Cognitive dysfunction is more difficult to diagnose. In the absence of any physical causes, one or more of the following behavioral changes may be observed—decreased reaction to stimuli, confusion, disorientation, decreased interaction with the client, increased irritability, slowness in obeying commands, alteration in sleep patterns, decreased responsiveness to sensory input, increased vocalization, and problems performing learned behaviors.⁷

How do I manage pain in older cats?

Pain is pain, no matter the patient's age. Start to treat pain, whether acute or chronic, as soon as possible. Give special consideration to any underlying conditions or drug interactions. Some causes of chronic pain include degenerative joint disease, inflammatory diseases, dental disease, and neoplasia. Acute pain can be caused by trauma, surgery, neoplasia, and conditions such as pancreatitis, urinary tract disease, and gastrointestinal disorders. A variety of oral and injectable pain medications are available for use in cats.⁸ I like to use piroxicam (1 mg daily) in cats with acute and chronic pain. Nutraceuticals such as glucosamine, chondroitin sulfate, and omega-3 fatty acids may also help alleviate some forms of pain.⁹

Advanced age is not a reason to avoid anesthesia in these patients. But take underlying conditions into account when selecting anesthetic agents and administering supportive care. Intravenous fluids before, during, and after the procedure are suggested to prevent renal compromise due to hypotension from general anesthesia and to provide vascular access if needed in an emergency.⁶

Monitoring senior cats before and during anesthesia is also important. Obtain blood work before any anesthetic procedure. Obtain preanesthetic blood pressure measurements and electrocardiograms in all cats, and continue to monitor these parameters while the cat is anesthetized. Other techniques that may be used are pulse oximetry, esophageal stethoscope auscultation, and respiratory monitoring (capnography). Maintaining body heat is also critical as many of these patients have decreased body fat. Postprocedure blood work may also be indicated, depending on the cat's clinical condition.

How often should senior cats be vaccinated?

Assess the risk of exposure to disease in each senior patient based on details from the medical and behavioral history. Cats that are inside only have little risk of contacting other cats with disease. They may benefit from the three-year vaccination program. An inside-outside cat has a higher risk for exposure to diseases from other cats but may be well-protected with the three-year vaccination program. Discuss the risks and benefits of vaccinations with owners to determine the appropriate vaccination protocol for their pets. Rabies vaccines should be given in accordance with the AAFP/AFM Advisory Panel on Feline Vaccines¹⁰ and local laws.

REFERENCES

1. American Association of Feline Practitioners/Academy of Feline Medicine Panel Report on Feline Senior Care. J Feline Med Surg 2005;7:3-32.

2. Hypertension Consensus Panel, American College of Veterinary Internal Medicine (report), in Proceedings. 20th Annu Vet Med Forum, 2002.

3. Laflamme DP. Nutrition for aging cats and dogs and the importance of body condition. Vet Clin North Am Small Anim Pract 2005;35:713-742.

4. DeBowes LJ, Harvey CE. Disorders of cats: the oral cavity and dental disease. In: Geriatrics and gerontology of the dog and cat. Philadelphia, Pa: WB Saunders Co, 1995;128-134.

5. Holmstrom SE. Geriatric veterinary dentistry: medical and client relations and challenges. Vet Clin North Am Small Anim Pract 2005;35:699-712.

6. Carpenter RE, Pettifer GR, Tranquilli WJ. Anesthesia for geriatric patients. Vet Clin North Am Small Anim Pract 2005;35:571-580.

7. Landsberg G, Araujo JA. Behavioral problems in geriatric pets. Vet Clin North Am Small Anim Pract 2005;35:675-698.