Senior Care: The New Frontier in Veterinary Medicine
 Services |
| Contacts |
| Staff Info |
| Pet Links |
| Pet News |
| What's New? |
| Take a Tour |
| Senior Pages |
| By Fred L. Metzger, DVM, ABVP Metzger Animal Hospital State College, Pennsylvania Veterinary medicine is an evolving discipline. While current veterinary practice has been focused primarily on treating existing disease, progressive practitioners are now welcoming the medicine of prevention and wellness. On the patient side, we promote vaccinations, regular health checkups and proper nutrition to set up puppies for a long, healthy life. On the client side, the necessity of bringing puppies in for four or more visits the first year lays the foundation for a long, healthy relationship between the client and veterinary hospital. But at the other end of the age spectrum, I see emerging a new, promising frontier in veterinary medicine. Senior care is the logical result of good preventive medicine, complete nutrition and overall wellness. Dogs are living longer, and just as puppies visit the veterinarian several times the first year of life, the latter half of life presents the need for increasingly comprehensive veterinary care for older dogs. The practice of senior care is rewarding medicine, not just in terms of financial benefits but in terms of professional and personal satisfaction as well. It includes more hospital visits, more diagnostic tests, nutrition counseling and increased need for chronic-care medications. The rewards? Significant. The winners? Everyone. By enlisting the entire veterinary team in taking the time to focus on senior care, clients are bonded to the practice, the level of medicine practiced is more satisfying, and dogs and their owners are given more quality years of life together. Senior care for dogs parallels the trend to senior care and wellness in human medicine. Television and the print media direct our attention to living longer, happier, healthier lives through advertisements, news stories, special reports and articles on new exercise programs, pain management products, new diagnostic tests, nutritional breakthroughs and disease prevention strategies. The needs of our best friends are no different. Just as humans reaching senior status need more frequent health checks and services from their physicians, so do dogs. And it is our duty to deliver this message. By their compliance, my clients confirm this is the level of service they want for themselves and for their pets. Senior Care vs. Geriatric Care Senior care begins with recognizing that older animals differ from young or adult animals, then implementing therapeutic and preventive medical strategies that address the needs of seniors. The majority of veterinarians recognize this need and opportunity. According to a recent survey of veterinarians sponsored by Pfizer Animal Health and IAMS, and conducted by Veterinary Medicine Publishing Group (VMPG), 98 percent of veterinarians believe older dogs have different medical needs than adults and that older patients can benefit from specialized medical services and testing (1). If this sounds like geriatric medicine, it is. But it encompasses much more. Senior care defines the category more broadly and implies a preventive as well as therapeutic approach to medicine. It is also a term that is more easily understood and more palatable to our clientele. To illustrate, Pfizer recently surveyed several hundred owners of dogs seven years of age or older. Ninety-one percent believed their dog was senior vs. just 47 percent who viewed their pet as geriatric. And while 94 percent of the owners defining their dog as geriatric also agreed that their dog was senior, just half of those who termed their dog senior would agree that the dog was geriatric as well (2). When we look at canine demographics, the numbers present veterinary medicine with a tremendous opportunity. Of the approximately 52 million dogs in the United States, more than a third fall into the senior category. A 1998 Gallup poll of dog owners, in fact, put the senior population at 39 percent, or nearly 20.3 million dogs. Some may question defining a dog as senior at age seven, but there are good reasons for drawing an arbitrary line. Dogs age at varying rates according to their body weight, genetics, nutrition, environment and overall health status. A dog does not suddenly become old at age seven any more than humans at age 40 or 50. But generalizations need to be made for clients to easily understand that at a certain point in their dog’s life, it is time to pay closer attention to their pet’s health status. The human correlation is easily grasped. Women reaching the age of 40 today recognize the importance of a baseline mammogram, and men realize the need for routine prostate screening. Are they geriatric? Certainly not. Likewise, with pets, the need for more comprehensive and frequent physical examinations and diagnostic tests begins around age seven and increases thereafter. Pet food manufacturers recommend switching to senior diets at age seven. And senior care implies preventive medicine much more than does geriatric. Effects of Aging The physiological changes that occur in senior dogs create important medical considerations. Hepatobiliary physiologic changes include decreased numbers of hepatocytes, increased hepatic fibrosis and decreased detoxification capabilities. Renal physiologic changes include decreased kidney weight, decreased glomerular filtration rate and renal tubular atrophy. The incidence of urinary incontinence also increases with age. Cardiovascular physiologic changes include increased valvular fibrosis, resulting in valvular endocardiosis and decreased cardiac output. Aging causes a decrease in the basal metabolic rate. Older animals tend to have decreased activity levels resulting in increased body fat percentage. This is especially important because increased body weight results in an increased incidence of diabetes; cardiovascular, respiratory and orthopedic diseases; and, perhaps, neoplasia. Immunologic effects include decreased phagocytic function and neutrophil chemotaxis, resulting in decreased immune competence despite normal numbers of lymphocytes. Aging is also associated with an increased incidence of immune-mediated diseases such as immune-mediated hemolytic anemia and immune-mediated thrombocytopenia, among others. Senior patients frequently require pharmacologic intervention for disease management. Since aging effects the absorption, distribution, biotransformation and elimination of most drugs, seniors have special pharmacologic concerns. Drug dosages may need to be adjusted and many drugs avoided if organ function is compromised. Pharmaceuticals biotransformed or eliminated by the liver and kidneys cause special concerns. Pharmaceuticals with special concerns in geriatric patients include antibiotics, NSAIDs, steroids, barbiturates, sedatives, analgesics, diuretics, ACE inhibitors, digitalis derivatives, chemotherapeutics, hormonal drugs, anesthetics and many others. Routine blood profiling increases the safety of drug administration by identifying underlying disease conditions which may preclude the use of certain pharmaceuticals. There are wide discrepancies between a veterinarian's view of aging and the dog owner’s view. The Pfizer/IAMS/VMPG survey reveals that the most common diseases veterinarians see in dogs over the age of seven are (in order) periodontal disease, osteoarthritis, renal disease and heart disease (1). On the layperson side, the Gallup poll shows dog owners define aging more in terms of activity level and movement, with 58 percent listing slowed activity, decrease in playfulness and difficulty moving as key indicators. Another 20 percent pointed to such physical changes as graying of the hair and changes in coat thickness, while just three percent mentioned dental problems (3). This chasm between veterinary knowledge and ability and client awareness needs to be bridged with ongoing client education. Defining a Senior Care Program Thanks to science and the efforts of leading animal health companies, we have at our disposal upgraded diagnostics, therapeutic agents and specialized nutrition to keep dogs living longer and healthier lives. The fact that we have these assets available right now is recognized by 94 percent of veterinarians (1), according to the Pfizer/IAMS/VMPG survey. Further, as Richard Goldston and Johnny Hoskins point out in Geriatrics & Gerontology of the Dog and Cat, most diseases of the senior animal are chronic. Again, the VMPG survey proves this is well-recognized by the vast majority of veterinarians. Eighty percent of veterinarians expect chronic care to be a primary area of growth for their practice over the next few years. Nutrition is another key factor in senior health. Virtually all veterinarians, 98 percent(1), in the Pfizer/IAMS/VMPG survey, believe the nutritional needs of dogs change as they age. Diet can play an important role in preventive health care - a fundamental component of our senior care concept of preventive medicine. There is strong agreement on the dog owner side, as well. The Gallup poll revealed that nearly nine out of ten owners believe a dog should eat differently when it enters its senior years. In formulating a senior care program, there are basics to include: • Recommending a minimum of twice-annual office visits, • Senior screening programs determined by the patient’s age and health status, and • Nutritional counseling both for the healthy senior patient that may need a specialized maintenance diet to help address the conditions of aging, as well as for the dog whose health is compromised by age-related disease. Implementing a Senior Care Program While veterinarians have at our disposal the knowledge, products and diagnostic tools to formulate senior care strategies on a case-by-case basis for our patients, the question becomes how to most effectively implement them. Client compliance is directly proportional to client knowledge, and responsibility for client education rests with the veterinary staff. Ideally, the client learning process should begin well before pets reach their senior years. If possible, for instance, begin discussing preventive blood profiling during the first puppy visit and help clients understand that puppies, adult dogs and seniors have different needs nutritionally and medically, and therefore require care corresponding to their life stage. Review your overall plan for wellness during those first puppy visits, including mention of preanesthetic testing, yearly blood profiling and more frequent exams once the dog reaches its senior years. I offer clients two senior care packages. The first includes CBC with blood smear, biochemical profile with electrolytes, complete urinalysis, blood pressure check, electrocardiogram and ocular tonometry. The second package, the option that draws the most compliance, adds dental prophylaxis to the package. Rarely do clients call and request a senior care package. Rather, they come in for routine vaccinations or exams, and that is when we initiate the discussion about senior care options. (Dental disease, by the way, creates an ideal introduction to the discussion because it is prevalent in older animals, clients are aware of it and you can visually demonstrate its presence in their pet.) With all clients, I refer frequently to an age-analogy wall chart to help clients track their dog’s life stage relative to human years and to understand the changes that aging is bringing to their pet (see Table 1). But even before I see the dog, our receptionists and technicians have already used the age-analogy chart to point out the dog’s relative age. I have found that preanesthetic testing makes the transition to routine blood profiling more logical as the patient ages. Baseline results obtained during preanesthetic testing for neutering, dentals, lumpectomies or other anesthetic events provide valuable comparison data for interpretation later in life. In addition, owners become familiar with the procedure, thus increasing compliance for future profiling. Routine profiling should begin when the patient reaches the senior age threshold. I have found that educational materials are critical components in increasing client knowledge. Report cards summarizing physical exam findings and our medical recommendations are helpful in increasing compliance. Specific brochures explaining the benefits, components and costs of the senior program allow owners to continue their education process at home. In my practice, client compliance has risen to about 80 to 90 percent by combining senior blood profiling with ultrasonic dental scaling. Using the senior health profile as a preanesthetic test for dentistry increases anesthetic safety and increases owner compliance by decreasing their anxiety. Most owners understand the need for dental scaling, yet owners of older pets may not comply with your recommendations because they fear anesthesia. A complete senior testing program helps decrease anxiety by increasing safety. As a result, we are able to do more dental procedures while initiating the concept of routine testing. Furthermore, because the majority of older patients require regular dental scaling, the stage is set for testing. The Spectrum of Rewards It is true that more frequent testing may cost clients more up-front. However, earlier diagnosis may actually save them money in the long run if the diseases can be treated prior to the development of any serious complications. The client cost for our most complete senior package is $208, with antibiotics costing extra. But with 80 to 90 percent compliance among owners of senior dogs, it is apparent that, once educated, these clients are willing to provide appropriate care for their pets. Veterinarians tend to underestimate the willingness of clients to provide care and their ability to pay for it. According to the Pfizer/IAMS/VMPG survey, for example, 93 percent of veterinarians are willing to spend extra time with older patients because of their more complex medical needs. And 85 percent believe older dogs should have a physical exam more than once a year (with 91 percent acknowledging that they would be more likely to identify disease in senior dogs earlier if clients would comply with more frequent examinations). However, just 57 percent of practitioners thought their clients would be willing to comply (1). In contrast, the Gallup poll found that most dog owners (83 percent) would do anything it takes to help their dog in old age. Seventy-five percent agreed that seeing their dog get old is equal to seeing a family member age. Most (75 percent) believe senior dogs should see a veterinarian more than once a year (this climbs to 81 percent among owners with three or more dogs), and 60 percent of all dog owners wish veterinarians could do more to help their senior pet. Furthermore, most dog owners are willing to pay for treatment. Nearly half (42 percent) of dog owners say they would spend $1,000 or more to extend their dog’s life, and 19 percent added they would spend whatever it takes (3). Indeed, senior care has benefited our practice. Since we have begun emphasizing this crucial aspect of medicine, practice income has increased upwards of 20 percent, due to increased exams, testing, dental procedures, nutrition counseling and sale of prescription diets as well as the identification and treatment of chronic disease such as arthritis. But the rewards of senior care extend beyond financial returns. On a personal note, it makes practice much more interesting. Older animals develop the conditions we were trained to diagnose and treat, and in doing so, all the disciplines of internal medicine, clinical pathology, radiology, surgery, nutrition are tied together. Interpreting laboratory results and recommending appropriate responses presents real challenges. Senior care encompasses the most difficult diseases dogs present, and often, multiple disease pressures. Add to that the satisfaction that comes from adding quantity and quality of life to the highly emotional bond between your clients and their dogs. Not only is senior care the next frontier in veterinary medicine, it is the most exciting field as well. Frankly, senior care embodies the reasons why most of us became veterinarians. Today’s practitioners can take pride in the results of their efforts. The medicine of prevention and wellness is giving dogs longer, happier, healthier lives than ever before. Their owners, our clients, are able to form even stronger, longer-lasting bonds with their pets. And in so doing, our veterinary practices grow, prosper and return unparalleled levels of professional satisfaction. References (1) Survey of veterinarians, 1998, sponsored by Pfizer Animal Health and IAMS Company, conducted by Veterinary Medicine Publishing Group, (2) Proprietary market research, 1998, Pfizer Animal Health (3) Rimadyl Dog Owner Survey, 1998, conducted by the Gallup Organization for Pfizer Animal Health |