Targeting care for senior cats and their caretakers

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Cats may be considered senior as young as 8 years of age.¹ The health status of the senior cat can change quickly, with few or no obvious external signs. Therefore, a senior cat should undergo a routine checkup with a veterinarian at least twice a year.

Early detection of disease allows for management of the disease and may lead to better quality of life. This routine care is often less costly and more successful than crisis management.

Recognizing pain and discomfort in the senior cat

No one wants their cat to be in pain, but we cannot help a cat if we don’t know whether they are experiencing pain. Historically, it has been extremely difficult to assess pain in cats, leaving many older cats to experience pain in silence. Luckily for veterinary professionals, there are new, reliable, and easy-to-use tools to determine whether a cat is in pain so we can give them the help they need.

When we assess that a cat is in pain, we can look for the source of pain and provide treatment and pain management. Some sources of pain in cats include the following:

• Osteoarthritis
• Dental pain
• Abdominal pain (gastrointestinal,urinary)
• Ingrown claws
• Ear pain
• Eye pain

“Cats are masters at hiding their pain.” If you haven’t said it, you have heard it many times. However, as it turns out, we have been wrong about this. Cats are not hiding their pain. They are expressing their pain in a consistent and reliable way. The feline expression of pain is very different from the human expression of pain. Looking for human expressions of pain from a cat, such as limping, crying, or moaning, means you are going to miss many cats experiencing pain.

Why is this? The social structure of humans is very different from cats. Humans are a cooperative species.² Our survival and safety are dependent on working together in a group. We evolved to acquire food together and protect each other. The outward expression of pain alerts the group that one of its members is in trouble so they can care for and protect them. For humans, a demonstrative expression of pain increases the likelihood of survival.

Conversely, cats are solitary survivors.³ Cats evolved to hunt alone and rely only on themselves for safety and protection. A demonstrative expression of pain such as limping, crying, or moaning would not alert other cats to provide protection, but it would alert predators that the cat is vulnerable and decrease the likelihood of survival.

Cats express their pain in far more subtle ways than humans. With a little education and training, we can recognize feline signs of pain and provide the pain-relieving care our cats need and deserve.

Assessing feline signs of pain

Researchers at the University of Montreal in Quebec, Canada, developed and validated a tool for assessing feline pain in the clinical setting using an image assessment called the Feline Grimace Scale (FGS).⁴ These researchers assessed ear position, the aperture of the eye, muzzle tension, whisker position, and head position and applied a score ranging from 0 to 2 for each, with 0 being most relaxed and 2 being most tense. These scores were then added together. A total score of 4 or above was indicative of a cat who was experiencing pain and in need of analgesia.

The FGS was designed to determine whether a cat would benefit from analgesia. It is the best available tool to flag pain in a cat, alerting the veterinarian to perform the necessary diagnostics to determine the source of pain and provide analgesia and any available treatment to resolve the source of pain.

Among the resources available to help identify feline pain, Sylvester.ai has adapted grimace score, artificial intelligence, and machine learning to provide a quick and easy tool to assess feline pain.⁵ With their Tably app, you simply take a picture of a cat, and the grimace scale interprets the cat’s pain with greater than 90% precision.

Before the development of the FGS, we relied on more complicated measurements of feline pain. These tools are the Glasgow Feline Composite Measure Pain Scale,⁶ which includes 28 descriptor options within 7 behavioral categories, and the UNESP-Botucatu Multidimensional Composite pain scale.⁷

Asking about behavioral changes can also provide clues about pain in cats. Cats experiencing pain may have changes in their daily routine. They may be less active, less likely to climb to their favorite resting places, and less likely to meet their owners at the door.

Adapting the Environment

As a cat ages, getting around may become more difficult. Owners can improve their cat’s quality of life by easing their access to the litter box, food, water, and resting places. Suggested assistance may include the following:

• Ease the cat’s climb to their favorite resting spots with ramps and stairs wherever possible.
• Add low-sided, large litter boxes in locations around the home and near the cat’s favorite resting places that are easy for the cat to access.
• Add multiple water sources in containers of different sizes near the cat’s resting areas. Low-sided, wide-based water bowls are ideal.
• Provide puzzle feeders or small, low-sided saucers of food in multiple locations around the house that are easy for the cat to reach.
• Elevate food and water bowls to help cats with degenerative joint disease be more comfortable while eating and drinking.

Vaccinating an older cat

There is always a balance to be struck when considering risks and benefits associated with vaccination for the individual patient.¹ Although advanced age and poor health may increase the risk of adverse effects, they may also render a senior cat more susceptible to infectious disease. It is important to note that most states require a cat to be up-to-date on their rabies vaccination regardless of their age. The 2020 American Animal Hospital Association (AAHA)/American Association of Feline Practitioners (AAFP) Feline Vaccination Guidelines provide additional information.⁸

Recommend vaccines based on each cat’s individual risks. A complete history can help determine those risks, including the following lifestyle questions:

• Does your cat go outside on their own or on a leash?
• Does your cat primarily stay indoors and go outdoors occasionally?
• Will you ever bring a new cat or kitten into your home either permanently or as a foster pet?
• Does your cat travel with you? Is your cat boarded? Does your cat visit a veterinary practice or interact with other cats?
• Do you handle other cats, increasing the possibility of bringing viruses home to your cat on your hands, clothing, or shoes?

Maintaining oral health

Study findings report that 50% to 90% of cats older than 4 years experience some form of dental disease ranging from mildly to extremely painful.⁹ This risk increases with advancing age. In addition to dental disease, older cats can develop masses in their oral cavity.

The AAFP asserts that a complete dental evaluation requires anesthesia for a thorough examination of the extraoral area including the nose, mandible, and area between the mandible and lymph nodes and an examination of the oral cavity including the gingiva, pharynx, palate, sublingual area, and teeth with dental radiography.¹ Additionally, the AAFP says that advancing age should not be a limiting factor in proceeding with dental care under anesthesia.¹

See the AAFP Anesthesia Guidelines for more information.¹⁰

Assessing blood pressure level

Hypertension is invisible and can cause severe and sometimes irreversible damage to the eyes, heart, brain, and kidneys. Senior cats should have their blood pressure level measured and recorded at each visit. For more information, see the AAFP Hypertension Educational Toolkit.¹¹

Maintaining healthy body mass

Obesity in cats is known to increase the likelihood of disease and decrease life span. Cats aged 7 to 11 years will require reduced caloric intake to maintain a healthy weight. This changes as a cat ages. For cats aged 12 years, the gastrointestinal tract becomes less efficient, requiring an increase in daily calories to maintain a healthy weight.

For cats older than 12 years, a body condition score (BCS) of less than 5 correlates with a decreased life span. These cats may require calorie- and nutrient-dense diets with highly digestible proteins. Additionally, they may not be able to tolerate large portions of food in 1 sitting. Cats benefit from smaller portions of food offered in frequent intervals throughout the day. It is critical to record the weight of the cat at each veterinary visit. Additionally, teach your clients how to monitor their cat’s BCS at home and alert you of any changes.¹

Monitoring blood work

At least once a year, the senior cat should have a complete blood count, blood chemistry test, urinalysis, and T4 test as a baseline. This will help monitor trends over time.

Client communication

Clients are more likely to make biannual visits when they understand why they are necessary and what will happen at the visit. Cats age more quickly than humans. A senior cat needs a routine checkup at least twice a year that includes the following actions:

• Evaluate the cat for signs of pain and discomfort. Based on the findings, provide appropriate treatment and pain relief.
• Discuss adapting a client’s home to help a senior cat thrive.
• Discuss the cat’s risks for contagious diseases and recommend vaccines if necessary.
• Perform a full examination of the cat’s teeth and oral cavity for signs of disease, which are often otherwise undetectable. If found, discuss treatment and pain management.
• Assess the cat’s blood pressure level and provide treatment if necessary.
• Weigh the cat, teach the client how to monitor their cat’s body condition at home, and make feeding recommendations.
• Perform blood work to monitor the cat for early signs of diseases including kidney and thyroid disease.
• Answer any questions the client has.

Veterinarians will help keep a cat comfortable and healthy as long as possible. Routine care is often less costly and more successful than crisis management.

Liz Bales, VMD has a special interest in the unique behavioral and wellness needs of cats. She is a writer, speaker, and featured expert in all things cat around the globe. Bales sits on the dean’s alumni board at the University of Pennsylvania School of Veterinary Medicine and on the advisory boards for dvm360^®, AAFP Cat Friendly Practice, Vet Candy, and Fear Free.

References

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3. The social structure of cat life. International Cat Care. October 5, 2018. Accessed February 20, 2023. https://icatcare.org/advice/the-social-structure-of-cat-life/
4. Evangelista MC, Watanabe R, Leung VSY, et al. Facial expressions of pain in cats: the development and validation of a Feline Grimace Scale. Sci Rep. 2019;9(1):19128. doi:10.1038/s41598-019-55693-8
5. How Tably works. Sylvester.ai. Accessed February 20, 2023.
   https://www.sylvester.ai/how-tably-works
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9. Feline dental disease. Cornell Feline Health Center. Updated June 2017. Accessed February 22, 2023. https://www.vet.cornell.edu/departments-centers-and-institutes/cornell-feline-health-center/health-information/feline-health-topics/feline-dental-
   disease#:~:text=Diseases%20of%20the%20teeth%20and,preventive%20dental%20care%20and%20monitoring.
10. Robertson SA, Gogolski SM, Pascoe P, Shafford HL, Sager J, Griffenhagen GM. AAFP anesthesia guidelines. J Feline Med Surg. 2018;20(7):602-634.
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