Geriatric cats: care within the veterinary practice

Nutrition and hydration

Appetite and nutrition are very important elements of any patient's daily management in the veterinary practice and, as with any feline patient, the geriatric cat is unable to tolerate long periods of inappetance. Prolonged anorexia in the cat can be highly detrimental to its recovery and in some cases may lead to hepatic lipidosis. In order to ensure patients in the veterinary practice are provided with accurate nutritional support it is important to calculate each individual's daily feeding requirement. This should be accurately calculated based on the patient's weight and the kcal provided by the given feed. This allows veterinary staff to understand whether a patient is eating sufficient calories for its size and health status. The elderly cat's desire to eat can be highly influenced by food type, texture, bowl preference and external stimuli and it is not unusual for the cat to choose not to eat if one of these components is deemed unsatisfactory. The majority of hospitalised patients do not have voluntary food intake and this is often very true of the cat and therefore a combination of significant disease and preferential feeding behaviours are often enough to lead to long standing anorexia in the hospitalised feline (Michel, 2001).

Bowl selection is a vital consideration as its material, shape and size can all have an effect on the cat's desire to eat from it. Ceramic or glass food bowls are generally the most preferred choice as plastic containers can scratch easily giving off a slight odour that some cats may not like. Stainless steel bowls are highly practical, however may be considered problematic to some cats as metal can taint the taste of both foods and water and also its reflective nature can be distressing to some cats. Bowl shape and size is also very important as in general older cats do not like putting their face into a small bowl to eat and so are likely to eat best off flat, shallow dishes (Halls, 2010, 2015; Kerrigan, 2015). A change in senses means a geriatric cat's smell and taste can be vastly reduced and therefore feeding highly aromatic diets of warm temperature will greatly enhance interest due to increased palatability. The volume at which these meals are fed must also be considered as large meals can become over-facing for some elderly cats leading to food aversions. Smaller, more frequent meals or high calorific content are generally more readily accepted and can provide valuable mental stimulation and interaction time between patient and nurse (Kerrigan, 2015).

The geriatric cat is vulnerable to dehydration especially when suffering from some degree of renal disease. It is understood that chronic kidney disease (CKD) may affect 30–40% of cats aged over 10 years (Sparkes et al, 2016), which reduces their kidney's ability to conserve water and hence causes dehydration. It is therefore important to monitor water intake of all hospitalised geriatrics to ensure they are adequately hydrated. Increasing the fluid content of their food may assist with this in patients that do not ingest sufficient fluid to meet their daily metabolic requirements. Raised water and feed bowls can also increase an older cat's comfort while drinking and eating (Kerrigan, 2014), as they are not required to lower their heads as far which may prove painful if they are suffering with stiffness or discomfort in the neck, shoulder or forelimbs (Figure 1).

Elimination

Elimination changes are not uncommon in the ageing cat and inappropriate toileting may be noted (Neilson, 2014). The type of litter tray and substrate must be carefully selected to enable the geriatric cat to toilet comfortably. Low sided trays allow easier access in and out and reduce strain on painful joints, or fracture sites. The fracture patient may also benefit from the use of just an incontinence sheet with litter placed. Substrate choice may also affect a cat's toileting behaviour: hard litters may be painful to dig in and uncomfortable under foot making it difficult for the geriatric cat to stand on them for any length of time. Softer sand-like substrates provide a more comfortable surface and easier material in which to dig.

Bedding choices

Body condition tends to be greatly affected in the geriatric cat with fat and muscle coverage reduced. Bony prominences are more pronounced which can cause pain and stiffening of the joints during prolonged rest periods. Appropriate bedding choices are therefore paramount in providing thick padded surfaces on which they can rest. Nurses should ensure the hospitalised geriatric cat is provided with a soft, thick bed to reduce stress on painful joints, promote thermoregulation and avoid urine scalding if incontinence is of concern. Hydrophobic veterinary beds are most suitable for this as they provide a thick heat retaining pile on top while encouraging any fluid to pass to the base layer keeping the top dry. Where a patient has not been seen to use its litter tray throughout the day, bedding should be frequently inspected to ensure it has not been soiled. This will avoid urine scalding and patient distress. Where bedding remains unsoiled and clean it is a good idea to avoid changing it too often to allow the cat to build up its own scent (author's experience). Where hypothermia is of concern, e.g. in recovery post medical/surgery procedure, the use of heat mats may be indicated, but the temperature must be monitored regularly to avoid over heating if mobility is reduced (Figure 2).

Wellbeing

Ageing animals are often less likely to cope well in a novel environment than younger ones, and the veterinary practice brings lots of new noises, smells and change to a cat's normal routine. For some geriatric individuals cognitive impairment may be present making disorientation and confusion more likely. These cases benefit greatly from time, effort and social interaction in a calm, cat-friendly environment (Landsbery et al, 2010; Gunn-Moore, 2014). Providing rest periods is also essential to avoid upsetting well established sleeping patterns. Scheduling a period of ’quiet time’ in the ward with the lights off allows elderly cats to catch up on much needed sleep; this often works best if the ward nurse selects a time each day between patient checks when least intervention is required, this will then give an hour or more of quiet time in the day when ward access can be restricted.

Encourage owners to bring bedding from home to leave with their cat if it is likely to be hospitalised for a prolonged period as familiar home smells can often help alleviate stress (Rodan et al, 2011). The use of synthetic pheromones within the ward may also help instil calm and improve demeanour in some patients (Griffith et al, 2000; Rodan et al, 2011).

Spending time with inpatients when medications or checks are not needed to be carried out is also highly valuable as it allows them to receive un-invasive nurse contact. In the author's experience spending some time providing TLC (tender loving care) to a cat can aid in improving its demeanour. Skin and fur condition may be significantly reduced in the ageing cat due to a reduction in mobility and thus a decrease in the ability to groom. Cats will often become matted and grooming can be uncomfortable due to painful joints (Urquhart, 2001). Care must be taken during grooming and it is often advisable to use softer brushes to increase comfort and compliance.