2021 AAFP Feline Senior Care Guidelines

Abstract

The '2021 AAFP Feline Senior Care Guidelines' are authored by a Task Force of experts in feline clinical medicine and serve as an update and extension of those published in 2009. They emphasize the individual patient evaluation and the process of aging, with references to other feline practice guidelines for a more complete discussion of specific diseases. Focusing on each cat encourages and empowers the owner to become a part of the cat's care every step of the way. A comprehensive discussion during the physical examination and history taking allows for tailoring the approach to both the cat and the family involved in the care. Videos and analysis of serial historical measurements are brought into the assessment of each patient. These Guidelines introduce the emerging concept of frailty, with a description and methods of its incorporation into the senior cat assessment. Minimum database diagnostics are discussed, along with recommendations for additional investigative considerations. For example, blood pressure assessment is included as a minimum diagnostic procedure in both apparently healthy and ill cats. Cats age at a much faster rate than humans, so practical timelines for testing frequency are included and suggest an increased frequency of diagnostics with advancing age. The importance of nutrition, as well as senior cat nutritional needs and deficiencies, is considered. Pain is highlighted as its own syndrome, with an emphasis on consideration in every senior cat. The Task Force discusses anesthesia, along with strategies to allow aging cats to be safely anesthetized well into their senior years. The medical concept of quality of life is addressed with the latest information available in veterinary medicine. This includes end of life considerations like palliative and hospice care, as well as recommendations on the establishment of 'budgets of care', which greatly influence what can be done for the individual cat. Acknowledgement is given that each cat owner will be different in this regard; and establishing what is reasonable and practical for the individual owner is important. A discussion on euthanasia offers some recommendations to help the owner make a decision that reflects the best interests of the individual cat.

Keywords: Senior; anesthesia; blood pressure; budgets of care; cancer; chronic kidney disease; cognitive dysfunction syndrome; comorbidities; degenerative joint disease; dental disease; diabetes mellitus; end of life; euthanasia; frailty; gastrointestinal disease; hospice care; hypertension; hyperthyroidism; osteoarthritis; pain; palliative care; quality of life; sarcopenia.

Figure 1

This 15-year-old cat shows a decreased pattern of grooming. Courtesy of Sheilah Robertson

Figure 2

Changes associated with aging (and often seen in apparently healthy senior cats)

Figure 3

Same cat as in Figure 1, showing signs of frailty, including loss of muscle mass and strength. This senior was diagnosed with sarcopenia, osteoarthritis and hyperthyroidism. Courtesy of Sheilah Robertson

Figure 4

This 12-year-old cat with DJD is laying with stifle and hock in extension to be more comfortable. Courtesy of Kelly St Denis

Figure 5

When this 11-year-old cat became unwilling to jump up to sit on the cat tree, he was examined and diagnosed with osteoarthritis. Courtesy of Sheilah Robertson

Figure 6

Subtle increases in sleeping pattern were noted for this 19-year-old cat. Courtesy of Kathleen Neumann

Figure 7

(a,b) This 14-year-old cat with painful DJD uses steps to access a favorite resting place. Courtesy of Heather O’Steen

Figure 8

Quality of life considerations. Courtesy of Sheilah Robertson

Figure 9

The five pillars of an appropriate environment

Figure 10

The four budgets of care. Courtesy of Sheilah Robertson