How to Care for a Senior Cat

Cats do not live forever,although we’d like them to.When you have shared your home with a cat for many years,he becomes an integral member of the family, and you develop strong emotional attachments. Cats provide undemanding and unending love.They are always there for you. You can prevent many problems that could shorten your cat’s life by following the suggestions about care that are offered in this book.Cats are very good at disguising their problems,so as they age,you need to be even more attuned to changes in their everyday activities and behaviors. Early detection of problems is the key to improving your cat’s longevity and quality of life.
HOW LONG WILL MY CAT LIVE?

There are many formulas for calculating a cat’s age in relation to human age.An old standby is that seven cat years are equal to one human year. Actually, in her first few years a cat does a lot more growing up than that. So the first few years of a cat’s life are equivalent to more than

seven human years,and the later years are equivalent to fewer.The table on page 114 compares the age of a cat with that of a human. Owners want to know what the life expectancy is for their cat,and in general I tell them it is between 13 and 15 years,especially if the cat stays indoors. However, we have many 19- and 20-year-old patients, and our oldest is 24! If a cat goes outside,her life expectancy is shortened because of the increased risks outdoor cats face.She is exposed to more diseases and dangers,such as poisons and cars. There are many different opinions on when a cat is “old.”There is no consensus on the age at which a cat becomes a senior,but a Panel Report on Feline Senior Care published in 1999 by the AAFP recommends beginning a senior preventative health care program by 7 to 11 years of age.By 12 years almost all cats start experiencing the effects of aging. There are certain diseases and conditions that occur in cats due to degenerative processes.Each cell in an animal’s body is programmed to last a certain amount of time,and this programming is different for each individual animal.Some animals look and act old at 10 years,while others are fit and spry at 15 years. Certain organs seem to age at a faster rate than others, and this is perhaps why certain health problems are more common in older cats.
SENIOR HEALTH CARE PROGRAM

Cats need the most veterinary and owner care when they are kittens and when they are seniors. Middle-aged cats are usually healthy and take pretty good care of themselves and can get by with once-a-year visits to the vet for their physical exams.

Regular veterinary examinations will objectively note small, gradual changes, which can add up to significant changes over a period of time. Even if you’ve lived with your cat for years, you may not notice subtle changes that occur in her conformation and health as she ages. A preventative health care program for healthy animals may include a complete history and physical exam and some diagnostic testing, including a CBC, blood chemistries, viral testing, urinalysis and measuring blood pressure. I think it’s beneficial to start a program like this around nine years of age. By establishing baseline values on body condition and organ function, you can detect changes as the animal ages. If a cat has an illness, she should be monitored at least every six months.
WHAT MAY CAUSE YOUR KITTY’S DEMISE?

Although you may not like to think about it, it’s a good idea to be familiar with the kinds of problems a senior cat can develop.As with any disease,early identification and treatment can help slow the progress of the disease and prevent related maladies.There are six diseases that are particularly common in senior cats:

1.Hyperthyroidism

2. Chronic renal failure

3. Hypertension

4. Cancer

5. Diabetes mellitus

6. Inflammatory bowel disease (IBD)

Liver disease,heart disease,neurological diseases and lung disease are also found in senior cats, but their frequency is greater in geriatric humans than in cats.
Hyperthyroidism

Hyperthyroidism is very common in senior cats and is usually the result of a benign growth on one or both of a cat’s thyroid glands,which are located in the neck.The thyroid glands produce hormones that affect general metabolism and organ function, and overactive glands make excessive levels of hormones. Hyperthyroid cats produce too much of the thyroid hormones. They can have ravenous appetites but still lose weight.They may have rapid heart rates, arrhythmia (irregular heartbeat), vomiting and diarrhea.This disorder is diagnosed by a blood test,and treatment is aimed at suppressing the gland medically or removing the overactive tissue by surgery or radiation. Chapter 18 contains much more information about hyperthyroidism in cats.
Chronic Renal Failure

Chronic renal failure is a degenerative process that slowly impairs the important functions of the kidneys,which filter the blood and produce urine.They are also responsible for water and electrolyte balance in the body. Kidney function is measured through urinalysis and blood testing,but these tests don’t even start to indicate problems until more than 50 percent of all kidney function has been lost. Cats with chronic renal failure typically drink a lot,urinate a lot and lose weight.As kidney disease progresses, the cat becomes thin, dehydrated and develops a terrible odor from the mouth. Treatment of chronic renal failure is aimed at maintaining an animal’s hydration and electrolyte balance as well as controlling some secondary problems that are associated with kidney failure (these can include anemia,dental disease and weight loss).

You can help prevent kidney disease by feeding your senior cat a good diet that does not over-acidify the urine and providing plenty of clean, fresh water. The kidneys are organs that do not regenerate,so once they are damaged, disease will progress. By intervening with diet,fluids and other treatment, the process can be slowed but not cured. It is hard to know how quickly problems will progress, so monitoring changes in blood urea nitrogen (BUN) and creatinine will give a veterinarian an idea of the stage of degeneration. BUN and creatinine are products that are present at higher levels in the blood when cats have kidney disease. However, as I’ve already mentioned, abnormally high values of these products are not even detectable until more than 50 percent of kidney function has been lost. If it is detected in the early stages,kidney disease can be managed, possibly for years.Management requires active owner participation and care,including fluid supplementation. Chapter 20 contains more information about renal problems in cats.
Hypertension

High blood pressure (hypertension) does occur in cats.Most often it is secondary to hyperthyroidism or chronic renal failure.Testing a cat’s blood pressure can be tricky, because cats are generally stressed when they go to a veterinary clinic and stress increases blood pressure. Hypertension can be addressed by controlling the primary disease that caused it,and by using oral medications. Chapter 16 contains more information about hypertension in cats.

Cancer

Cats are living longer now than they ever have, and this has increased the incidence of cancer.Cancer is new tissue produced by the unregulated growth of cells.The cause of most cancers in cats is not known— just as it is not known in humans.Some types of cancer progress rapidly,while others are slow to spread.Some types are external and can be observed by owners,and others are detected when a veterinarian is palpating an animal during a physical examination. There are veterinary oncologists who specialize in animal cancer treatment, and each year leaps and bounds are made in cancer treatment.Many of the same types of drugs and therapies used for humans are available for cats.And new, gene-based therapies are being studied as possible treatments for pets even before they are being studied for humans,as cancer care centers for both people and animals team up to find the best ways to fight this terrible disease.The prognosis is different for each type of cancer and for each individual cat.The treatments available for cancer include:
• Chemotherapy

• Surgery

• Radiation

• Cryotherapy (freezing the cancer cells)

• Immunotherapy
The goal of treating cancer in animals is to prolong life while maintaining a good quality of life.It is not simply to keep an animal alive.If an animal is having problems handling the treatment, it is changed or discontinued.Veterinarians do not want the treatment to be worse than the disease.

Cancer will cause a variety of clinical signs, depending on where the cancer is. Most cats with cancer will have weight loss, elevated white blood cell counts and anemia.The blood tests available today are not geared to specifically detect cancer.Testing for cancer markers in the blood of cats is not as advanced as it is in humans, but expect the technology to be available in the future.
Diabetes Mellitus

A cat with diabetes mellitus is unable to properly use glucose,which is the major source of energy for the body.The cat will eat food and produce glucose in the blood,but that glucose will not be transported into cells for nourishment,so even though the cat is eating,her body starves. The clinical signs associated with diabetes are similar to those of chronic renal disease. Diabetic cats have voracious appetites, and they typically drink a lot of water,urinate a lot and lose weight. The condition arises when the islet cells of the pancreas are unable to produce enough insulin to metabolize the glucose.Insulin is the hormone that allows glucose to enter cells in the body.Most diabetic cats need to be given insulin injections twice a day. Chapter 18 contains more information about diabetes in cats.
Inflammatory Bowel Disease

Inflammatory bowel disease (IBD) is a problem that affects the lining of the stomach and/or intestines. Cats with IBD typically have vomiting and/or diarrhea that does not respond to conventional remedies.To definitively diagnose IBD, biopsies of the stomach and intestine are needed.Biopsies can be obtained using an endoscope (a tube with tiny instruments at the end that is passed down the cat’s digestive tract— under anesthesia,of course) or through exploratory surgery. Treatment for IBD involves reducing inflammation, controlling infection and, usually, long-term medication. The prognosis for cats with IBD is good, but IBD can progress in some animals to a type of cancer called intestinal lymphosarcoma. Chapter 14 contains more information about IBD in cats.
Liver Disease

The liver is a vital organ responsible for digestion,vitamin and mineral storage,metabolic processes and removing wastes from the bloodstream. If it is not too severely damaged by disease,the liver can regenerate.

In a geriatric cat, the liver can become inflamed, infected or cancerous and stop functioning normally. Signs of liver disease include jaundice (yellowing that is especially visible in the eyes), vomiting, weight loss and anemia. Blood tests and palpation of the liver provide clues, but most liver disease can only be diagnosed by a liver biopsy.Biopsies can be obtained through exploratory surgery or with a needle guided by ultrasound. Chapter 14 contains more information about liver disease in cats.
Heart Disease

Cats do not develop arteriosclerosis—clogged arteries that impair blood flow to the heart and lead to heart attacks in humans. Instead, most feline heart disease occurs in young and middle-aged cats.When a geriatric cat experiences heart failure, it is usually in connection with another illness. As mentioned earlier, a common disease in older cats is hyperthyroidism, and when this condition is not controlled, heart failure can occur.The heart muscle simply wears out after being overstimulated for a period of time.When the heart fails, the rhythm of the heartbeat is affected,fluid can pool in the chest and circulation can be impaired. Signs of heart disease include weakness,panting,open-mouth breathing and coughing. Diagnostic tools available to evaluate heart disease include X rays,ECG (electrocardiography) and ultrasound (echocardiography).Chapter 16 contains more information about heart disease in cats.
Neurological Disease

Seizures are periods of abnormal electrical activity in the brain. If an older cat has a seizure, possible causes may be hypertension, metabolic imbalances or cancer.When routine diagnostic testing does not pinpoint a cause,other tests are available. To evaluate the neurological system of a cat, tests may include a cerebral spinal fluid tap (CSF),magnetic resonance imaging (MRI) and computer-assisted tomography (CAT scan). Chapter 19 contains more information about neurological disease in cats. Cognitive dysfunction is another neurological disorder occasionally seen in senior cats.It is characterized by disorientation and confusion, disturbances of the sleep-wake cycle,reduced social interaction and loss of housetraining.These signs must be present in the absence of hormonal or metabolic imbalances, medical diseases and other neurological problems to make the diagnosis. The diagnosis is tentative

without a brain scan and cerebrospinal fluid (CSF) analysis—a laboratory test that examines a sample of the fluid surrounding the brain and spinal cord.The drug selegiline (l-deprenyl) is used to treat cognitive dysfunction, because it can increase dopamine levels in the brain (dopamine is a chemical transmitter that carries nerve signals across the spaces between nerve cells).
Lung Disease

Cats who have had life-long asthma or long-standing infections can develop scarring in their lungs.As they age, the scarring can progress and cause respiratory collapse. Cats can die suddenly from respiratory collapse.If an animal’s lungs are unable to inflate properly,oxygen cannot enter the blood and the animal can suffocate. Fluid also prevents the lungs from expanding, and certain disease processes can cause fluid to build up in the lungs (pulmonary edema) or within the chest cavity (pleural effusion). Both of these are potentially life-threatening conditions. Cats who are having problems breathing will often sit upright,cough, breath with their mouths open and clearly appear to be in distress.They need immediate veterinary help.X rays of the chest cavity and removing a small amount of fluid or lung tissue with a needle for examination (called needle aspiration) can help diagnose the cause of lung disease. Chapter 13 contains more information about lung disease in cats.
KEEPING YOUR OLD FRIEND COMFORTABLE

As different parts of the body wear out,it may be difficult for a cat to maintain her regular activities.If you have an older cat,you want to be sure to make things as easy as possible for your old friend. It is common for vision and hearing to be impaired as a normal part of the aging process, although it is unusual for a cat to go completely blind solely due to aging. If vision is compromised, the animal can

usually see better in daylight than at night.She will do better if important items such as food bowls and the litter box are always kept in the same areas where she can easily find them. Although it is best to keep all cats indoors, it is extremely important to do so if your cat is deaf.Complete deafness occurs occasionally in older cats.You should not let a deaf cat outside alone, because she will not hear noises that would normally alert her to danger,such as the sound of approaching cars.
The Importance of Water

Because kidney disease is so common in older cats,maintaining good hydration can make a big difference in how an older cat feels.At my clinic, we teach many owners how to give their cats fluid injections under the skin at home to help maintain or improve their pet’s hydration. This process is called subcutaneous administration of fluids. (The word subcutaneous is derived from sub,meaning below,and cutaneous, meaning related to the skin. Instead of going directly into a vein, fluids injected in this manner are absorbed by the blood vessels under the skin.) It is difficult to make a cat drink under the best of circumstances, but it is even harder when the animal is dehydrated and weak. Depending on the cat and the owner,giving subcutaneous fluid injections can be easy.If this is something you would be willing to try,you should discuss the procedure with your veterinarian.
Senior Nutrition

Because they are not building muscle and are less active than younger cats, senior cats need less protein and fewer calories.As a cat ages, the digestive and absorptive processes of the gastrointestinal system can become less efficient.Many companies produce “senior”or “geriatric” diets formulated for these situations.However,an active,healthy senior cat does not automatically need to be eating a senior diet.Discuss your cat’s condition with your veterinarian before you switch her diet. Dental disease is common in older cats and can affect how much and what a cat will eat. Dental health should be assessed at each veterinary visit,and the diet changed to accommodate the cat’s dental function. Softer foods that require little or no chewing may help an older cat. For a cat with a poor appetite,dense foods that provide a lot of nutrition in a small quantity can be appropriate.It is always important for a senior cat to eat and at least maintain her body weight.

Arthritis

It is inevitable that joints will develop at least some mild arthritic changes over time. Arthritis, or degenerative joint disease (DJD), can cause pain and restrict a cat’s movement.If a cat cannot get around well, she may not be able to perform her normal functions. Arthritic cats who spend time outdoors are in danger because they cannot run and jump as well as they might need to in a dangerous situation.When joints hurt,it is more difficult to jump down from places the cat has jumped up on. It is a good idea to start keeping an older, achy cat indoors for her own protection. The location and type of litter box might need to be changed for an arthritic cat.You want to make it as easy as possible for the cat to get in and out. Consider uncovering a hooded box or getting a box with lower sides if the cat is having a hard time using it. The placement of food and water bowls should also be considered. If a cat cannot move her head and neck well,elevating the bowl could make a big difference in her ability to comfortably eat and drink. See Chapter 17 for more information about arthritis.
Kitty Comforts

Older cats can lose body fat and muscle.They can become less insulated against cold temperatures and can develop calluses and “bed sores” when bony parts rub against hard surfaces cats lie on.Be sure your cat has something soft and warm to lie on, such as a towel, throw rug or kitty blanket that will keep her more comfortable.
Bugs and Pests

As horrible as it sounds,insects like to take advantage of weak animals. Older cats may not be able to move away or scratch when insects bother them.Insects want to get a meal as easily as possible,so if an animal is not shooing them off,they are going to stay and eat. Check your older animal for fleas and use flea control when needed.(Always make sure the product you are using is appropriate for older cats.) If the cat goes outside, monitor the areas she sleeps in and make sure ants are not bothering her.Also check to make sure that flies are not bothering an outdoor cat. Flies can lay their eggs on animals who don’t move away, and the eggs will hatch into maggots about 12 hours later.

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