Reasons why ageing clinics are good for your practice – An interview with Dr Zoe Belshaw
16 August 2023
You might find that you’re getting more and more clients worried about their senior dog. So, if you’re not already running ageing clinics at your practice, it would be a good idea to start thinking about it. Ageing clinics can be a great way to improve client engagement, patient welfare, and even enhance your job satisfaction.
We spoke to Dr Zoe Belshaw, about the types of things that you can include in a clinic, how often they should run, what tools can help you, and what you can do to make your ageing clinics successful.
Why should you run an ageing clinic?
This is a great starting point for anyone considering running an ageing clinic: why am I wanting to run one; why might owners come; and how can I get my colleagues on board? Firstly, there can be a lot of personal satisfaction in running a successful ageing clinic. It can be a great time to talk in depth to owners about topics like quality of life and household adaptations that are hard to fit into a standard consult. In addition, you may be able to correct common misconceptions about ageing and identify new medical problems that otherwise might have been missed.
In terms of selling the idea to colleagues, we know that many owners perceive medical problems associated with old age to be part and parcel of normal ageing, so they are unlikely to present their older pets to the clinic for that reason. Alternatively, they may try to squeeze questions into a booster consultation – if they still come to those – which doesn’t work for anyone. A dedicated “MOT” clinic where there are no stupid questions provides space and time for these conversations.
They may also lead to owners being more on-board with further investigations, new diets, or supplements. Owners interviewed for research frequently cite frustration at consultations feeling rushed, so a longer session where they can sit and chat things through may be very appealing.
What are the types of things that can be included in the clinic?
Ageing clinics often include a clinical examination followed by diagnostic screens including questionnaires, blood tests to look for common diseases associated with old age, urinalysis, and a weight check. Some clinics also include blood pressure monitoring and ophthalmoscopy. It’s important to be clear about what additional procedures might incur charges, such as nail trims and anal sac emptying. This doesn’t need to be a universal model though; it could centre on an owner-led chat.
For example, a key component could be sitting down with owners to ask if there is anything major or minor that they are worried about or struggling with in relation to their older pet, perhaps providing examples like walks getting slower, indoor incontinence or cats struggling to jump to give ideas of what might be worth discussing. This is likely to bring up problems that might not otherwise have been mentioned and can help identify what the big issues and/or barriers are for them. This may lead on to relevant tests afterwards.
Owners may also want to discuss subjects including diets and supplements they have read about online, walk lengths and whether or not to vaccinate; it’s worth thinking through some of the possible owner-led topics in advance so all staff running the clinic can provide consistent, correct information. In addition, any clinic should ideally include gentle probes about quality and quantity of life to see if this is something owners have considered and would like to discuss.
Finally, most ageing clinics currently focus on cats and dogs. However, as the numbers of house rabbits and guinea pigs grow, there may well be scope to expand clinics to these species too.
How old is old enough?
This is tricky one as, at least for dogs, their ageing rate may be highly dependent on their breed and size. For ease of administration, many practices have a lower cut off at seven or eight years of age for both cats and dogs. However, it is worth bearing in mind that this will be relatively young for toy dog breeds and quite elderly for the giant breeds.
Do you think it should be a paid-for service?
Ideally, yes though I know historically some clinics have found it difficult to find the right price-point to attract clients whilst covering costs. Whatever the fee, the cost needs to be transparent and well justified to the owners. Clients are likely to be unhappy if the person running the clinic is not sure what they are meant to be doing, and if tests, procedures, or discussions advertised as being part of the clinic are not performed.
Owners need to be aware that veterinary nurses cannot make diagnoses themselves, and that referral to a veterinary surgeon may be required for further investigations, incurring extra charges. Having the emphasis on the consultation discussion as a troubleshooting opportunity may be more appealing than a list of tests.
How often should the clinics be run?
The standard seems to be every 6-12 months for each patient, but that in part depends on the remit of the clinic. For example, if the focus for an older dog is on regular conversations about their quality of life for a chronic disease, it may be relevant to have a monthly session. Conversely, a relatively young patient with no current problems found on screening might not need to come again for a year.
Are there any tools that can help with the clinic?
Yes, BSAVA PetSavers has recently launched the Ageing Canine Toolkit which is a free-of-charge checklist and booklet that can provide a great template for a canine ageing clinic. It includes a list of questions around topics that our recent research found owners might consider to be normal for an older dog. We hope using this tool will lead to useful conversations about whether or not these changes are “normal” and if any aspects need further investigation.
The booklet component has helpful owner-facing advice about common conditions of older dogs and could be used as a take-away reference guide for what to look out for as their pet gets older. It is supported by a poster for practice waiting rooms, and they can both be ordered free of charge from BSAVA. There isn’t one for cats, yet…
Any tips for success?
The biggest one is to have a clear remit for these clinics. Costs need to be advertised transparently and all staff members from reception to senior staff must be aware of which patients are eligible and what is included. They are likely to work best if there is a group of people driving them rather than one individual, both for sharing ideas and to maximise the chance of them being run regularly.
Make sure you know what timeslots will be available, check there will be a consulting room free, that the equipment you need will be available and you all know how to use it, and have a clear protocol about what to do if a nurse is leading a clinic but needs a veterinary surgeon to look further at an identified problem.
Dr Zoe Belshaw is a veterinary surgeon with a clinical specialism in small animal internal medicine. She received a PhD from the University of Nottingham in 2017 for investigating welfare assessment in canine osteoarthritis, and was awarded the BSAVA PetSavers Award in 2020. She has worked in general practice, referral clinics, university teaching hospitals and charity practice. She currently juggles looking after a toddler and collaborative research characterising the Pandemic Puppy phenomenon and exploring perceptions of purchasing imported puppies.