As cats become elderly they are at increased risk of developing both health and behaviour problems (Gunn-Moore, 2011; Caney, 2014). These can be detrimental to the welfare of the elderly cat, and if they result in cats showing behaviours that are problematic to their owners, such as house soiling and excessive vocalisation at night, they can also be detrimental to the human–animal bond, increasing the risk of elderly cats being abandoned, rehomed or euthanased (Gunn-Moore, 2011; Landsberg et al, 2011; Halls, 2018).
There are two main areas where veterinary nurses can usefully support owners of elderly cats. They can encourage and make it easier for owners to bring their cats to the surgery for regular health checks, as earlier diagnosis and treatment will improve the prognosis for many health problems. They can also ask about and provide advice on any behaviour problems that arise, including advice on simple changes that can be made in the home to support cats that are becoming less mobile or that have cognitive or sensory deficits.
The importance of diagnosing and treating health problems in elderly cats
Elderly cats are susceptible to developing a number of different health problems that can adversely affect their welfare and may also result in behaviour changes. The most common medical conditions affecting health and behaviour in elderly cats (Gunn-Moore, 2011; Caney, 2014) include:
The sooner a medical condition is diagnosed the better the prognosis for treatment is likely to be, as well as improving the welfare of the cat. However, cats often do not show obvious clinical signs in the early stages of disease, so owners may not be aware that there is a problem (Caney, 2014). Regular health checks are the best way to identify diseases early, but owners of elderly cats may be reluctant to bring them in for health checks. This may be because they do not see the need in a cat that seems to be fine, because they are concerned about costs, or because surgery visits are stressful for the cat, and therefore for the owner (Caney, 2014).
Veterinary nurses can play an important role in encouraging owners of elderly cats to bring them into the surgery for regular health checks, both through educating owners on why this will be beneficial for their cat's health and welfare, and also through making surgery visits less stressful for both the cat and owner. For more information on minimising stress associated with travel and with surgery visits see Rodan et al (2011), Atkinson (2018) and Endersby (2018).
Nurse clinics can be very useful for initial screening for health and behaviour problems, particularly if they allow sufficient time to discuss the owner's concerns about their cat's health and behaviour in detail and also to allow time to examine the cat in a way that is minimally stressful for them. The cat can be referred on to see a veterinary surgeon if there are concerns that they could have a health problem (Eyre, 2018). Nurse appointments also provide opportunities to offer support to owners of elderly cats with or without chronic health or behaviour problems, including advice regarding simple changes that can be made in the home to help elderly cats feel more secure and enable them to access resources and important parts of their environment. Promoting nurse appointments for senior cats on social media and in waiting room displays provides a good opportunity to point out the benefits of regular health checks to owners.
Providing behavioural support for elderly cats and their owners
Identifying changes in behaviour in elderly cats
Behaviour changes in elderly cats can occur as a result of underlying medical problems, learning or as a result of increasing anxiety. The most common problem behaviours reported in elderly cats (Gunn-Moore, 2011; Halls, 2018) include:
In addition, many elderly cats are anxious, and this can reduce their ability to cope with changes in their routine and environment, can make veterinary visits more stressful, and potentially increase the chances of them showing stress-related problem behaviours at home including urine marking, overgrooming or hiding.
It is important that veterinary surgeons and veterinary nurses ask owners about their cat's behaviour at every visit, as owners do not always volunteer this information during consultations (Landsberg et al, 2012). It is particularly important to ask about any recent changes in the cat's behaviour. It may help to use a check-list, as outlined in Table 1.
| Behaviour changes noted | Increased (or yes) | Same (or not sure) | Reduced (or no) | Description if relevant |
|---|---|---|---|---|
| Mobility | Ability to jump up onto or down from high surface | |||
| Ability to go up or down stairs | ||||
| Ability to use cat flap | ||||
| Amount of time spent outside | ||||
| Any sign stiffness or lameness? (Y/N) | ||||
| Any change in where the cat spends time outside the house? (Y/N) | ||||
| Activity | Amount of time spent sleeping during day | |||
| Amount of time spent sleeping at night | ||||
| Activity levels generally | ||||
| Amount of time spent playing with toys | ||||
| Amount of time spent hunting birds, mice etc. | ||||
| Interactions with people and other pets | Frequency of interactions with the owner or other family members | |||
| Type of interactions with owner or other family members | ||||
| Frequency of interactions with other pets in the home | ||||
| Type of interactions with other pets in the home | ||||
| Tolerance of being picked up by owner | ||||
| Vocalisation frequency | ||||
| Vocalisation volume | ||||
| Cognitive ability | Any sign of confusion or forgetfulness? (Y/N) | |||
| Does the cat ever appear to be ‘lost’ in the house or garden? (Y/N) | ||||
| Toileting behaviour | Frequency of urination | |||
| Frequency of defecation | ||||
| Any change in location of urination? (Y/N) | ||||
| Any change in location of defecation? (Y/N) | ||||
| Does the cat have accidents outside the litter tray? (Y/N) | ||||
| Eating and drinking | Any changes in appetite? | |||
| Any changes in frequency of drinking? | ||||
| Changes in preference for eating wet or dry food? (Y/N) | ||||
| Grooming behaviour | Has the cat's grooming behaviour changed in frequency? | |||
| Have the areas groomed changed? (Y/N) | ||||
| Does the coat look well-groomed or unkempt? (Y/N) |
This information can potentially provide pointers to the presence of a number of underlying medical conditions such as osteoarthritis, dental disease, sensory loss, cognitive dysfunction and endocrine disorders, as well as problem behaviours including house-soiling and excessive vocalisation. Further investigation of any suspected medical or behavioural problems can then be arranged. Using a check-list can potentially allow comparison of behaviour from one visit to the next (Gunn-Moore, 2011).
Advice to help owners improve the home environment for elderly cats
Owners can improve the welfare of their elderly cats and reduce the likelihood of them developing behaviour problems, such as house-soiling, through making simple changes to the environment at home. Veterinary nurses should be able to advise owners about the types of changes that would be beneficial for elderly cats generally and also those that might be particularly useful for a cat with specific health problems. Advice can be provided in the form of discussion during a consultation, and also through providing handouts.
Enabling easy access to important resources.
All cats need to be able to move freely around their environment and access important resources easily. Important resources include food, water, comfortable resting places, toilet locations and places to withdraw or hide if the cat does not wish to interact with people or other animals in the home. Elderly cats with medical problems affecting their mobility or sensory abilities, or cognitive dysfunction, which can be associated with impaired spatial awareness and navigational ability, can find this particularly difficult (Gunn-Moore, 2011).
Location of resources
Cats naturally prefer to eat, drink and toilet in separate locations, so it is important to space these resources out carefully while ensuring they are all easily accessible from the cat's resting area (Gunn-Moore, 2011). For cats that spend time on different floors in the home it is sensible to locate a full set of resources, including a litter tray, on each floor, so cats can always access them easily wherever they are. Once resources have been located appropriately they should always be kept in the same places so the cat can find them easily.
Increasing accessibility to food and water
In addition to providing food and water in slightly separate locations, it is a good idea to raise bowls off the ground by a few inches to enable cats with joint and spinal problems to eat and drink more comfortably, for example by standing them on a solid block or upturned box. Cats that are used to being fed on a raised surface, such as a window sill or worktop, may need a ramp or steps to enable access, or if this is not possible, food and water should be provided in more accessible locations.
Elderly cats sometimes have reduced appetites, and owners may need to experiment with offering different types and textures of foods, offering smaller, more frequent meals, or warming the food a little to encourage their cat to eat (Eyre, 2018). It is also important to ensure elderly cats can always access drinking water as they can become dehydrated fairly easily. It can help to provide a variety of different drinking containers around the cat's environment (Figure 1).
Increasing accessibility and attractiveness of toilet locations
Many house-soiling problems occur because cats have difficulty accessing an appropriate toilet location. Cats with mobility problems usually prefer large, low sided litter trays (Halls, 2018). Low sided trays are easier to get into and out of than high sided trays, and larger trays are much easier to turn around and crouch in, especially for cats that are stiff. A gardener's potting tray can make a good ‘walk-in’ litter tray. Trays may need to be cleaned more often, especially if cats have polyuria or digestive problems. Finer grained litters may be preferred because they tend to be more comfortable under the paws and easier to dig than coarser litters. Cats that have previously toileted outside may no longer be able to access these locations and, to prevent house soiling, will need to be provided with litter trays indoors. Cats with cognitive dysfunction often have impaired spatial navigation ability and can get stuck in corners or behind furniture. It is therefore sensible to avoid putting litter trays in corners or behind furniture.
Sleeping and resting areas
Beds should be comfortable and padded, easy for the cat to get into and out of, and large enough for them to lie out flat if they wish. Cats prefer to rest in raised places where they can feel safe and where they can observe household activity from a safe distance (Figure 2). They also use raised places as a means of avoiding things that scare them. Cats with mobility problems may need ramps or steps in order to access these locations. Elderly animals can become cold very easily. Sleeping areas should be kept warm, especially at night in the winter, and electrically heated beds may be welcomed. A Feliway diffuser (Ceva) plugged in close to the cat's bed may help reduce anxiety and help the cat settle better at night.
Moving around inside and outside the house.
Non-slip matting or carpet in locations of important resources and on the walkways between important areas can improve accessibility for elderly animals with mobility problems.
Cats with mobility problems may no longer be able to use a cat flap so owners will need to let them in and out, unless they prefer to stay indoors.
Unfortunately cats with cognitive dysfunction often become disorientated and may get lost outside the house, even close to home. They are also at increased risk of injury, for example through road traffic accidents, as are cats with mobility problems and sensory loss. Some elderly cats prefer to remain indoors, but if cats do want to go outside they can do this more safely if the cat will wear a harness, or possibly by fencing the garden to prevent the resident cat leaving and other cats entering (see Fencing in your Garden: http://icatcare.org/advice/fencing-your-garden).
Maintaining a constant environment for very anxious cats
Elderly cats that are very anxious, and those with severe cognitive dysfunction, can find changes in their routine and environment extremely stressful and will benefit from a consistent routine and environment. They may cope best when restricted to a single room containing food, water, a litter tray, resting and hiding places. It is important to keep furniture and resources in the same places and to avoid big changes in the scent profile of the room, for example avoiding the use of strongly-scented cleaning products or air-fresheners, as these can be very challenging for cats. It can also help to maintain a fairly consistent routine, ensuring that important events such as feeding, owner interaction and litter tray emptying occur in the same order and at approximately the same times every day.
Social interactions with owners
As cats become older their requirement for social interaction with their owners may change. Some cats may become more withdrawn and interact less, while others may try and initiate interaction more often, for example using vocalisation.
Play
Owners should be encouraged to play with older cats, although games will need to be tailored to the individual animal according to any mobility problems or sensory deficits they may have. Short play sessions with fishing rod toys or toys that roll and/or make sounds will suit most cats. Searching for smelly treats can also be an enjoyable activity, even for cats with vision or hearing loss. Cats often get bored of toys quite quickly so rotating toys every few days can help them remain interesting.
Grooming and claw trimming
Elderly cats may not be able to groom themselves thoroughly, so their coats may become matted. Owners need to be prepared to groom them more often, but this must be done gently, especially if the cat has lost weight so that the bones are prominent. Claws will also need to be trimmed more often to prevent them becoming overgrown. If owners are unable to do this themselves they will need to bring the cat into the surgery more frequently to have their claws trimmed. Dealing with excessive vocalisation, especially at night Excessive vocalisation, especially at night, is not uncommon in elderly cats and can be a significant source of distress for owners (Halls, 2018). This behaviour often occurs due to separation-related distress, but can be exacerbated by a number of medical conditions that either cause the cat to be unsettled at night or increase anxiety and confusion. These include pain associated with dental disease or osteoarthritis, hyperthyroidism, hypertension, sensory loss and cognitive dysfunction (Halls, 2018). It is important that any underlying medical conditions are identified and treated. However, owners may also need advice on how to manage cats showing this behaviour, particularly to ensure they are not inadvertently reinforcing the unwanted behaviour by giving attention or food.
Social interactions with other cats in the home
Relationships between animals that have previously got on well can sometimes break down when one animal develops age-related health problems or cognitive dysfunction (Cory, 2013; Landsberg et al, 2013).
Reducing competition for resources
It is important to minimise competition for resources by providing extra sets of all important resources in different locations in the home. Owners of cats with polyphagia or polydipsia must be advised to provide extra sources of food or water, and may need to separate the cats at potential problem times such as meal times. Elderly cats may particularly value warm resting places and it is sensible to make sure there are a number of these accessible to reduce competition and tension between cats.
Dealing with the loss of a companion cat
Elderly cats that have lived together for many years and been strongly bonded to another cat may struggle and grieve after the loss of the other cat. If this happens, owners will need advice regarding how to support the remaining cat. This will include keeping routines and interactions the same, and ensuring the bedding etc smelling of the other cat is not removed too soon so the scent reduces gradually. A Feliway diffuser in the cat's resting area(s) may also help them feel more secure. Owners often find this period of grief very upsetting, but cats generally adjust after a period of time. It is essential that owners understand that they should not go out and replace the lost cat with a new kitten, as this will not be a substitute for the cat that was lost, and instead is likely to be a significant source of stress for the older cat.
Conclusion
Veterinary nurses can play an important role in supporting elderly cats and their owners, resulting in improved welfare for elderly cats throughout their later years and improved quality of life for both cats and their owners. It is important to encourage owners of elderly cats to bring them to the surgery regularly, and to ask about changes in their behaviour every time they come. This should enable health and behaviour problems to be identified and treated earlier, improving the prognosis for treating them as well as improving the welfare of the elderly cat.
Other resources for veterinary professionals and owners
Caney S, Halls V. Caring for an elderly cat. 2016. Vetprofessionals (available as an ebook or paperback).
ISFM/CEVA Booklet: Practical recommendations on the measurement of indirect blood pressure in cats. https://icatcare.org/sites/default/files/PDF/CEVA-BP-Booklets/ISFM%20BP%20recommendations%20English.pdf