Make the oldies golden: Handling anxiety in senior patients

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As veterinary professionals continue to provide quality preventive and wellness care for their patients, we are seeing a “graying” of this population-which I love! However, taking care of senior pets takes an all-inclusive approach, continuing preventive measures but also dealing with body systems issues as they arise, from organ dysfunction and osteoarthritis to tumors and behavioral issues. Managing them ourselves can be frustrating enough. Managing them with pet owners is an entirely different beast. Here are some lessons I learned with taking care of our beloved golden oldies.

Handling the confusion and anxiety

Cognitive dysfunction syndrome (CDS) in our patients can lead to some of the most frustrating issues to manage. Once we've ruled out other medical problems, we have tools to assess the level of cognitive decline that might be present in our patients. The acronym DISHA has been used for years to assess cognitive dysfunction syndrome (D for disorientation; I for social interactions; S for sleep and wake cycles; H for house-soiling, learning and memory; and A for activity) has even made a change from DISHA to DISHAA to provide additional focus on the increased anxiety that some pets exhibit.

A minor level of increased anxiety may be due to normal aging processes. If there is a decreased ability to adjust to changes readily, and a potential decrease in their senses of hearing, sight and smell, they can startle more easily. It may be more generalized, with them seeming to enjoy things less or even being jumpier and grumpier. Health issues such as polyuria and polydipsia or osteoarthritis could also contribute to anxiety if there's house-soiling and discomfort.

But if your client states that their pet is showing more extensive signs of anxiety, from panting, shaking, trembling and being more irritable to having sleep and appetite issues, then you need to pay closer attention. If they seem really restless or clingy, howl or are more depressed and lethargic, they should be presented for a complete evaluation. If they develop more advanced separation anxiety when left alone or at night, or are showing new signs of storm anxiety, fear of loud noises or fear of strangers, then intervention is recommended.

Dealing with this at home

Since CDS is considered a diagnosis of exclusion, manage any other medical or physical issues to see if there's improvement, and keep in mind that it can coexist with other diseases. If it's determined that cognitive issues are contributing to the anxiety, there are several steps you can recommend.

First, tell the owner to avoid changing the pet's environment too much, while at the same time providing some enrichment and sharing some activities. Have the pet owner make adjustments to conditions that can make them anxious: use non-slip matts on slick floors or get toe-grips to help them get around better.

If house-soiling is an issue, have them taken out more frequently or use a diaper or belly band. If accidents do occur, tell the owner not to punish or scold the pet as that can cause more anxiety. Instruct them to move slowly around the pet and approach them carefully, as sensory deficits (hearing, sight) added to anxiety can make them irritable and even aggressive!

For separation anxiety, when the owner leaves or even at nighttime when pets might feel abandoned, have them provide a secure place with favorite objects (an old shirt), and leave on lights or music or TV to make it seem like someone is there. Different products such as pheromones, supplements and even Omega-3 fatty acids help in some patients, so consider recommending those as well.

For more severe reactions, especially for separation anxiety or noise phobia (storms), certain medications can help, as can giving the owner information about counter-conditioning their pet.

As these changes start showing up in your patients, start a proactive approach, when the interventions you can recommend will be more effective rather than waiting until the signs are severe. Provide optimal care for your senior patients from the start, and you can help make their golden years the best they can be!

Dr. Heidi Lobprise is a veterinary dental expert with Main Street Veterinary Hospital and Dental Clinic in Flower Mound, Texas.