Treatment and Care of the Geriatric Veterinary Patient offers veterinarians a complete guide to treating and managing geriatric canine and feline patients.
* Offers practical guidance on managing all aspects of veterinary care in geriatric pets
* Takes a holistic approach to managing the geriatric patient, from common diseases and quality of life to hospice, euthanasia, client communications, and business management
* Focuses on dogs and cats, with a chapter covering common exotic animals
* Provides clinically oriented advice for ensuring quality of life for older pets
* Includes access to a companion website with videos, client education handouts, and images
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Geriatrics and Fragility
Mary Gardner (Research Assistant Stacy Glass)
Introduction
Determining who was going to pick up Margaret, the 89-year-old matriarch of the Gardner family, for Thanksgiving was usually more of a debate than what type of pies we would bake that year. You see, Grandma Gardner was fragile - we often compared her to an egg - and she needed special assistance in many facets of her life. She still lived alone in a small condo in South Florida, but this New Jersey transplant was in no way fully independent. Grandma Gardner was a shadow of her younger self, muscle atrophied, age-spots dotting her hands and face, thick glasses, thin skin and extremely wobbly. She needed help rising from a chair, assistance into the car, and could only lift about three pounds; with her, everything involved extra consideration, even purchasing milk. We had to buy a quart instead of a gallon, as the gallon was too heavy for her to lift unassisted. We also had to help cut her food into smaller pieces, as her ability to swallow properly became a challenge, and we certainly could not tell her too many jokes while she ate, as she had a boisterous laugh which predisposed her to aspiration! Regardless, she still had most of her wits about her, and honestly, she was a delight to be around, the member of the family with the least drama and the best advice!
Fetching Grandma Gardner for an outing was no small feat. The person appointed to this task had to have the "right" car: One large enough to fit her walker with enough room in the front seat for her to stretch out, yet just the right height and size for her to easily get into, with a steady arm assisting her, of course. She also had to be comfortable enough to properly handle her cherished homemade apple cake (a secret family recipe which she tightly held on to). When picking her up, it was imperative to remember her sweater as even with the 85-degree Florida weather and 90 percent humidity, she still became easily chilled. Plus, this person had to be willing to leave early to take her home in the event she tired before everyone else.
I was always the appointed one, as I had the perfect car. Frankly, I genuinely enjoyed the opportunity to pick her up. I loved being in her condo, seeing the pictures she dearly treasured (especially of her and my late Grandfather, Figure 3.1), hearing the sound of the grandfather clock, and the unique, yet pleasant smell. I don't know what it was - but the smell of Grandma's house was one that I adored. Of course, the candies she kept fully stocked in the dish on the end table were also a plus!
Figure 3.1 Margaret and Edward Gardner dancing in the 1970s.
Grandma Gardner (Figure 3.2) was not in the best of "health." Most of the ailments she had trouble managing were from the natural declining progression of life; nonetheless, in no way was she ready for hospice. Apart from something drastic happening, she had years left, and it was safe to say that she also was not your "normal" older person - or senior citizen. She was what I consider a "geriatric," a term that is often unclear, generating multiple questions: What exactly is a geriatric? What graduates someone from a senior to a geriatric? Is there technically a difference between the two terms? Does "geriatric" relate to the need for much greater care, being at risk for more disasters, or is it simply a term used once someone has made it to a certain age?
Figure 3.2 Grandma Gardner (and her youngest son, my father, Allan) at Thanksgiving dinner 1995.
As a veterinarian who concentrates exclusively on geriatric pets, hospice and euthanasia, I can see the parallels that our companion animals have to humans as they mature, age and inevitably decline. A nine-year-old Labrador may fit the criteria of a "senior" while still functioning perfectly fine in the home. However, a 12-year-old Labrador with no terminal disease looming might have a much harder time managing the ailments that plague the advanced aged pet. Thus, the family must care for the elder pet differently. Think back to the reference of picking up Grandma Gardner (in her late 80s); this experience involves much different efforts than picking up my father who is a bit younger, in his mid-60s. As extra assistance was required for Grandma Gardner, the advanced aged Labrador may also need the same type of consideration. For instance, the food bowl may need to be raised, the floor lined in bath mats, nightlights added to the dark hallway, and a ramp installed to get up the back steps or into the car. Although there is evidently more care taken for the further aged Labrador the question is raised: Is there technically a difference between senior and geriatric pets? Are they treated differently in terms of veterinary medicine? Regardless of the definition, I believe that they should be treated differently because they indeed, are different.
Senior or Geriatric . It's All in a Name - or Is It?
My journey into understanding geriatrics began with seniors and was relatively basic, with the goal of answering broad questions such as: what does "senior" mean, and how do human and veterinary medicine define it? The word "senior" arose in the late thirteenth century from Latin seniores meaning "older." Its original use in the English language dates back to the 1510s as a definition of rank, suggesting "higher in rank, longer in service." It was also used at this time as an addition to a personal name indicating "the father" when father and son had the same name (for example, Allan Senior and Allan Junior). The term "senior citizen" was first recorded in 1938 to define an elderly person, one who is past the age of retirement; however, the term had nothing to do with the individual's medical state.
An article titled "Ageism in Language" in a newsletter from the American Society of Aging (ASA, 2007) presented the following question to readers, "What term(s) do you think are appropriate when referring to people aged 65-plus?" The most commonly used expressions and percentage of individuals considering each term 'appropriate' were:
- older adults?=?80%
- elders?=?41%
- seniors?=?33%
- senior citizens?=?11%
- elderly?=?10%.
Based on these statistics, is the word "senior" becoming a word of the past? Are more people beginning to use the term "older adult" to define those over the age of 65? Should we, as veterinarians, be saying "older pet" rather than "senior pet?" This concept led me to researching how the American Veterinary Medical Association (AVMA) uses the term "senior." In my research, I was unable to find an actual definition; nonetheless, the AVMA does offer a page on their website that addresses the question, "When does a pet become 'old'?" Their answer:
It varies, but cats and small dogs are generally considered "senior" at seven years of age. Larger breed dogs tend to have shorter life spans compared to smaller breeds and are often considered senior when they are 5 to 6 years of age. Contrary to popular belief, dogs do not age at a rate of seven human years for each year in dog years."
(AVMA, 2017).
Both the AVMA and the ASA offer no clear definition of what a "senior" is; however, I learned that the term does not relate as much to "biology" as I thought it would, which led me to wonder, what is a "geriatric?"
Geriatric Medicine for Humans
The US elderly population is expected to dramatically rise over the coming decades (the same can be said for the elderly pet population); thus, increasing the need for more focus by physicians on geriatrics. Since advancements in human medicine most often precede veterinary medicine, I decided to take a look into the history of human geriatrics to get an understanding of how it came to fruition, what a geriatrician does, and if there are parallels we can make in veterinary medicine. Accordingly, a human geriatrician must first be a family medicine physician or internal medicine physician to qualify for the certification of geriatrics. The certification is referred to as a certificate of added qualifications (CAQ). Fewer than 10,000 of the 120,000 practicing general internists and family physicians in the United States have earned a CAQ in geriatric medicine (Warshaw et al., 2003). To get their CAQ, the physician must first complete a fellowship program and then sit for the exam. The five most reputable schools offering a fellowship program for geriatric medicine are:
- John Hopkins
- University of California, Los Angeles
- Icahn School of Medicine at Mount Sinai
- Duke University
- Harvard Medical School Teaching Hospital.
While geriatric medicine cares for the older population, the specialty itself is quite young. Box 3.1 shows a timeline of the growth of human geriatric medicine (Forciea, 2014).
Box 3.1 The Growth of Human Geriatric Medicine
1943 The American Geriatric Society was organized and held its first...
