Geriatric Dog Care

Old age happens to the best of us – even our dogs. And as our dogs enter into the golden age, they may have specific needs or problems that must be addressed. The aging process brings about a gradual decline in a dog’s physical and sometimes mental abilities. Becoming aware of these issues allows an owner to provide the best possible care.

Not all dogs age at the same rate. Generally, smaller breeds live longer than larger dogs and mixed breeds usually live longer than pure breeds. A general guideline as to when a dog might be considered geriatric may be based on the dog’s adult weight. Small dogs (under 20 pounds) are considered geriatric between 9 and 13 years old. Medium sized dogs (21 to 50 pounds) are considered geriatric between 9 and 11 years old. Large breed dogs (51 to 90 pounds) are considered geriatric between 7 and 10 years old. Finally, the giant breed dogs (over 90 pounds) are usually considered geriatric between 6 and 9 years old.

Ideally, caring for the geriatric dog should focus on preventative measures. Whenever possible, it is better to prevent a problem from occurring, rather than to wait for a problem to develop. Detecting diseases in the early stages greatly improves the outcome. Different dogs have specific risk factors that influence the diagnostic approach to geriatric medicine. Risk factors are characteristics of the breed, genetics, environment and lifestyle of your dog that may put him or her at greater risk of developing a particular disease or other age related changes.

Veterinary Care

Within the last few decades, advancements in veterinary medicine have caused a dramatic increase in the longevity of our pets. Today dogs are living longer and healthier lives. If there is a problem with your older dog, don’t assume it is just because of old age, and that nothing can be done. With appropriate treatment, many conditions can improve. Your veterinarian may do the following to assess your dog’s health and to maintain a healthy condition.

• A thorough and complete medical history. Your veterinarian will note changes in behavior and physical abilities.
• A complete physical examination
• Complete blood count (CBC)
• Biochemical profile
• Urinalysis
• Fecal exam for parasites
• Heartworm blood test, if appropriate for the area of the country

Treatment

All dogs should receive routine vaccinations as required by law (rabies) and vaccines that are appropriate for individual needs. Specific vaccines and frequency of administration may vary, and should be discussed with your veterinarian. Treating an older dog depends on the individual requirements or problems of your pet. The most common problems of geriatric dogs are:

• Nutritional issues – managing obesity or special needs
• Dental disease
• Arthritis
• Metabolic disease
• Endocrine disorders
• Cardiac disease
• Skin tumors
• Urinary problems
• Prostate disease in intact male dogs
• Cancer
• Behavioral and cognitive dysfunction

Home Care and Prevention

A periodic inspection of your pet, at home, may uncover potential problems. Make sure that your pet has clean, warm and protected living conditions, and provide easy access to clean fresh water.

Feed a good quality dog food that is appropriate for your dog’s specific needs, and do not allow your pet to gain excessive weight. Discuss unexpected weight gain with your veterinarian. Based on a complete geriatric work-up a prescription dog food might be advised. Groom your pet and, if possible, brush your dog’s teeth regularly. Finally, follow your veterinarian’s recommendations as to exercise, nutrition and any medications that may be needed.

Pets today are living longer and better quality lives than ever before. Many factors are responsible for this increase including improved nutrition, veterinary care and educated owners. This increased longevity means that there are more dogs reaching an older age, and that owner’s will be faced with the special demands and problems that become apparent with age. Understanding the aging process and the most common problems that face the geriatric dog is the first step in providing the best possible care to your older animal. The main focus of geriatric health care is owner education and the early detection and prevention of disease.

It is important to first realize that aging itself is not a disease; it is simply a stage of life. Increasing age causes a gradual decline in the body’s ability to repair itself, maintain normal body functions, and adapt to the stresses and changes in the environment. Many changes occur in dogs as they age. Changes in metabolism occur so dogs require less food. Older dogs are also usually less active and thus, commonly gain weight, making obesity one of the more frequent problems seen in the senior dog. Changes in a dog’s environment or routine may actually contribute to behavioral changes or even illness. Trying to minimize severe or sudden changes in the geriatric animal is always a good practice. With time, dogs begin to have a gradual decline in their senses (hearing, smelling, vision and taste). Your pet may not respond to stimuli as rapidly or in the same manner as when he was younger. It is not uncommon for older dogs to spend more time sleeping and have more difficulty being roused.

Additionally, the body’s ability to repair itself decreases, and the function of the immune system is compromised with increasing age. Metabolic and endocrine problems, organ dysfunction, and cancer are all seen with increased frequency in the senior pet. Degenerative changes in the muscles, bones and joints are commonly seen as arthritis and muscle weakness.

Some of these problems may be difficult to help, however it is usually possible to significantly improve the quality of your pet’s life by educating oneself, and becoming aware of potential problems. Most veterinarians will recommend more frequent veterinary visits and additional diagnostic tests for geriatric animals in an effort to find the early stages of disease, before they become problems. Practicing prevention is always better than treating a disease already present. In the long run, preventative medicine improves quality of life, and is more cost effective than waiting for problems to appear. A well-educated and proactive owner is the first step in optimal senior dog care.

Many of these tests are recommended on geriatric dogs even when they are feeling totally normal. The routine geriatric exam and accompanying diagnostic tests are recommended to ensure that the early stages of disease is discovered, and appropriate preventative measures and treatment plans instituted. The most common diagnostic tests performed by your veterinarian as part of a complete geriatric work-up include:

• A complete medical history. Any problems or concerns that an owner has about their pet should be discussed; however, it is equally important that the veterinarian ask specific questions that may uncover problems unknown to an owner. Certain problems that an owner may simply attribute to “old age”, and just something that they will have to live with, may be signs of underlying disease and be very treatable. Some veterinarians have specific geriatric health history questionnaires that can be filled out by the owner or a health professional. Asking the right questions is very important in obtaining a thorough geriatric health history.
• A complete physical examination. Your veterinarian will perform a complete physical examination that may uncover specific problems. The eyes are checked for age related changes. Cataracts may be noted. The ears are checked for signs of infection or allergies. The mouth, gums and teeth are evaluated, with dental disease and gingivitis being common findings. Lymph nodes are palpated (felt) for enlargement. The skin and quality of the hair coat are observed. Skin tumors are a common finding, and a poor hair coat or a lack of grooming may be signs of allergies, parasites, infections or systemic illness. The heart and lungs are ausculted (listened to), and new heart murmurs noted. The abdomen is palpated for any masses or organ enlargements. Finally, the general body condition and weight is recorded.
• Complete Blood Count (CBC). A CBC evaluates the red and white blood cell lines. A decrease in the red cells indicates anemia, not an uncommon finding in the aging animal. Red blood cell morphology (shape) is also assessed, and helps determine if the condition is acute, chronic or related to a neoplastic (cancer) condition. The total white blood cell count is also noted, and increases may indicate inflammatory or infectious conditions. The specific types of white cells (neutrophils, lymphocytes, eosinophils, monocytes and basophils) are also counted and are recorded in their relative proportions. Increases or decreases in individual white cell types may provide incite into various disease conditions. Occasionally, abnormal or immature white blood cells are seen, suggesting a potential cancerous process.
• Biochemical Profile. The biochemical profile is a very valuable test in the geriatric animal as it evaluates multiple organ systems. The liver and kidney function are evaluated, and the blood sugar is checked. Elevations in the blood sugar may indicate diabetes. Electrolytes are also checked and abnormalities may indicate the need for further diagnostics. The cholesterol may be elevated in certain endocrine problems (thyroid and adrenal disorders). Plasma protein and albumin level are also reported, and decreases might indicate kidney, liver or gastrointestinal disease.
• Urinalysis. A urine sample may be obtained in a clean container by the owner prior to the examination, or by the veterinarian. The urine sample helps in diagnosing kidney problems, urinary infections or diabetes. If indicated either by clinical signs or by the microscopic evaluation of the urine, the urine is cultured for bacteria.
• Fecal examination for parasites. Since gastrointestinal parasites may be more debilitating in geriatric animals, a yearly fecal exam is recommended. Additionally, some parasites have zoonotic (spread to people) potential, re-enforcing the value of yearly fecal exams. Routine fecal floatation, and specific tests for Giardia are recommended.
• Heartworm blood tests. For dogs at risk, heartworm tests is advised. Depending on the area of the country you live in and the type of heartworm preventative your dog is receiving your veterinarian may suggest yearly testing.

The above represent the most routine diagnostic tests that your veterinarian may advise for your senior pet. Based on the history and physical examination findings, common additional testing might include:

• Aspiration of skin masses. Probably one of the more common findings on the physical examination is small masses or lumps found on or under the skin. In most cases these are benign tumors or cysts that grow slowly and rarely cause problems. Unfortunately the only way to be sure is to sample the mass. This is most easily accomplished by aspirating the individual mass, and evaluating the recovered cells cytologically (microscopically). Sometimes the number or location of the masses makes sampling impractical. In these cases, your veterinarian can help determine if aspiration is worthwhile. The size and location of all masses should be recorded in the medical record, so that changes in previous masses or the development of new masses can be noted.
• Endocrine function tests. Common endocrine problems of the older dogs are thyroid and adrenal disorders. A thyroid panel or a thyroid stimulation test can be done to diagnose hypothyroidism (decreased thyroid function). The most common signs of hypothyroidism are weight gain, lethargy, skin changes and a poor hair coat. Another common endocrine disorder of geriatric dogs is hyperadrenocorticism (Cushing’s disease), caused by increased cortisol secretion by the adrenal gland. Dogs with this disease often present with increases in thirst, appetite, urination and or panting. Animals also may present with weight gain, a potbellied appearance and skin changes. Tests to diagnose adrenal disorders include an ACTH stimulation test, and a low dose dexamethasone suppression test.
• Radiographs. X-rays may be advised based on the initial tests or physical exam findings. Chest X-rays are part of a heart work-up such as if a new murmur was found. They are also needed for evaluating the lungs, and as a screening test for cancer. Abdominal radiographs might be needed if organ dysfunction is suspected or organ enlargement or masses are palpated.
• Blood pressure measurement. Hypertension, or high blood pressure, is being increasingly identified in the geriatric dog. Usually, it is associated with other disease conditions including kidney disease and hyperadrenocorticism.
• Cardiac evaluation. If there is indication of potential heart disease (a newly discovered or a worsening murmur, or a nocturnal cough) a more complete cardiac evaluation is indicated. Chest radiographs, an EKG and an echocardiogram will help better define the extent and cause of potential heart disease and whether treatment is necessary.
• Abdominal ultrasound. Abdominal ultrasounds offer a non-invasive method of visualizing of masses and organs within the abdomen. Generally, more detail and structure can be obtained with an ultrasound than with radiographs.

At the end of the geriatric visit, a geriatric wellness assessment may be completed and given to the owner.

The treatment of the geriatric dog varies according to individual requirements, and the problems found. The following is a list of the most common geriatric problems and their general treatment recommendations:

• Nutritional concerns. The proper diet is very important in the care of a geriatric dog. There is no best food to feed a geriatric dog. The best food to feed depends on the specific problems or nutritional requirements of the individual animal. For example, obesity is a very common problem of older animals. Obesity is a serious concern in the geriatric animal because it directly correlates to a decreased longevity, and may contribute to other problems. Dogs that are arthritic have a far more difficult time moving and may require strong anti-inflammatory drugs to ease their discomfort. Weight loss in these animals may have great impact on improving their quality of life. Your veterinarian can prescribe or recommend special lower calorie, high fiber diets that make weight loss easier. Additionally, through the geriatric work-up, special nutritional requirements or restrictions may be recommended. These diets attempt to either slow the development of the disease process, or improve specific organ function. Special diets for many diseases (even in the early stages) including kidney, liver, gastrointestinal, heart, dental and skin disease are available. Even diets for diabetes and cancer may be recommended. Proper nutritional management is a very important part of the care for your geriatric dog, especially since it is something that you have control over.
• Dental disease. A very common finding on a geriatric exam is dental disease and gingivitis (inflammation of the gums). A dental cleaning may be recommended by your veterinarian. Many times an owner is reluctant to put their geriatric dog under anesthesia; however, if there is significant dental disease present, a dentistry may be in your dog’s best interest. Untreated dental disease usually leads to tooth loss, and may serve as a reservoir of infection for the rest of the body. In this manner, severe dental disease may pose a risk to other body systems. It is not uncommon for an owner to comment on how much better their dog feels after a dental, when they were not even aware that their dog may have been ill prior to the dental.
• Arthritis, also called degenerative joint disease, is another very common issue affecting geriatric dogs. While it is to be expected that older animals will tend to “slow down” with age, animals with arthritis may feel much more comfortable if appropriately treated. Signs of arthritis in dogs include difficultly rising, having trouble on stairs or jumping, falling on slippery floors, having difficulty getting comfortable or being restless at nights. Many times your pet will be worse right after he gets up, and then “warms out of it” and improves with time. There are many anti-inflammatory medications that may significantly improve your pet’s quality of life and comfort level. Never start medication on your own. Your veterinarian can recommend the best medication for your dog.
• Metabolic problems. One of the biggest benefits of routine geriatric diagnostic testing is the early detection of a variety of metabolic conditions. Finding evidence of early kidney disease is probably the most common. Underlying liver disease may also be discovered. In some incidences further testing may be suggested. Other times specific dietary or lifestyle changes may be advised, and potential medication started.
• Endocrine disorders. Endocrine problems may be suspected based on historical, physical or laboratory findings. The two most common endocrine problems affecting geriatric dogs are hyperadrenocorticism (Cushing’s disease) or hypothyroidism. Both disorders are treatable, and proper treatment may dramatically improve your dog’s overall attitude and strength.
• Cardiac disease. Newly discovered heart murmurs are a common physical exam finding in the geriatric dog. Many times these murmurs are found before a dog is symptomatic of any heart disease. Finding a heart murmur in an older dog does not mean that the dog has cardiac disease, but it is an indication for further diagnostics. The most common cardiac disease in the senior dog is chronic valvular heart disease. Thickening and irregularities of the valves of the heart may lead to abnormal blood flow within the cardiac chambers, eventually causing cardiac enlargement and heart failure. Early detection of this disease and proper therapy may slow its progression.
• Skin tumors. On the basis of the size, location and aspiration results, your veterinarian may recommend removal of one or many skin masses. Sometimes these masses may be removed with only local anesthesia, other times general anesthesia is required. Your veterinarian may also decide not to remove a mass. In this case, the mass should be closely monitored for any changes in size, shape or texture.
• Urinary problems. Excessive urinations are usually related to increased thirst and metabolic problems or urinary tract infections. Older dogs may sometimes become urinary incontinent, leaking small or even large amounts of urine when lying down or when sleeping. If the incontinence is due to infection, antibiotics will usually help. If infection is not present, there are other medications that can safely and effectively treat the problem.
• Prostate problems. If your dog is an intact male, he is at significant risk of prostatic disease. Prostatic infections, hyperplasia, abscesses and cysts are all potential problems in the intact male. Tumors of the prostate occur with equal frequency in both neutered and intact males. A rectal examination is required to fully evaluate the prostate.
• Unfortunately, cancer is a significant problem facing the geriatric dog. Some common breeds such as golden retrievers and boxers are at increased risk of potential disease. Not all cancer needs to be fatal. Surgery, chemotherapy, even radiation therapy, is available that can significantly extend your pet’s quality time, or produce a cure. The prognosis depends on the type and location of the cancer.
• Behavioral and cognitive dysfunction. As dogs age they may become more “set in their ways”, more inflexible, less patient and more irritable. Sometimes they will forget learned behaviors including normal urinary and defecation habits. Geriatric dogs may sleep a lot more, and be less responsive to external stimuli. These signs may be related to underlying disease, or may be due to the gradual decline in their senses and cognition (thought process). If no underlying causes of the deterioration can be found, some dogs might respond to medications that treat cognitive dysfunction (Anipryl®).

Optimal treatment for your pet requires a combination of home and professional veterinary care. Follow-up can be critical, especially if your pet does not improve rapidly.

• Administer all medications as directed. Alert your veterinarian if you are experiencing problems treating your pet.
• Giving your pet a periodic home health exam is an excellent way to monitor for potential problems. Check the teeth and mouth for dental problems and note any foul odors. Feel the skin for any lumps, bumps or discharges. Feel the limbs and joints for swellings or pain. Observe for any swelling in the abdomen. Note any sudden weight gain or loss. Watch for any changes in water consumption or appetite. Changes in your pet’s behavior, appearance or attitude should be discussed with your veterinarian.
• Provide your senior pet with a clean and warm place to sleep, and limit changes in his or her environment. Soft bedding should be provided. Sudden or prolonged changes in temperature should be minimized, as many geriatric dogs are less tolerant of cold or hot weather conditions.
• Good grooming practices promotes healthy skin and hair coats. Groom your pet regularly.
• Proper dental care begins at home. Dog’s teeth may be brushed at least a few times a week to decrease the incidence of dental disease. Special flavored toothpaste for dogs should be used, as the human products are poorly tolerated.
• Provide a good quality dog food based on your dog’s individual needs. Make sure your pet does not gain or lose too much weight. Avoid table scraps, and try and stick with a consistent diet.
• Unless directed otherwise by your veterinarian, routine exercise is very important to a geriatric dog. Excessive exercise should be avoided, but a small to moderate (depending on your dog’s need) amount is beneficial.
• Routine blood work may be advised. Re-checking blood tests may aid in following the progression of certain diseases, and any potential treatment changes. Additionally, if your pet is on any medications, blood tests may need to be monitored to make sure there are no potential side-effects.
• Geriatric dogs should usually have routine veterinary exams at least twice a year. Full diagnostics are usually not required this often, but a check-up is recommended.