BSAVA PetSavers spoke to Carl Gorman, president of the BSAVA, about his book The Ageing Dog and his interest in geriatric animals.
Dogs’ lives have a more telescoped timescale than human lives. They have a brief ‘childhood’ and then a long period with little change. Once they reach geriatric status, the age of onset varying with breed, they can seem to us to age very rapidly. To a vet this is the time when they become most interesting, with a variety of diseases of ageing becoming possible. The annual check-up for an older dog holds many more possibilities for a vet compared to those for dogs in their prime. As an owner, I am very aware that this is the time in a dog’s life when I will need to make adjustments to all aspects of their care, from exercise and nutrition, to coping with reduced cognitive ability and adaptability. Helping to educate owners about the needs and challenges of older pets is important and often enjoyable.
The advances in medical diagnosis and care make this an exciting period of a dog’s life to be caring for it. If we assume that the average dog qualifies as geriatric at around 8 years of age, then potentially that dog might spend half its life as a geriatric, so it’s a huge opportunity and challenge for vets and owners.
2. In the introduction to the book, you say that ‘One of the saddest things I hear is to be told that an older dog’s symptoms are “just old age”, meaning that they are to be expected and therefore just accepted’. Do you think this is a common interpretation by owners?
Like many vets and nurses I have had many periods suffering imposter syndrome, and wondering whether I know any better than an interested client with access to Google. Time and time again this is disproven when I see that clients misinterpret so many signs and clues that they see in their pets. The claim that a dog ‘is stiff but not in pain’ is one that vets will probably hear almost daily.
I spend a lot of time explaining to clients that old age in itself is not a disease. The ageing effects on organs and the skeleton mean that a variety of disorders are more likely, but that doesn’t make them normal. More importantly, just because they are common disorders of older pets doesn’t mean that they have to be accepted and not managed.
Arthritic pain and dental disease are two of the commonest disorders which tend to be dismissed by owners unless their true effects are explained. I never blame clients for not understanding, but rather appreciate that I do actually know a bit more than they do at times.
3. BSAVA PetSavers is funding a citizen science project at the University of Liverpool investigating healthcare in senior dogs, which aims to develop a canine ageing and wellbeing tool for use in consultations with older dogs. How important do you think the owner-vet relationship is in caring for senior pets?
It’s highly important that the approach to the care of an older dog is a coordinated, team approach. As veterinary professionals, our responsibility is to identify problems which may be causing suffering or distress to senior pets, and then to make clients aware, explain the implications and see how we can work together to ensure the wellbeing of the pet. Any tool which help clients and vets achieve this is to be welcomed. I think that well-thought-out and clear tools such as quality of life guides and wellbeing tools have to be a help.
Without having the client’s understanding and support, we can’t ensure that pet’s wellbeing, so a good trusting relationship is key. We also have to be aware of the range of willingness of clients to pursue any palliative care. We must not judge their degree of attachment to their pet, so long as the outcome is humane and ethical. So if by using a tool a client decided that a dog was less than happy, and chose euthanasia, we would have to support that if we felt it was not inappropriate. At the other end of the scale we would have to be honest with a client who we felt was prolonging life without adequately ensuring the welfare of the dog. Again, appropriate tools can really assist those conversations.
4. Can you offer any top tips for owners with an ageing dog about how to best overcome the challenges associated with old age?
Number one is to ensure that as an owner you are aware of the potential challenges of an old dog, and to be able to recognise when conditions are affecting your pet’s welfare. There are myriad ways to support older dogs, including ensuring ease of access to areas, adapting feeding positions and regimes, increased grooming and contact, assisting with hygiene, altering home routines to take account of changing toilet and sleep patterns and enhanced bedding. This is without ensuring that all steps necessary are taken medically (or physically) to ensure that pet is as comfortable as possible.
Awareness and recognition are the baseline, and then an owner can take steps or seek help to alleviate the problems. Seek advice from vets and take advantage of, for example, nurse clinics for geriatrics which can be so helpful.
5. The loss of an animal is a very traumatic experience, but one that all owners will have to come to terms with. What advice would you offer to help them prepare for this time?
However much we hope that our pets will ‘pass peacefully in their sleep’ the reality is that 90% of us will have to take the decision to put our pets to sleep. Rather than avoiding the subject, clients should talk to their vets before the time comes to find out what is involved and what choices there are both for the euthanasia process and for the disposal of the pet’s body. Ideally have a plan in mind (such as – home or in-clinic euthanasia, boundaries to help decide the right time, cremation/burial options, whether to be present or not, do they want mementos such as hair clipping or paw prints) so that these decisions don’t have to be made when in a highly emotional state. Several of my clients have these plans recorded on their pet records, together with the preferred vet. Many find that it helps to have these discussions beforehand, preparing them better for the inevitable. Describing the euthanasia process as similar to having an anaesthetic (as far as the pet is concerned) can be helpful.
The decision as to the right time has to be the owner’s except in certain circumstances where we may have to gently insist that it is not fair to continue. I try to reassure clients that everyone is different and that there is normally an extended period where there is no wrong or right decision. I do use my own experiences to show empathy, and to explain that I find the decision for my own pets every bit as hard as they do – but that I never regret the decision however upset I may be, and that is important.
It can help to use tools such as the end-of-life goals tool below,1–3 or to speak to a bereavement counsellor before the event. Grief doesn’t start at the moment of euthanasia but often goes on for a long time before and can be debilitating. By dealing with the fear of loss, a client may spare themselves suffering (and cost) and also do the best for their pets.
1. https://www.vetmed.wsu.edu/outreach/pet-loss-hotline/issues-to-explore/terminal-illness 2. http://vetsocialwork.utk.edu/wp-content/uploads/2016/03/EndoLifeValues-Goals.pdf 3. https://www.bluecross.org.uk/pet-bereavement-and-pet-loss
Carl graduated from Bristol vet school in 1985. After working in Swindon, Portsmouth and Cheshire, he took on a practice in Newbury where he is now Clinical Director. He has a wide range of clinical interests including surgery, avian and exotic medicine and geriatrics. Since 2000 he has been Small Animal Editor, and now Consultant Editor of UK Vet Companion Animal. He is the author of Clients, Pets and Vets, about communication and nonclinical aspects of practice, and The Ageing Dog which advises clients on the care of geriatric dogs. He is also writing the palliative care chapter for the new edition of the BSAVA Manual of Advanced Veterinary Nursing.