Fearless columnist Natalie L. Marks is an educator, consultant and practicing Chicago veterinarian. Dr. Marks is a leader within the Fear Free movement, was a member of the original Fear Free advisory board and is Fear Free Certified Elite. She passionately believes that all veterinarians should be committed to the physical and emotional health of their patients.Read Articles Written by Natalie Marks
As of late, just about everyone I know is trying to invest in one of the world’s hottest industries — ours. And for a good reason. A recent Morgan Stanley report predicts that today’s $100 billion U.S. pet industry will explode to $275 billion by 2030. Among the reasons: the incredible upswing in new pet owners and increases in per-pet spending. While we don’t always know what the future will bring, we do know that during each trip around the sun by people and their pets, the human-animal bond grows stronger and becomes more central to their lives.
Given that many millennials and Gen Zers view their pets as children, veterinary practices must reassess the patient and client experience. We need to enhance our services and how we communicate with pet owners. And as their pets grow older year by year, we should provide special guidance and support.
Here’s a quick refresh of a veterinary client’s journey from home to the practice and back and how we can best care for senior pets.
From Home to Hospital
We all know the frustration of having to wait for answers. Our clients feel the same way. When they forget to ask something and then call back and can’t reach us, they grow more frustrated, and our workdays and to-do lists become longer.
What to do? Help clients prepare for the visit. Post a checklist on your website, or when confirming an appointment, text “things to bring”: favorite treats, any needed support devices, a list of questions, previous medical records, and all current medications and supplements. Some patients might feel better smelling something from home, so ask the client to bring a toy, blanket or warm bed. While I know the load might be too much for some families to schlep to the hospital, others will welcome the opportunity to make their dog or cat more comfortable.
The efficient, proactive workflow at the hospital starts with the initial contact. Have your customer service representatives survey clients ahead of time about any sensory challenges of the patient, such as vision impairment, hearing loss or reduced motor skills. Knowing this information and noting it in the medical record will allow the veterinary team to prepare for the visit, building the trust of pet owners as they experience an individually tailored visit.
Try to keep senior pets on a routine as much as possible. In a perfect world, have the CSR team time a canine appointment for after the animal’s regular walk or before a mealtime. Hungry patients are more accepting of high-reward treats. Pet owners genuinely welcome schedule blocks for senior cats if possible.
The management team should inspect the hospital periodically to eliminate problem areas for senior patients. The strategy might include:
- Replace old fluorescent lights with high-efficiency incandescent bulbs. The buzzing from old light fixtures can be uncomfortable for dogs and cats.
- Play classical music or install white-noise machines to create a relaxing atmosphere for both the patient and owner.
- Apply a fresh coat of paint to the walls. (I suggest a pastel palette.)
- Upgrade floors to a grip and tread surface, which is essential for dogs. If a remodel is in your practice’s future, spend time with an architect to select flooring that is not only durable and easy to disinfect but also has better traction for aging dogs.
- Install a ramp for pets and their family members if stairs are the only way into the veterinary hospital.
Exam Room Etiquette
The COVID-19 pandemic significantly disrupted the appointment workflow. The idea of an exam room as just a seven- to 10-minute holding space needs to change. Instead, I like to think of the exam room as a warm, casual space where a pet owner and the veterinarian can sit and discuss the medical and behavioral needs of the furry animal.
Like in the rest of the hospital, find ways to better support a senior pet in the exam room. I always start with secured flooring and surfaces. If installing nonslip flooring isn’t possible, yoga mats are a cheap and easy alternative. Older pets might prefer to lie on a warm bed or blanket placed on the floor or exam table.
Some senior canines can benefit from toe grips placed over the nails for better security. Veterinary nurses can shine here by demonstrating how to apply toe grips and sending the owner home with newly purchased grips.
As for food, I think about ways to reward senior patients from the moment they see me so that they develop a positive association. Keep in mind that senior dogs and cats might take longer to eat due to dental disease or the loss of smell and taste. High-reward treats need to be presented in ways that are easy for the patient to see, smell and hold in the mouth. For example, treats can be warmed or broken into small, easily chewed pieces.
What’s also essential is to consider how older patients are touched. Many senior patients have arthritis, back pain, dental disease, chronic ear infections or all the above. Not only does this awareness dictate the need for pet owner education and recommendations about diagnostics and therapeutics, but it also should guide the order of the physical exam.
In a dog with severe otitis, don’t start with an otoscopy. In a cat with severe stomatitis, end with the oral exam. Strongly consider sedation if palpation of particular body parts is too much for a patient.
I encourage veterinarians to learn trigger-point massage. In this technique, the body is first scanned for warmth and areas of sensitivity. Once identified, gentle pressure is placed on the affected areas for five to 15 seconds and then lessened to release the muscle tension and relieve pain. The technique can be applied during the physical exam to make the senior patient more comfortable after range-of-motion movements or the palpation of sensitive areas.
One sensitive organ system we tend not to pay as close attention to is the skin. Many senior dogs and cats can develop drier and more fragile skin, and their hair can be more coarse or thinner in certain spots. Be considerate when palpating, restraining and administering injections or treatments.
And don’t forget your feline patients. Cats need the same security in footing. It can be achieved with a nonslip mat placed on the exam table, by strategically positioned scratching posts, ledges or trees, and by a warm, pheromone-impregnated towel.
Senior cats, especially those dealing with a metabolic disease like hyperthyroidism and chronic kidney disease, tend to have poor body condition scores and less-than-ideal amounts of lean muscle mass and fat, causing poor temperature regulation. On the other hand, warm bodies and warm joints are much more amenable to examination, specifically during range-of-motion exercises. And with more than 75% of senior cats showing signs of lumbar osteoarthritis and back pain, we want to detect the conditions while feline patients are visiting.
Tips for Home Enrichment
When pet owners are ready to go home, don’t let these senior considerations end in the hospital. Share information about enrichment ideas by email or on your website. In the exam room and lobby, you demonstrated how the right flooring, music, lighting and hands-on touch support senior pets and address their deficiencies and sensitivities. Here is what your clients can do to help senior pets at home:
- The logistics of feline food bowls are critical. Cats need a bowl location that lets them approach from any direction and is away from litter boxes and floor-to-ceiling glass windows. In addition, many senior pets have undiagnosed neck pain. Elevate their feeders or place food on shoeboxes so they don’t have to bend down to eat or drink.
- Speaking of litter boxes, a cat’s bathroom behavior and posture change with age. Therefore, encourage clients to invest in litter boxes that have low entryways. Also, the rule of “one litter box plus one” becomes more crucial with senior patients suffering from kidney disease, diabetes or other ailments that increase the need to urinate.
- Educate clients about metabolism changes in senior pets, especially the animal’s possible struggle to regulate body temperature. In a perfect world, set the home thermostat to 78 to 80 degrees Fahrenheit.
- Create a play corner for a senior dog or cat. Doing it helps keep the toys in one area for convenience and encourages pet owners to stimulate the animal physically and mentally every day. Anxiety increases as pets age, so continuous cognitive stimulation can help.
I’ve always felt that a pet’s senior and twilight years are some of the most precious and memorable times. As so many dogs and cats live longer and fuller lives, veterinarians can play a central role in the relationship by creating the experience that senior pets and their owners want.
Ask dog and cat owners to bring these pet items to the next veterinary appointment:
- Favorite treats
- Support devices
- Previous medical records
- Current medications and supplements
- Toy, blanket or warmed bed
WHAT’S NEW IN CAT CARE
The American Association of Feline Practitioners’ 2021 Feline Senior Care Guidelines can be found at catvets.com/senior-care. “The newly emerging concept of frailty is introduced in these guidelines and how practitioners can incorporate this into the senior cat assessment,” said task force co-chair Michael Ray, DVM. A client brochure is at bit.ly/3k7lEmN.