use less restraint for blood draws, use blankets on the tables, be gentle during the exam. Senior cats are like senior people – they can be achy and grumpy, but if you let them think they are running the show, all is well. Follow your patient's lead. Let the cat set the pace and parameters of the exam. Be flexible. Your clients will love it, your patients will love it, and your stress level will be much lower.