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What is preventative healthcare?
Caring for elderly cats: preventa4vehealthcare and early disease detec4on• Preventa(ve care is health care that prevents
disease, injury, or illness, rather than trea3ng a
condi3on that has already become catastrophic oracute. The goal of preven(ve care is to help people
stay healthy.

Sarah Caney; sarah@vetprofessionals.com
Vet Professionals Ltd; www.vetprofessionals.com

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Preventative healthcare examples

What is early disease detection?
• Detection before onset of clinical signs• ‘Apparently healthy’ cats
– May include cats with clinical signs that have not been noticed orconsidered unimportant by their carers• Aim: improve quality and length of life through early detectionof illness and appropriate intervention• Clinicians need to sell this concept to their clients!

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Why is this important?
• Improved treatment outcome– Some condiFons are ‘curable’– Progression of others can be ‘slowed’– Improved quality of life
– BeIer teamwork with carer• Carer involved, empowered5‘Cats <4.2 kg at the /me of diagnosis had signiﬁcantly shorter survival/me compared to cats ≥4.2 kg at diagnosis (P < 0.0001).’61

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How can we achieve this?

iCatCare www.icatcare.org• Lifestage appropriate veterinary care
• Maintain contact with cats and carers throughout the cat’s lifetime

Mature/Middle-aged
7-10 years• Individualised approach ‘titrated’ towards each cat and owner

Senior
11-14 years

Developed by FAB,
now ICC: icatcare.org

Super Senior
15 years+

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Rou:ne screening: what’s recommended?
• Cats aged up to 7 years

www.catcare4life.org– Annual health check including weight check, physical examination• Cats aged 7 – 10 years (Mature)– Annual health check: add BP, urinalysis and blood profiles• Cats aged 11 – 14 years (Senior)’Selling’ lifestage appropriate care to your clients• Chronic kidney disease– > 35% of Senior cats

• Hyperthyroidism– Around 10% of Senior cats

• Diabetes mellitus– Around 0.5% of all cats

• Systemic hypertension– 20% of Senior cats– 20-60% of cats with CKD– 10-20% of cats with hyperthyroidism– Health checks every 6-12 months including:BP, urinalysis, bloodwork and T4• Cats aged 15 years+ (Super Senior)– (Me: health check every 3 months)– 6-12 monthly BP, urinalysis, bloodwork and T4

9• Osteoarthritis– > 90% of Senior cats

• Cognitive dysfunction syndrome– 28% Senior cats, > 50% Super Senior cats

10History taking – senior cats
• What questions are important?
• Weight - has the owner noticed any changes?
• Appetite - increase or decrease seen?
• Thirst - any increase?
• Litter tray and toileting behaviour changes?
• Urination, defecation - any problems?
• Mental status - any change (any evidence ofcognitive dysfunction)?

11History taking - senior cats
• More ques3ons• Energy levels - any
hyperacFvity/restlessness?
• GI signs - any vomiFng or diarrhoea?
• Any visual deﬁcits?
• Mobility issues - sFﬀness, reduced
jumping, changes to where sleeps etc

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Owner questionnaires• Can be helpful and save time
– General health– Mobility– Cognitive dysfunction

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Inglis Healthy Pets Clinic, Dunfermline

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Examination of the elderly cat• Needs to include:– Posture, gait (where possible)– Blood pressure– Oral/dental examinaFon– Thyroid palpaFon– Cardiac assessment– Abdominal palpaFon– Eye examinaFon– Weight and body condiFon score17183

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BP measurement

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Weight loss: when is it significant?

Monitor and record the pa:ent’s weight• When there is a downward trend in weights• Above a certain percentage of weight lost
• When muscle condition has been lost

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Assess weight and % weight changes• Accurate scales• Weigh and BCS on every visit• Look at % weight changes– < 5% - ? signiﬁcance:
monitor (2-4 weekly)– 5-10% - signiﬁcant:acFon should be taken– > 10% - serious!

65kg person:! 63.4 kg = 1.6kg (3.5Ib) loss = 2.5%
! 61.8 kg = 3.2kg (7Ib) loss
= 5%
! 60.1 kg = 4.9kg (11Ib) loss = 7.5%
! 58.5 kg = 6.5kg (14Ib) loss = 10%
4 Kg cat:! 3.9 kg = 100g loss = 2.5%
! 3.8 kg = 200g loss = 5%
! 3.7 kg = 300g loss = 7.5%
! 3.6 kg = 400g loss = 10%% weight change: =(difference in weight original weight) x 100%

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Urinalysis

USG screening in elderly cats

• Normal result– USG > 1.040 (1.040 – 1.090)– No further acNon required• Abnormal result– USG < 1.035– Main diﬀerenNals CKD, hyperthyroidism, DM– Further invesNgaNons recommended• Borderline result– USG 1.035 – 1.040– May or may not be signiﬁcant– Recommend reassessment in < 6 months

2526• AimsBenefits of intervention

What further inves:ga:ons?

• Check for common health problems, confirm suspected diagnosis, assess general
health• Blood• Ideally• Haematology• Biochemistry (including Idexx SDMA)• Total T4• If not poss, pre-anaesthetic screen• Urine• Many older cats will have clinical or subclinical problems that can behelped by us– Eg osteoarthritis, hyperthyroidism, renal disease– Possibility of immediate benefit with therapy, may be possible
to cure the condition• Earlier diagnosis helps lead to a better treatment outcome– Eg cats with systemic hypertension diagnosed and treatedbefore they go blind• Healthier cat - happier owner - fulfilled clinician!

• Specific gravity + dipstick

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What’s the justification forearly disease detection?
• Cats are the masters of disguising illness• Clinical signs are oFen subtle and gradual in
onset/progression

How effective is early disease screening?
• 21 diabe3c cats, 21 control cats
• Study assessing ocular manifesta3ons of diabetes• Control cats
– Not diabe^c– Age-matched: 10 – 18 years old– Not receiving any medica^on for at least one month– Not known by the owner to be suﬀering from any symptoms of ocularor systemic disease– Perceived to be ‘completely healthy’• Many owners perceive a thin elderly cat to be ‘normal’• Clinical signs can be confusing• Subclinical illness is common!

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All of these cats were perceived to be
Resultssummary‘completelyhealthy’by their owners!

• Urine specific gravity– Normal (> 1.040) in a third of cats
– Abnormal (< 1.035) in a third of cats
– Borderline (1.035-1.040) in a third of cats

• Blood pressure– Significantly elevated in 3 cats (14%)• Further investigations

3 diabe(c cats diagnosed withconcurrent hyperthyroidism during
the study:
tT4 67, 78, 214 nmol/l– 2 cats hyperthyroid (10%)– 7 cats CKD (33%) including 1 in Stage 3 CKD (creatinine 283 μmol/l)31

Current experience: Inglis Vets

• Cats aged 7 -10 years– Around 10% of those invited agended ‘senior checks’– Very popular with owners– 20% of cats referred on to vets for further treatment/advice(mostly dental, obesity management)• Cats aged 11 – 14 years– > 30% of cats referred on to vets for further treatment/advice(dental, CKD, hyperthyroidism, hypertension, etc)
• Cats aged 15 years and over– > 50% of cats referred on to vets for further treatment/advice(dental, CKD, hyperthyroidism, hypertension, etc)

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Banyard 1998 Aus Vet J 76:600-601

Paepe et al JFMS 2013; 15:8-19• 100 healthy cats
– 6-10 y (n=56), Aged 11y+ (n=44), not on medication for 2 m, clinically healthy– 11 cats too thin (CKD, hyperthyroid, FIV), 40 too fat– Blood pressure high in 8% cats: 160-170 mmHg (n=4); > 180 mmHg (n=4)– Systolic heart murmur in 11 cats (all normotensive, one hyperthyroid)– Goitre: 20 cats: 3 cats with increased TT4– Lab work
• 15 cats with USG < 1.035– 8 cats with ⇧ SCr and ⇩ USG: 6 borderline proteinuric, 2 hypertensive• 2 cats: hyperglycaemia and glycosuria

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Other studies

Why might a carer choose not to aWend?

• Dell’Osa and Jaensch 2016 Aus Vet J 94:317-323• They may feel that their cat looks fine so why bother the cat or the vet?
– Stress puts carers off vet visits, especially if considered non-essential– Cats aged 6-9 years assessed in similar detail– ‘Of the 130 cats, only 26 had no abnormalities identified in the testing panel. Mostchanges were minor or considered artifactual; however, changes diagnostic ofsignificant disease or warranting additional evaluation were identified in 25 cats
(19.2%)’• Some research on owner expectations of vaccination and preventative
healthcare appointments Belshaw et al 2017-2019– Checklists appreciated– Owners like the opportunity to discuss a range of issues whether related to thereason for the visit or not35• They may feel that a cat walking with a stiff gait, a thin cat with gradual
drop-off in weight etc are normal/to be expected in older cats
• They may feel that investigations are likely to be stressful, costly orpainful• They may worry that there is no treatment available to help their cat(so why bother to investigate)• They may fear that the vet will euthanase their cat

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My vision for the future…

Successful integration of Wellcat protocols• Include BP and UA screening
tests free of charge (or in normal fee)

• Integrate lifestage care into your practice• Make it normal to– Guarantees good uptake– Helps bond and educate clients– Financial gain throughappropriate use of follow-up
diagnostic tests, treatments etc– Follow iCatCare’s guidelines– Measure blood pressure in older cats
– Assess urine samples in older cats
– Include assessments as part of the annual
health check (ie offer as much as possible
included in your normal prices!)– See old cats more frequently• Start by integrating UA screening– Start with older patients("age # "problems!)

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Successful integra:on of Wellcat protocols

Successful integra:on of Wellcat protocols• Consider…

• Consider– Client evenings/open days

– Telephone/skype consulta^ons– SMS/email health ques^onnaires withvet nurse/vet callback– Op^on for carers to drop oﬀ urine samples– Op^on for carers to come in without their cat– U^lise your VNs!

– Owner questionnaires (waiting room)– Train owners to bring in urine samples– Timetable longer appointments for old cats
• Ideal 20 minutes minimum– Combined Vet and Nurse appointments• 20-30 mins with VN: history, weigh, BP, eye exam, urinalysis• 10 mins with VS: collate data, additional questions, make a plan39

• It is possible but it is also hard workto achieve – don’t be daunted!

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Affiliation and Further resources

Video tutorials

Cat café videos for owners
Ten minute tips forvets/VNs

sarah@vetprofessionals.com
www.vetprofessionals.com

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