Geriatric and Hospice Care for Veterinary Technicians
Key Terminology in Geriatric and Hospice Care
Decubital ulcers: Pressure sores or bedsores that develop over bony prominences in recumbent patients.
Geriatric: Pertaining to the branch of medicine dealing with the problems and diseases of old age and aging individuals.
Hospice: A type of care and philosophy of care that focuses on the palliation of a chronically ill, terminally ill, or seriously ill patient's pain and symptoms, and attending to their emotional and spiritual needs.
Polyphagia: Excessive hunger or increased appetite.
Defining Life Stages in Dogs and Cats
Life stages are not universal; they differ significantly based on the animal's health status, size, and breed. The following ranges are standard classifications:
Large and Giant Breed Dogs: * Senior: Individuals aged years. * Geriatric: Individuals aged years and older.
Standard Dogs: * Senior: Individuals aged years. * Geriatric: Individuals aged years and older.
Cats: * Senior: Individuals aged years. * Geriatric: Individuals aged years and older.
Fundamental Considerations for Geriatric Care
Geriatric care requires a shift in focus due to fundamental differences in disease processes, behavioral traits, and nutritional requirements found in older animals.
Impact of Early Intervention: Prevention, early detection, and timely intervention significantly improve the lifespan and quality of life for aging dogs and cats.
Care Components: * Owner Education: Informing clients on what to expect during the aging process. * Disease Prevention: Implementing strategies to ward off late-life ailments. * Early Detection: Identifying medical and behavioral problems at the earliest stage possible to ensure a better prognosis.
Clinical Frequency: Active geriatric monitoring should ideally begin at years (the senior life stage). * Physical Examinations: Should be performed twice per year (bi-annually). * Diagnostic Screening: Routine screening for underlying issues. * Chronic Illness Management: Patients with existing chronic conditions require more frequent examinations.
Physiological and Metabolic Changes in Aging
The geriatric stage is characterized by a progressive decline in the function of multiple body systems:
Metabolism and Activity: * Metabolic rate decreases alongside a reduction in physical activity. * Caloric intake must be decreased by to prevent obesity. * Body composition shifts: the percentage of body fat typically increases while muscle mass decreases.
Physical Condition: * Skin: Becomes thickened. * Skeletal system: Bone mass is lost, often leading to osteoarthritis.
Immunity and Health: * The immune system becomes less capable of warding off infections. * Increased risk for the development of autoantibodies and immune-mediated diseases.
General Decline: Functional decline affects organs, sensory perception, and mental acuity.
Comprehensive Clinical History and Annual Screening
Accurate history taking is vital for geriatric patients. Veterinary technicians should inquire about:
Appetite and Bowel Movements: Any changes in food intake or stool consistency.
Hydration: Changes in drinking (polydipsia) and urination (polyuria).
Activity Level: Sudden changes in energy or mobility must be investigated.
Family Interaction: Changes such as suddenly hiding or becoming excessively clingy.
Medications: Current drugs and supplements being administered.
Annual Diagnostic Tests for Geriatric Patients:
Complete Blood Count (CBC) and Chemistry screen.
Urinalysis.
Blood pressure monitoring.
Chest and abdominal radiographs.
Thyroid testing.
Ocular pressure screening.
Electrocardiogram (ECG).
Common Geriatric Pathologies and Symptoms
Older pets frequently present with vague symptoms such as inappetence, lethargy, and weight loss. Specific conditions include:
Oral Health: Technicians must weigh the necessity of anesthesia for professional cleaning against the efficacy of at-home care. * Complaints: Halitosis (bad breath), difficulty chewing, holding food in the mouth, and excessive salivation.
Cardiac Disease: Auscultation is critical for detection. * Small Breeds: Frequently experience thickening of heart valves and chronic valvular disease. * Large Breeds: Commonly develop dilated cardiomyopathy. * Cats: High incidence of hypertrophic cardiomyopathy (HCM). * Complaints: Fatigue, exercise intolerance, collapse, and coughing.
Respiratory Disease: * Complaints: Coughing, exercise intolerance, and increased breathing rate or effort.
Neoplasia: Early detection is the most crucial factor for treatment success.
Kidney Disease: * Complaints: Polyuria/polydipsia (PU/PD), anorexia, weight loss, and muscle weakness. * Management: Treatments aimed at slowing progression include diet changes, fluid support, and specific medications.
Incontinence and Neurological Issues: * Urinary and fecal incontinence may stem from neurologic disease or spinal cord abnormalities. * Neurologic abnormalities may include inflammation or neoplastic lesions. * Mentation Changes: Symptoms include confusion and altered sleep-wake cycles.
Orthopedic Disease (Osteoarthritis/DJD): * Management: Weight control, physical therapy/rehabilitation, and household modifications. * Pharmacology: Use of nutraceuticals, anti-inflammatories, and pain medications.
Endocrine Disorders in Geriatric Patients
Hyperthyroidism
Prevalence: Common in middle-aged to older cats.
Pathophysiology: Excessive production of thyroid hormone.
Signs: Increased metabolic rate, polyphagia, weight loss, PU/PD, vomiting, and life-threatening cardiac complications.
Treatment Options: * Radioactive iodine therapy. * Anti-thyroid medication (Methimazole). * Surgical removal of the gland. * Iodine-restricted diet (e.g., Hill's Prescription Diet Y/D).
Hypothyroidism
Prevalence: Common in middle-aged to older dogs.
Pathophysiology: Inadequate production of thyroid hormone.
Signs: Weight gain, lethargy, and muscle weakness.
Treatment: Oral thyroid hormone supplements.
Diabetes Mellitus
Prevalence: Middle-aged to old dogs and cats.
Pathophysiology: Inadequate insulin production or insulin resistance (receptors fail to respond). Insulin is required for glucose to enter cells.
Signs: PU/PD, polyphagia, weight loss, and increased glucose in urine (which predisposes the patient to UTIs).
Prognosis: The #1 cause of death is euthanasia resulting from owner frustration with managing the disease.
Treatment: * Daily insulin injections (e.g., Vetsulin—note: this medication must be SHAKEN before use). * Significant diet changes.
Hyperadrenocorticism (Cushing’s Disease)
Prevalence: Mostly seen in dogs.
Pathophysiology: Excessive production of glucocorticoids (cortisol) from the adrenal cortex.
Signs: PU/PD, muscle wasting, increased appetite, pot-bellied appearance, and susceptibility to secondary skin and urinary infections.
Treatment: * Medication: Aimed at decreasing cortisol by promoting the destruction of adrenal cortex tissue or blocking cortisol production pathways. * Surgery: Removal of the adrenal gland. * Replacement Therapy: Possible use of glucocorticoids like Prednisone, prednisolone, or cortisone acetate.
Nutritional Assessment and Hospice Care
A proper nutritional regimen for a geriatric patient involves evaluating medical history, physical examination, and laboratory results to account for individual health challenges.
Principles of Hospice Care
Hospice care provides a caring environment for the terminally ill, focusing on physical and emotional support.
Pain Management: Technician and owner collaboration is necessary to assess pain. Common drug classes include NSAIDs, steroids, opiates, and nutraceuticals.
Nursing for Recumbent Patients: * Decubital Ulcers: High-risk areas include the elbows, shoulders, tarsi, and hips. * Requires aggressive preventative measures and treatment.
Fluid and Bladder Management: * Subcutaneous Fluids: Owners are often taught to administer these at home. * Bladder Expression: Technicians must teach proper methods and cautions to avoid trauma. * Urine Scalding: Caused by urine remaining on the skin; requires specific treatment to protect the skin barrier.
Nutritional Support: * Appetite Stimulants: The underlying cause of inappetence should be identified before applying stimulants. * Feeding Tubes: Used to maintain nutrition. Benefits include consistent caloric intake when the patient is unable or unwilling to eat naturally.