Ron Hines DVM PhD
|Kidney disease in your cat|
|A New Approach To Arthritis & Pain Control In Cats|
Healthy lifestyles we set for our cats don’t change with age. It’s jut that the bills don’t generally come due till late in life.
Veterinarians believe that about a third of a pet’s potential for a long and healthy life is determined by its genes. As a cat’s species life-limit approaches, that genetic component becomes more and more important. But that still leaves you with two-thirds – a great deal you can do to keep your cat healthy. Many of my articles discuss those lifestyle decisions – nutrition, environment, vaccination, specific disease and how to treat or avoid them. There is not much known about average life spans of cats in the United States; but it does appear that the number of cat oldsters has substantially increased in the last 20-30 years – probably because most of us now immunize them as kittens and keep them indoors where they are less subject to accidents and disease.
Some say that one year to a cat equals seven of our years. Actually a one-year-old cat is similar to a teenager – about 17 years of age. A two-year-old cat is about physically equivalent to a 24-year-old human. After that, cat years drop in relation to human years so that by 10 years of age, a cat will be equivalent to you when you are fifty. By the time a cat reaches fifteen it is nearer in cat-years to a seventy-three year-old person. My oldest feline patient was a twenty-three years old neutered male cat – equivalent to about a hundred and four year old man.
What Should I Feed My Elderly Cat?
Cats thrive on diets that are high in moisture (canned or fresh), relatively high in meat protein and fat, and balanced in essential minerals and nutrients. Pet food manufacturers and nutritionists rely on the National Research Council in formulating commercial diets. All National brands are quite similar in their nutrient analysis, but they often differ in their digestibility based on the quality of the ingredients used. Cats do not, by nature, thrive on carbohydrates or plant-derived proteins. Store isles are full of feline “life stage” diets. There is very little underlying science to support these nutritional formulas. My only suggestion is not to exceed NRC cat nutrition guideline on protein in elderly cats because of their high susceptibility to kidney decline. (ref) Wet, canned or fresh diets supply the extra water that older cats are often deficient in. (ref) But they also increase the rate at which a cat’s teeth forms tartar and periodontal inflammation. (ref)
Don’t feed your cat generic or house brand because their low price dictates that their ingredients be of lower quality. Mid or average priced cat foods tend to have better quality ingredients and most national brands market top-of-the-line premium formulas that are likely to be a bit better. Those are the brands I suggest.
I don’t recommend that you feed your cats the boutique, high-cost, brands sold in pet shops, by groomers or on the Internet either. The small companies that make them do not have the resources to do frequent quality control and analysis of their products. Many are produced by contract facilities, with just the sack, label and marketing left to the entrepreneur marketing the food. If a problem does occur, not enough pet owners use any particular one of these brands for the FDA to be alerted promptly. Products produced by small companies are also more likely to vary from batch to batch than those sold by larger food corporations. They also tend to sit on the store shelves longer and get stale.
Many of the private label brands, or their sub-ingredients, are manufactured by a few large US or foreign firms – so the only thing special that you have purchased is the bag, can or marketing campaign. By your pet foods where you buy your own food, after all, you already trust your health to them.
Should I Feed My Elderly Cat Canned Or Dry Food?
Over the years, most veterinarians, including me, recommended dry cat chows for all their feline clients. Vets noticed that cats on dry kibble tended to have cleaner teeth, less gum disease and less of a problem with obesity. Dry cat kibble also lacks can-liner chemicals that some veterinarians associate with hyperthyroidism (bisphenol-A). (ref)
We are less sure if that is reason enough to recommend dry diets now.
Dry cat kibble is very convenient for owners. It doesn’t smell like canned food does and it doesn’t spoil nearly as quickly as canned foods do once they are opened. It is economical and, theoretically, meets all of your pet’s nutritional needs. However, it is quite an unnatural diet for cats. Most dry cat foods are much higher in grain carbohydrates (and some in plant-based proteins) then cats were designed to eat. Some veterinarians associate the high carbohydrate content of many dry chows with susceptibility to diabetes. This has not been proven. Many dry cat foods have been sprayed with fats to make them more palatable. This fat can become rancid and unhealthy. But the biggest potential problem is that cats eating dry diets almost never drink sufficient water to equal the hydration they would get consuming a canned or homemade diet. Some veterinarians associate this potential dehydration with kidney disease, and bladder disease (struvite/oxalate crystals). This is, again, unproven. Dry cat foods are also more susceptible to bacterial contamination (salmonella, etc.) than canned foods.
Canned cat food, like dry chows comes in low, medium and premium formulas all related to the price of the product’s ingredients. If you feed them, stay with premium brands and feed a wide variety of flavors, not just one. Cats tend to prefer the taste and smell of pungent fish-based canned foods. But it has been my experience and that of other vets that cats do not thrive on canned, fish-based cat food when these are fed in excess or exclusively. (ref) Perhaps this is due to the very low quality (stale and partially decomposed,unsaturated fatty acids and lipid peroxides) of the fish products that generally end up in pet foods. (ref) If you must feed these fish products frequently, give supplemental vitamin E and B-1(thiamine).
If your cat allows you to brush its teeth or you feed a small amount of dry dental kibble at the end of the day, your cat’s teeth and gums should stay reasonably healthy into old age. Try some of the new, more effective dental chews for cats as well.
It is true that cats tend to prefer canned diets and eat more of it. That can be a problem if the cat gains too much weight. But you can control that by feeding no more that it takes for your pet to maintain a healthy body weight. Read about that here.
If you have the time and inclination, you can always prepare a home cooked diet for your cat. There is more information on that here. No factory is capable of turning out as healthy and tasty a product as you can in your own kitchen.
Regardless what food you decide to feed, make changes in your elderly cat’s diet slowly. Most cats are nibblers and intermittent feeders. They like to take a few munches, do something else for a while, and then return. This is not a problem with dry kibble cat chows, but canned food, left out all day can spoil. So canned foods are best offered in 4 or more spaced meals throughout the day.
Kidney and Urinary Tract Issues
Another important advantage of canned or moist diets over dry chows is that cats have a tendency to drink insufficient water to compensate for a dry chow or kibble diet. In the wild, the ancestors of your cat ate a diet of rodents and birds that was about 80% water. The signs of dehydration, as in humans, can be nebulous (vague) and only significant over time [ ref1, ref2, ref3]. More severe dehydration can accompany any disease in which apathy or reduced mobility occurs. If you do decide to feed your cat a dry diet, adding warm water to it prior to feeding is wise. However, if you do that, the possible increased dental issues need to be thought about too. Read some of your options on that here and here.
Should I Feed A Diet Formulated Especially For Senior Cats?
A lot of diets are marketed as “Especially For Senior Cats”. You will notice they are vague in describing how and why their “senior” diet differs from the Company’s diets for younger, mature cats. They’ll add a few ingredients with exotic names, tinker here, tinker there. That’s because none of these companies actually knows what changes in their diet formula – if any – might be best for older cats. But all major pet food companies feel compelled to offer one. Do they have a “Senior’s Only” isle of food at your regular supermarket?
Based on what we we know about older humans (70+), most of these “senior diets” have increased amounts of vitamin D and B6, calcium and fiber, with some added antioxidants and omega fatty acids thrown in for good measure.
Older cats do seem to have a reduced ability to digest fat and protein. Some studies have found that ~50% of cats 15-25 years old are underweight. That could be due to their reduced sense of smell and taste, decreased intestinal absorption, bad teeth or a side effect of one of the common chronic diseases of older cats – particularly hyperthyroidism and kidney disease. We really do not know. Several of these “Senior Diets” have fewer calories than those marketed for midlife. Be careful about using those if your cat is already thin. You can read a study that discusses diets for older cats here.
For examples, Nestle Purina (the makers of Purina, Purina One, Friskies, Arthur’s, Chef’s Blend, Fancy Feast, and Tender Vitals cat foods) dominates the international pet food industry. The Company has one of the best group of animal nutritionists in the World. Yet, the difference between their Senior and Adult formulas are insignificant. Their “Vibrant Maturity® 7+ Formula” differs from their regular adult formula only in fiber (5% vs. 2%) (by the addition of soybean hulls), slightly more calcium and less phosphorus and a slight increase in omega-6 fatty acids (1.6% vs 1.5%). In their Senior formula, they doubled the amount of vitamin E anti-oxidant and increased the amount of glucosamine by adding more poultry and fish bi-product meal. According to the information they provide on the senior product, it was not test it in old cats to see if it performed any better than their regular formula. (the AAFCO standards they quote are the same for both products). So although there is certainly no harm in feeding this senior diet, there is no proven benefit either.
If your elderly cat has a tendency to constipation, the extra bran fiber might be helpful. If you believe in the protective power of antioxidants, you should see to it that your pet receive them for its entire life. If your cat needs added fiber because it has diabetes, the added fiber might be helpful, however their senior formula is too high in carbohydrate for that use. Their increased glucosamine might help old cats that have arthritis. But the amount they consume will be less than with many feline joint supplements.
So, if you plan to offer your elderly cat a dry diet (which is not my first choice), a “Senior Formula” is a good food. But there is not much science to back up the minimal formula modifications that have been made.
Another problem with “senior” formulas is their one-size-fits-all caloric content. Many adult neutered cats tend to be too chubby – until they reach about 12 years of age. After that, many become too thin. Some gain or loose too much weight somewhat earlier or later. Overweight cats need a diet formula that is less caloric while underweight cats need just the opposite. It is the carbohydrate content that binds dry kibble during the baking process. Grain free does not mean carbohydrate free and these companies have not found a way around the need to have sufficient carbohydrates in their mix to produce dry, baked, cat food.
If your older cat is chubby, adding water to its diet might help keep it trim and active in addition to protecting its kidneys. Up to 30-40% water can be added to dry cat foods. (ref) That can be even more beneficial if your cat’s kidneys are not as efficient at filtering out waste as they once were (high blood BUN and creatinine).
Would A Vitamin Or Other Supplement Help My Elderly Cat?
If you are feeding a nationally marketed major brand of canned or dry cat food (with AAFCO or NRC standards), you do not need to add vitamins or minerals. If you feel your cat might benefit from anti-oxidants, Omega-3, or glucosamine/chondroitin supplements, it is perfectly fine to give them in doses proportional to their body weight – although the science behind their being helpful is not that strong. ( ref1, ref2) I prefer the brands marketed for humans – but given in proportion to a cats much lower body weight. Pets that are in decline, not eating properly, and pets that have digestive problems preventing proper nutrient absorption might benefit from added vitamins as well. A veterinarian who knows your pet personally needs to make that decision because too much of certain vitamins (D,A & E) can cause as many problems for your cat as not enough.
Is My Old Cat Too Fat? – What’s Wrong With A Chubby Cat?
Obesity is quite a common in older cats. The most common problems I see in overweight, older cats are diabetes and urinary tract problems. Fat cats are also less inclined to groom themselves adequately.
It is often said that overweight elderly cats are more prone to arthritis, heart disease, liver and pancreatic problems – and that may well be true. But I do not know of any studies that document it.
If your cat does not have a sluggish thyroid or an overactive adrenal gland (hypothyroidism, low F T-4, Cushing’s disease) its obesity is simply due to consuming more calories than it expends (burns). So you have three choices : feed the cat a less fattening diet, feed the cat less of what it is now eating or increasing its exercise. Hypothyroidism is quite common in dogs; it is quite rare in cats. Many more elderly cats have the opposite problem, hyperthyroidism. Those cats loose weight.
Reducing your old cat’s weight through increased exercise can be beneficial to its health. You can purchase a laser pointer, add cat furniture, leashed walks outdoors and any other encouragements to activity you can imagine. But those things will almost never be sufficient in themselves in getting your cat back to a trim, healthy weight. You will also have to make diet modifications.
Feeding a less caloric diet may be all you need to do. Some owners find that a diet higher in protein and lower in carbohydrate leads to gradual weight loss. Other cats loose weight on diets that are less caloric because they are bulked with fiber. Most of these feline weight loss diets are also reduced in their fat content, but fat content must not be reduced too much. Minimum fat requirements for cats are considerably higher than those for dogs. Another great way to reduce the caloric content of your cat’s current diet by adding ground cooked or pureed vegetables. Since cats are not, by nature, grazers, you will have to experiment to see which it handles well without, diarrhea, flatulence or bloat. Make these additions or changes slowly. Any diet change can bring on a a few days of loose stools that usually firm up again with time.
Your cat’s weight loss must be gradual. Cats that abruptly reduce their food intake are susceptible to hepatic lipidosis – a serious problem. A serious diet requires a serious scale, a diary, careful observation and lots of willpower on your part. If a cat is otherwise healthy, I begin by reducing its diet volume by ~15%. If you are using a new, lower caloric diet, follow the directions they provide – and be sure your cat is actually eating it. When changing your pet’s diet, always do so gradually – mixing a bit of the new in with the old. Some higher-fiber low-cal diets cause diarrhea, other cats just won’t eat them.
Is It Important That I Don’t See My Cat Drinking Much Water?
Elderly cats are more prone to dehydration and fatigue than younger animals. They are less likely to get up and seek out water and many have weakened organs that do not tolerate dehydration stress well. So keep several bowels of water out for your older cat.
Another potential problem veterinarians discuss is chronic dehydration. I know I keep harping about that. This is thought to occur when cats subsist primarily on dry cat food. Cats just don’t appear to ever drink sufficient water to compensate for the lack of moisture in dry, versus canned or fresh homemade diets. Cats that consume insufficient water can be more susceptible to urinary tract crystal formation (FUS) and, perhaps, kidney disease as well.
Bad thinks are known to occur in the children of human desert communities that do not consume enough water over time. (ref) The Worshipful Company of Cooks figured this out among the elderly downtrodden they cared for many centuries ago. (ref)
Thin cats can be more susceptible to dehydration because much of the body’s water is normally stored in muscle. Also, elderly cats with “weakened” kidneys (low specific gravity urine) cannot conserve their body water well. Much of the increased water they consume goes almost directly into their diluted urine.
Feeding a canned or high-moisture fresh home-cooked diet avoids these worries. If your elderly cat is less motile, scatter multiple water dishes around the house at its favorite locations – dishes that have low sides. (Sometimes a recirculating fountain or drippy faucet will draw their attention)
Giving A Hand With Grooming
Many elderly cats lack the energy and flexibility to keep well groomed without your help. It is particularly a problem in longer-haired cats, but mats along the spine and in the groin and armpits can occur in any oldster. Sometimes, the skin under these mats is quite inflamed. I prefer to remove these mats with a matting comb, a soft slicker brush and very carefully-used scissors. Groom your cat several times a week rather than letting the mats get large and out of hand. If at all possible do not take cats to grooming parlors or veterinarians for this service. It stresses cats out too much. You can have a trusted mobile van groomer visit your home. Long haired cats can be sheared at home twice a year. Again, have a mobile groomer do it in your home if possible. I prefer it not be attempted in their van. Cats can escape, and the van is not any less stressful than a grooming shop. Frequent brushing also prevents cats from binding up (constipating) with swallowed hair.
Be sure to check your pet’s claws as well. They overgrow in inactive cats. Elderly cats rarely if ever require a complete immersion bath. You can almost always clean them sufficiently with a soft wash cloth, infant-safe soap and warm water. Flea baths are a waste of time and very stressful to cats. Your vet has plenty of topical and oral products for sale that do a much better job.
Your Old Cat’s Kidneys CKD (= Chronic Renal Failure, CRF,CRD)
For an article on this subject alone, go here.
When elderly cats begin to fade, it is often because their kidneys are no longer working properly.
As cats age, there is a slow but steady decrease in the weight of their kidneys and a loss of filtering ability. Cats are born with a certain number of filtering apparatus in their kidneys (glomeruli and nephrons). These filters are lost when the walls of the blood vessels that form them thicken, scar and become blocked as cats age (the process is called chronic glomerulonephritis or chronic interstitial nephritis). Cats are born with extra reserves of glomeruli. But eventually, not enough of these toxin-filtering units remain functional. When that point is reached, wastes begin to build up in your cat’s blood stream. (a rise in blood BUN and creatinine) This is called uremia (azotemia). Many older cats are borderline uremic. Any stress that causes these cats to drink less can put them into a full-blown uremic crisis.
Diet and lifestyle can be risks for early kidney failure in cats. (ref) Some vets believe that low quality diet formulas (high in ash), increase the rate at which kidney damage occurs. And, as I mentioned earlier, some veterinarians also associate the kidney damage of older cats with chronic dehydration (not consuming enough water).
The two most common signs of CKD that owners observe are weight loss and increased thirst. The most common signs that veterinarians find are smaller and firmer than normal kidneys, an increased albumen in the cat’s urine, increased levels of urea nitrogen (BUN) and creatinine in the pets blood and an increase in blood phosphorus. However, the problem is stealthy. Symptoms and some of the abnormal lab test results do not occur until more than half of the pet’s kidney blood-cleansing abilities have been lost.
Examination of your cat’s urine for abnormal protein leakage is sometimes the earliest warning of kidney changes. The most sensitive tests currently available are the microalbuminuria test and the urine protein:creatinine ratio (Urine P:C). However, it is not clear if these tests will always predicts which cats need, or will need treatment because not all age-related kidney changes in cats lead to eventual illness. (ref)
Nothing will halt the gradual loss of your cat’s kidney’s abilities over time. It is a fact of aging and It happens to us too (ref). But there may be things that will slow it down. Keeping your cat well hydrated by feeding wet foods is one thing that may help. Another is the addition of antioxidants to its diet. Fish oils, containing omega-3 fatty acids might also slow the progress of kidney inflammation (ref) although to what extent, is unclear. Several pet food companies market diets for cats with kidney problems (eg Hills Prescription K/d, Purina NF, etc). Protein in those diets is of higher quality and furnished in smaller amounts based on the results of studies published a number of years ago. (ref) You can read all about these renal diets for cats here.
Keeping your cat’s teeth in as healthy a state as possible might also slow the inflammatory changes associated with CKD. (ref) We know that dental disease is associated with kidney failure in humans. (ref) You can read about all the things you can do to keep your cat’s teeth and gums healthy here.
Veterinarians and cat owners have always wondered why kidney failure is such a common occurrence in elderly cats. Some organ or system inevitably fails in all of us and we are always looking for reasons why that happened. Much of that cause-and-effect speculation turns out to be only an illusion. But there are veterinarians that are suspicious that the common vaccinations most cats receive might even play a part in kidney disease (ref) – another good reason not to over-vaccinate your cat.
Your Cat’s Creature Comforts
Making small modifications to your home and household routine can make life easier for your elderly cat. If they could, they would also tell you that they greatly appreciate a life free of disruptions and change.
A soft bed, in a quite, accessible location will be much appreciated. Get one that doesn’t have a lip on the front.
Many old cats appreciate added warmth on cold days. Either set your home thermostat higher or purchase a low wattage heating liner that warm to approximately 100° F. But be sure your cat is ambulatory enough to move to a cooler spot if it so desires.
Build or buy ramps to help your cat climb onto its favorite sofa or recliner.
Keep food and water bowls within easy reach. Use shallow bowls with low sides and keep water bowls in multiple locations around the house.
Purchase several easy-entry litter boxes.
Warmed, canned cat foods with pungent odors and a bit of added water to encourage picky eaters.
New pets – especially new cats – invading their space are never appreciated.
A gentle, house call veterinarian to avoid stressful trips to an animal hospital is always appreciated; as is a pet sitter when you travel. No matter what uplifting name they give a boarding cattery, how accommodating the staff, how pleasant the appearance, it will always be a flophouse in the eyes of your cat.
Loss Of Litter Box Training – Soiling In The House
This is a common problem in older cats. The first thing to do is separate a behavioral issue from a health issue. Some cats loose litter box training because they are old. (ref) , others, because they are stressed and still others because they are ill. These three causes occur in roughly equal numbers.
When removing inter-cat stress, other stressors, and dietary and home modifications do not solve the problem; your veterinarian needs to become involved. Blood and urine tests will check if a urine problem is due to urinary tract disease and other tests can rule out digestive tract disturbances and metabolic problems such as diabetes or hyperthyroidism.
Even arthritis can make cats reluctant to use their litter box. When an underlying disease has been ruled out, you will find my general suggestions in dealing with this problem here.
What Health Problems Are Common In Older Cats?
As I mentioned earlier, your cat’s kidneys are quite sensitive to the passage of time; so kidney (renal) failure is a very common health problem in older cats. High on the list are also cancers. For reasons unknown, cancers in cats are often more aggressive than those seen in dogs. These health problems often make their appearance between 9 and 11 years of age. By the age of 12 they are even more common. It is also common for oldsters to have more than one problem going on at a time. Hyperthyroidism, hypertension ( high blood pressure) and kidney problems – the trinity of feline health issues – often appear on your doorstep together. When your veterinarian runs blood tests on your older cat, the results will probably not be quite the same as they were when it was younger. You can read about some of those changes here.
What Changes In My Cat Might Alert Me To A Health Problem?
Behavioral and physical changes in an elderly cat are never a good sign. Of course, when a cat’s environment changes, that cat makes changes and adaptations. But otherwise, any changes in eating or elimination habits, weight, mobility, and daily behavior needs to be examined. Your veterinarian is the best person to do that.
Hyperthyroidism – A Common Problem In Older Cats
An over active thyroid gland is quite a common problem in older cats. Some owners mistake the symptoms of this disease for an unexpected burst of youthful energy. However, with time, it leads not only to weight loss and increased activity but to high blood pressure, digestive upsets, excessive thirst and urination, and heart and biochemical abnormalities. Luckily, most cases are quite easy for your veterinarian to diagnose (T4, TSH). In a few, more sophisticated thyroid tests may be needed to catch the problem.
Cats with this problem are best treated with radioactive iodine to destroy abnormal thyroid tissue but they can also be managed with a medication called methimazole (Tapazole). For more information on this condition you can read the article on hyperthyroidism in cats that I previously mentioned .
Hypertension – High Blood Pressure
Just as in humans, high blood pressure will eventually damage your cat’s body. It is harder to take the blood pressure of cats than it is of humans and the results are not always as accurate. But many veterinarians have the specialized equipment to do it. Agitation will falsely raise your cat’s blood pressure. So several readings need to be taken. Most vets begin treatment if your pet’s blood pressure is over 170 but some do not think it is warranted unless it is higher (180 mmHg). If your cat is over 8-9 years old, you might inquire if the test is available.
Most cats with high blood pressure have the problem because of hyperthyroidism and/or kidney disease. The most common sign that owners notice is reduced vision or blindness. High blood pressure slowly destroys small blood vessels. Those in the eyes, heart and kidneys are particularly susceptible. It is still unclear if kidney failure is causing the high blood pressure or vice versa. Perhaps both processes are at work.
Luckily, there are several medications that will help keep it under control. The one most commonly used is amlodipine (Norvasc, etc.). (This drug is in a group called calcium channel blockers). If your cat balks at accepting its daily pill portion, compounding pharmacies can prepare something less bitter.
Some veterinarians also recommend a reduced salt diet.
(My hypertension article was mentioned earlier)
Diabetes often strikes mature or elderly cats that are overweight. Owners usually bring these pets to veterinarians because of the large amount of water they are drinking, too much time in the litter box urinating or a sudden loss of weight. (A single elevated blood or urine glucose test does not prove that your cat is diabetic)
Some veterinarians associate diabetes with feeding diets that are too high in carbohydrates. Almost all cats with the problem do better on a higher protein, higher fiber, low carbohydrate diet. (ref)
Once your cat’s blood glucose level has been stabilized, having a blood Free T-4 and a urine microalbumin test is a good idea since elderly cats often have multiple health issues. You can read more about diabetes in cats here.
The Dangers Of Being Too Thin
As cats approach 12, they may have a harder time maintaining their traditional body weight. Those that are abnormally thin are at greater risk of dying, just as overly thin humans are.
It is wise to check the T4 (thyroid hormone) level of all elderly cats. Weight loss is one of the most common symptoms of hyperthyroidism that cat owners are likely to notice.
If you notice that your elderly cat has lost weight, the first thing to do is to have it examined by a veterinarian. The vet will do the routine tests that usually identify common diseases of older cats. If these tests come back negative, try some things on your own:
Old cats can be quite fussy about what they eat. Many have dental problems, vision problems and an apparent reduced sense of smell and taste. Those with digestive disturbances can be less able to absorb nutrients in ordinary diets.
So select canned or fresh, meat-based diets that are high in calories. Most older cats prefer the ones that have a pungent aroma. Warming their food to body temperature (102 F) will also make it more appealing. Feed your cat small amounts more frequently. Some cats prefer your presence and petting while they munch. Off their food in shallower bowls.
Weight loss problems in elderly cats are almost never due to parasites. So repeated worming medications are not likely to help. Don’t give in to feeding human Tuna, potted meats, scraps or baby foods because you will just exchange one problem for another.
If, after one month of following these suggestions, your cat has not gained substantial weight, the best thing to do is to have your veterinarian refer you to a veterinary internist practicing in a multi-specialty clinic, a veterinary school teaching hospital or just to accept that your cat is nearing the end of its life. If specialty care is not an option, your regular vet can supply your pet with palliative treatment for specific symptoms as they occur. With guidance from central laboratories, local vets anywhere in America can perform almost all of the laboratory tests that a specialists might run, obtain help in interpreting the result and suggest further tests that are needed.
Your Old Cat’s Teeth
Most of the old cats I see have some amount of dental disease. Read more about that problem here. Although few have cavities many have lost much of the gum that surrounds the base of their teeth as well as heavy accumulations of tartar (plaque, calculus).
You can prevent this problem by starting to brush your cat’s teeth when it is a kitten and by supplementing your cat’s diet with food products and treats marketed to keep cat’s teeth clean. (ref)
This is more than a case of simple hygiene; bacteria that surround the base of teeth can move to the kidneys and heart valves (periodontal disease). They are a constant source of inflammation and discomfort.
If your cat is loosing weight, reluctant to eat, drooling or chewing gingerly, examine its teeth. All cats with advanced dental problems have a very strong, unpleasant breath.
Periodically having your veterinarian clean your cat’s teeth will slow this problem down. Since general anesthesia in elderly cats is not without risk, when I see older cats with severe dental disease, I usually suggest that all severely affected teeth be extracted rather than cleaned again and again. Cats do very well without many teeth, they seem perfectly happy after all these bad teeth are gone and their appetite and weight often return to normal.
When you “brush” your cat’s teeth at home, use toothpaste designed for cats. I prefer a rubber fingertip applicator over a toothbrush because it allows you to better massage the pet’s gum line and reach inner surfaces of the teeth and gums. Start getting your cat used to the procedure when it is a kitten. To have significant benefit, home tooth care needs to start when the cat is young – before changes are severe.
Eye Changes And Cataracts
What most owners call cataracts in their cats is actually a change called nuclear sclerosis of the lens. When it is just a slight haze, it does not appear to affect a cat’s vision. Another common change is a lacy appearance to the colored portion of the eye, the iris (iris atrophy). (ref)
Cats with hypertension often have irreversible changes in the rear interior portion of their eyes (their retinas) that do effect, or prevent vision.
Cats are not prone to the type of heart attacks that occur in humans. When they do develop heart problems, they are usually a type called cardiac myopathy. Cardiac myopathy often produces clots that lodge in the lower portions of the venous system causing rear leg paralysis. Many breath with an open mouth and tire easily. Many veterinarians suspect that there is a relationship between hyperthyroidism and heart problems. ( ref1, ref2 ) So vets often check the thyroid status, kidney function and blood pressure of cats that arrive with suspected heart problems.
Besides the hepatic lipidosis that is caused by sudden refusal to eat, elderly cats sometimes develop cholangiohepatitis, a form of chronic hepatitis. Making the diagnosis can be difficult and often involves biopsying the cat’s liver using an ultrasonically guided needle. It is something best done at a specialty clinic. When your veterinarian suspects a liver issue, a needle biopsy or one obtained through open surgery is really the only way to find the root cause. Other than cholangiohepatitis, tumors of the liver are another cause of hepatic problems that is often encountered.
Intestinal motility often drops off in elderly cats making them prone to constipation. Dehydration will further complicate this problem as will arthritis. This problem can usually be managed by clipping long-haired cats, increasing the amount of fiber in their diets and the amount of water that they consume. When this is not enough, giving them periodic hair-ball remedies containing petrolatum or administering lactulose usually control the problem. Petrolatum-based remedies must not be over-used and lactulose must be used cautiously in diabetic cats. Never give your cat phosphate enemas such as Fleet.
If the problem is occasional and mild, you can try adding a teaspoon full of rice bran or psyllium seed powder or a tablespoon of wheat bran to your cat’s diet. Two teaspoons full of unsweetened canned pumpkin is another alternative. If your cat is bloated and uncomfortable or can not pass stool, it needs to visit the vet.
Personality And Behavior Changes
Hepatic Encephalopathy needs to be ruled out
Many of the personality changes you see in older cats are not due to changes in their brain. The infirmities that affect old cats also affect their behavior. Arthritis can limit your pet’s ability to do the things it once enjoyed, high blood pressure can affect its vision, obesity and diabetes limit their mobility and kidney, deaf cats no longer respond to familiar voices and intestinal problems can cause them to loose litter box training.
Words commonly used by owners in describing this problem are dazed, confusion, disorientation, forgetful of past learning and pleasures, trapped in corners, spacey, aimless wandering, less playful, more irritable.
Many elderly cats have changes in their sleep-wake cycles. It is common for them to be up more at night, yowling, pacing, and aimless wandering or restless but a few withdraw into themselves, playing less and sleeping more.
Hyperthyroidism is often suspected in these cases. One normal blood test for hyperthyroidism is not enough in cats with these behavioral changes. Repeated or more sophisticated tests may be required to confirm hyperthyroidism in old cats with personality or behavior changes.
In some cases, the problem is in their brain itself. This is cognitive dysfunction syndrome or, simply, senility. In humans, this would be called Alzheimer’s disease. There are physical health problems that can cause similar signs, things like hyperthyroidism or certain tumors, but many of these cats just no longer possess their youthful brain function.
Sometimes you can make schedule changes to minimize the problem. Things like confining the cat to other areas of the house, playing soft music or keeping the cat awake and active until you go to bed. Keeping food, water and litter box conveniently available to the cat might also help.
Some cats improve when given selegiline, a medication approved for brain infirmities (CCDS, senility) in dogs. In a few cats, a nightly dose of antihistamine allows them to sleep better. Some seem to do better on tranquilizers like diazepam (Valium®) or anti-anxiety medications like amitriptyline (Elavil®). They are all worth a try when other treatable causes have been ruled out.
Dealing With Arthritis Pain
Many older cats have decreased mobility and joint pain due to arthritis. However, they rarely limp or have visible joint enlargement. They are often reluctant to jump onto sofas or chairs or to climb stairs and they may have difficulty getting into their litter boxes, preferring to defecate next to the box.
Cats do not show pain the way children or dogs do – they disguise it well. They may walk with a shortened, mincing or tippy-toed gait and the range of motion of their joints is decreased. They may meow or nip at you if you manually over-flex or extend their legs. This pain is usually worse in the shoulders and elbows.
Or you may just observe that your pet doesn’t play like it once did or it may be irritable with you or other pets.
If your pet is carrying a leg or reluctant to use one, the problem is probably not the generalized arthritis of old age.
Cats do not tolerate common pain medications well. In all other species, NSAIDs (Non-steroidal anti-inflammatory drugs like Rimadyl® = Zenecarp® = carprofen) are the first choice in the relief of arthritis inflammation and pain. Cats do not metabolize or react to these drugs like dogs and humans do (ref). So they are dangerous to give to your cat for prolonged periods (at least at the dose and frequency with which they are given to dogs). When you decide that the benefits of a pain-free (and possibly shorter) life outweigh things as they are now, these medications might have a place in your cat’s treatment. But cats on long-term NSAID’s need to be monitored closely for toxic side effects (hidden bleeding into the digestive system, anemia, kidney and liver toxicity, intestinal perforations, etc.)
That leaves us with considerably less effective methods of pain control in cats than we have for dogs. The most commonly used one is a glucosamine and chondroitin nutritional supplement. Many owners of older, arthritic cats are pleased with their performance of these products and there is certainly no harm in giving them to your cat in reasonable doses.
Another option are injections of Adequan (polysulfated glycosaminoglycan). They are an option if oral glucosamine/chondroitin is not effective. The company hypes this product shamelessly (ref), but perhaps it might help your pet. It is not approved by the FDA for use in cats, but you can discuss its use with your veterinarian. Since both glucosamine/chondroitin and Adequan are usually used as part of a multi-faceted pain control program, it is hard to judge their true effectiveness. Controlled weight loss is important if your arthritic cat is overweight. (ref)
The warmth of an electric heating pad, used as a cat bed-liner, is also helpful as are good nail care, ramps, and litter boxes and food dishes with low sides. Some arthritic cats appreciate a gentle massage. As I mentioned earlier, be sure your cat is ambulatory enough to get off of any heat source once it finds it hot or uncomfortable.
There may come a time when steroids, such as prednisolone, are legitimate alternatives to a cat in constant discomfort. Cats can tolerate these medications for quite some time when the dose is cautious, intermittent, and the cat is closely monitored for the side effects all steroids cause.
Never give your cat Tylenol or aspirin and do not apply topical liniments without veterinary supervision.
The frequency of cancers increase with age in everyone, cats included. And almost every treatment that is available to humans is available, somewhere, for your cat. The question I cannot answer is if your cat would want to undergo some of these treatments if it could discuss the matter with you. You know your cat best, and you are the one who can best make that decision – not your veterinarian.
There are endless variations of cancer and they can appear anywhere in your cat’s body. For a tumor to be named and identified, a portion of it (a biopsy) must be sent to a pathologist. That is the only way a valid treatment plan can be put together.
Some of the symptoms that might lead you and your veterinarian to suspect cancer in an elderly cat are lumps, bumps and unhealed sores anywhere on its body, weight loss, loss of appetite, difficulty eating or swallowing, chronic diarrhea or vomission, bleeding or discharges, persistent lameness, difficulty breathing , urinating or defecating.
Read more about cancer in older pets here.
Will More Frequently Visits To My Veterinarian Make My Cat Live Longer?
There are certain diseases of cats that have early warning signs that your veterinarian will detect before you do. That is why an annual blood test ( geriatric or wellness profile), dental, and physical exam including a blood pressure check might extend your pet’s life. If you yourself detect changes in your cat’s body weight, activity level or any other bodily function, bring the pet in regardless of the date of its last exam. The American Association of Feline Practitioners recommends a veterinary visit for elderly cats every 6 months and it is true that the earlier certain diseases are detected, the more options you might have to treat them.
Elderly, indoor pets, other than those in shelters or group homes or other extraordinary situations, have passed the point in their lives when vaccinations and fecal exams are of benefit to them. Do not agree to them. If your veterinarian still sends yearly vaccination and fecal check reminders to elderly clients, perhaps it is time to look for another health care provider for your pet.
Don’t leave your cat’s health up to your veterinarian. Just as important as your vet’s skills, are your observations of your pet at home. Weight loss accompanies many of the diseases common in older cats (other than early diabetes and certain liver, heart and tumor problems where weight increases). So keep records and weigh your cat frequently. Check its body surface, limbs and mouth for changes and keep note of its urine and elimination habits when you change its litter box.
Are There Other Things Can I Do To Keep This Buddy Of Mine With Me Longer – I’ll Miss This Cat So Much!
There will always be, hucksters, marketers and even some veterinarians who claim that they will provide you with amazing remedies and treatments outside the borders of traditional veterinary or human medicine. We all love our pets so much that we really want to believe them. I am a product of the Midwestern prairies,Texas A&M University and the NIH , so I do not believe in treatments and remedies that are not based on provable science. You may not agree with that . If so, there are endless potions, concoctions, homeopathic remedies, fountain-of-youth herbal blends,“new age” medicines and revitalizers that will be offered to keep you and your pet healthy and young forever. Most of the products offered to you or for your cat will be safe and there is certainly no harm in trying most of them if you wish. But when evidence-based veterinary medicine has nothing left to offer your cat, I would prefer that you just say a prayer to God to watch over this small creation of his in this life and beyond. That is what I would do.
End Of Life Issues
I wrote an article on dealing with terminally ill pets and the grief that will cause. You can read it here.
Dr Bernard Rollin, of the Department of Philosophy at Colorado State University has written an article for veterinarians on this subject. He cautions against keeping suffering animals alive too long. You can read his article here.