Golden oldies – common conditions affecting ageing cats

According to PDSA Animal Wellbeing Report 2023, 53% of adults in the UK own a pet, with 24% of the UK adult population owning a cat, which is an estimated 11 million pet cats¹.

Due to continual advances in the veterinary sector, this has greatly improved the overall quality of health of our patients and, therefore, we are seeing an increasing number of senior cats.

Ageing is a gradual process. The body slows down, and muscles and bones weaken. Weight gain is common; however, some patients may alternatively lose weight due to illness.

Cognitive function, eyesight and hearing declines; skin becomes less elastic²; and coats appear dull and unkempt, with white hairs emerging. Sleep patterns change and the immune system declines, which makes older cats more prone to infections.

Senior pets may also have swallowing difficulties². Deterioration of body systems occurs, making heart, kidney and liver issues – to name a few – likely. However, the ongoing need for vaccinations, flea and worming treatment, and mental stimulation in the form of play should not be overlooked.

The following are common medical conditions seen in older cats.

Arthritis

Arthritis is defined as inflammation of the joints. Most recent studies show radiographic evidence of arthritis in the limb joints affecting between 60% and more than 90% of cats older than 12 years of age³.

Clinical signs include behaviour changes, showing less interest in play, difficulty grooming, overgrown nails, lameness, reduced mobility and unwillingness or reluctance to jump or climb. The use of validated feline OA checklists in practice is vital to capture cases and improve our level of diagnosis.

Zoetis provides a cat OA checklist (Figure 1) that can be used in practice and given to clients to use as an aid to monitor their pet at home. Primary treatment for patients with OA is therapeutics alongside weight management and/or an exercise plan because obesity puts extra strain on joints. Exercise should be little and often. Soft, thick bedding is also important, and a ramp can aid cats with getting on and off furniture.

Patients showing signs of pain may be prescribed pain relief from their veterinary surgeon. Regular blood tests need to be performed to ensure medication is not affecting major body systems including the liver and kidneys.

Solensia (frunevetmab) is becoming an increasingly popular choice of treatment for cats with OA. It is administered as a monthly injection given subcutaneously and is the first and only anti-nerve growth factor (NGF) monoclonal antibody drug licensed for cats. Solensia works by targeting NGF and alleviating pain related to OA.

Nutraceuticals can be supplemented. Yumove contains omega-3s to help soothe stiff joints, while glucosamine supports and maintains joint structure⁵. Hyaluronic acid in Yumove lubricates and cushions the joint, and vitamin E helps to maintain joint mobility⁵. Multifunctional diets with added ingredients to help with mobility are available.

Physiotherapy can help arthritic patients. Massage (stroking) is the use of sweeping movements across muscles, which aids relaxation; prepares tissues for other techniques; and promotes pain relief, and psychological and emotional well-being⁶. Extra pressure is applied for effleurage, following the contours of musculature⁶.

Avoid applying extra pressure over bony areas such as the spine. Petrissage is more vigorous. A qualified veterinary physiotherapist will be able to decide which technique would be the most beneficial.

It may be beneficial to purchase a horizontal cat scratching post to place less pressure on joints. Provide play in the form of inquisitive games for mental stimulation. Sleeping areas should be free from draughts and clients should assist with brushing and grooming their pets regularly.

Cognitive dysfunction syndrome

Almost one third of cats aged 11 to 14 years old develop at least one geriatric-onset behaviour problem that relates to cognitive dysfunction, and this increases to more than 50% for cats 15 years of age or older⁷. Clients may notice their pets’ sleeping habits change with increased vocalisation – especially at night.

Confusion, wandering around the house, staring, lack of grooming, aggression and inappropriate elimination indoors may also occur. Additionally, cats may be more dependent on their owners and follow them around the house. Changes in cognition should be addressed with the veterinary surgeon. It is important that clients keep a stable routine and do not reprimand their pet if they accidentally eliminate in inappropriate places.

Chronic kidney disease

Chronic kidney disease (CKD) is an irreversible condition affecting an estimated 30% to 40% of cats older than 10 years of age and 81% of cats older than 15 years of age⁸. The author’s golden oldie Toffee (Figure 2) is 12 years old and has CKD, arthritis and hyperthyroidism.

Loss of renal function over a long period of time results in azotaemia, which is defined as an increased concentration of urea and creatinine in the blood⁸. Clinical signs are noticeable when 75% of nephrons have already been lost⁹. Signs include:

• polyuria
• polydipsia
• weight loss
• dehydration
• oral ulceration
• halitosis
• anaemia
• hypertension
• uraemia
• anorexia
• vomiting
• lethargy
• depression⁹

Muscle wasting is another sign. Sarcopenia is age-related muscle loss and cachexia is disease-related muscle loss. Cachexia is commonly seen with renal disease.

Treatment for CKD is vast and depends on the cause and severity. Due to the progression of the disease, regular blood and urine tests are required. Kidney disease is graded between one to four on the International Renal Interest Society kidney staging guidelines.

Therapeutic diets are important with renal disease to protect kidney function, and ensure adequate nutrient intake and hydration. Controlled phosphorus in the diet is vital, as excess levels can cause excess calcium to be produced, which leaves deposits in the kidney⁸. High quality-controlled protein reduces the likelihood of the body producing excess urea from excess protein, which can be toxic to the brain and kidney¹⁰. Due to appetite changes with kidney disease, many options of flavours and textures of food are available for palatability.

Other treatments, including the use of phosphate binders, may be required. Cats with kidney disease may have increased blood phosphate levels, which need to be reduced to slow the progression of CKD. Antiemetics, vitamin B₁₂ supplements and treatment for proteinuria may be required⁸. Cats with CKD are at an increased risk of developing bladder and kidney infections, which may require antibiotics to treat. Clients may indeed be shown how to administer SC fluids at home to assist hydration.

In the later stages of CKD, dehydration may occur. If severe, cats may need to be hospitalised for IV fluid therapy. Erythropoietin injections to treat anaemia may be required, which can occur secondary to kidney disease⁸.

Kidneys initiate the production of red blood cells in the bone marrow and many cats with CKD are anaemic due to the lack of stimulation in the bone marrow⁸. Monitoring blood pressure is crucial because hypertension can contribute to the acceleration of the disease over time. Medication may be required for those with high blood pressure.

Endocrine disorders

Hyperthyroidism

Hyperthyroidism is due to an overproduction of thyroxine hormone, which increases metabolic rate. Polyphagia with weight loss, aggression, hyperactivity, heart murmur, tachycardia, polyuria, polydipsia, vomiting and diarrhoea are all clinical signs. A goitre (enlarged thyroid gland) may be felt. If left untreated, hyperthyroidism can cause damage to the heart, brain, eyes and kidneys, and cause breathlessness¹¹.

Treatment includes lifelong medication (methimazole or thiamazole) to control hyperthyroidism. Given the varied side effects of thyroid medication, including vomiting, lethargy, inappetence, liver abnormalities and haematological abnormalities, regular blood sampling is required. Medication is provided in many forms, including from tablets, transdermal gel applied to the ears and as a liquid solution.

Radioactive iodine therapy is an alternative treatment method that involves an injection of radioactive iodine, usually given in referral practice, which destroys the abnormal thyroid tissue without endangering other organs¹². This method does not require an anaesthetic and eliminates the need for daily medication¹². The patient is hospitalised for one to two weeks while treatment is carried out. Medication may be required for a month prior to radioactive iodine therapy starting.

Another option is to feed a suitable diet with limited amounts of iodine. However, this needs to be the only food fed, or the effectiveness will reduce. Thyroidectomy is the final option of treatment, which involves removing the thyroid gland under anaesthesia. In older patients especially, anaesthesia does pose an increased risk.

Ensuring water is readily available, grooming the patient regularly and reducing stress can be helpful. However, hyperthyroidism may mask kidney disease. This is the case with the author’s cat Toffee because he is a newly diagnosed hyperthyroid with previously diagnosed CKD.

Cancer (neoplasia)

Although some lumps may not be concerning, others may be neoplastic. A tumour can either be benign (non-cancerous and may still grow, but does not invade other areas of the body) or malignant (cancerous, grows and spreads to other parts of the body). Types of cancer seen in older cats are lymphoma (affects white blood cells), mammary gland tumours and squamous cell carcinoma (affects the skin)¹³. Weight loss, increased thirst, polyuria, lethargy, difficulty chewing or swallowing, vomiting, diarrhoea and palpable/visual lumps are clinical signs¹³.

Diagnosis is dependent on x-rays, surgery, biopsy or fine needle aspirate to identify what the lump is. If a tumour is detected, treatment depends on the severity – whether it is surgically removed or the patient requires chemotherapy or radiation therapy, depending on the veterinary surgeon’s recommendation.

If chemotherapy is preferred, clients need to be vigilant when handling and administrating medication at home, if this is an option. We need to be very careful if chemotherapy is administered in practice, as well as when cleaning the litter tray and dealing with faeces and soiled bedding. If the diagnosis is severe and the prognosis poor, the veterinary surgeon would discuss quality of life and may recommend euthanasia for the patients’ best interests.

Heart disease

Hypertrophic cardiomyopathy (HCM) is the thickening (usually of the left ventricle) of heart muscle that interferes with relaxing of the heart and prevents normal filling, leading to poor diastolic function¹⁴. It decreases cardiac output and can lead to heart failure¹⁴. Maine coon, ragdoll, British shorthair, sphynx and Persian breeds are more likely to develop HCM¹⁵.

In cats, HCM may be secondary to another medical condition. High blood pressure commonly seen in cats with hyperthyroidism and kidney disease, over time, will put additional strain on the left ventricle, which can affect the walls and muscles of the heart. Clinical signs include hearing a heart murmur or gallop rhythm on auscultation, dyspnoea, lethargy, tachycardia and tachypnoea. A complication in cats is aortic thromboembolism, where a blood clot leaves the heart, lodges in the aorta and stops blood flow to the hindlimbs, resulting in paralysis of one or both hindlimbs¹⁴.

An ECG, echocardiogram (heart scan), x-rays, monitoring blood pressure and blood sampling determine diagnosis. Treatment for HCM consists of long-term medication, depending on the cause and clinical signs.

Dental disease

Dental disease is extremely common and may be secondary to another underlying condition.

Periodontal disease is caused by a build-up of plaque and tartar. Inflamed, reddened and bleeding gums, halitosis, pawing at the mouth, weight loss from decreased appetite and failure to groom adequately are all indicative of dental disease¹⁶. Clients may report their cat transferring food from their bowl elsewhere because they are associating pain with the food bowl.

Treatment depends on the cause. In many cases, extraction of the affected teeth is required. Teeth brushing and regular dental cleaning slows the tartar build-up.

Other issues common in senior cats include the following.

Overgrown nails

Overgrown nails occur due to reduced activity and the nails may grow into the pad. If severe enough, this can affect gait and mobility. Nails should be clipped regularly.

Lack of grooming in older cats and hairballs are likely. Hairballs can cause vomiting and constipation. Regular brushing is advised; however, extra care should be taken over spine and hairless areas.

Obesity can affect grooming, so discuss weight management with clients. Dental disease or joint problems can affect their ability to groom, so any changes should be notified to the veterinary surgeon².

Eyesight/hearing/sense of smell

Eyesight, hearing and sense of smell decline with age. Clients may notice their pet walking into things, have cloudiness in their eyes due to cataracts or glaucoma and be apprehensive to jump. Not being as responsive to their name being called is seen with hearing loss and loss of appetite, while putting their nose in their food is a sign of smell reduction.

Treatment for any of these issues is case dependent. However, ensuring things are kept in the same place, talking and stroking patients each time they enter a room can assist with eyesight issues. For hearing issues, avoid startling them – especially when they are asleep. For sense of smell, tempt feeding and microwaving the food for a few seconds will make the food smell more enticing.

As previously discussed, senior cats are prone to medical conditions and, therefore, should be seen in practice every three to six months for vet appointments.

Running senior wellness clinics is so important because we can use our extensive knowledge to identify any abnormalities and notify the veterinary surgeon. Wellness clinics bond clients to the practice and increase communication, trust and compliance.

The following is an outline of what should be discussed at senior wellness clinics:

• Clinical history and any updates – has their water intake, urination, defecation and appetite been the same, increased or decreased? Any behaviour or mobility changes? Vomiting or diarrhoea? Any dramatic weight gain or weight loss?
• Nutrition discussion, although this would be dependent on the patient’s condition.
• Check mobility and gait – allow cats to emerge from their carrier in their own time while observing their mobility.
• Blood pressure check – allow the patient to be accustomed to their new surroundings before taking blood pressure. Multiple readings should be taken and an average worked out.
• Weight check.
• Head-to-toe health check.
• Temperature, pulse and respiratory rate.
• Pain score.
• Body condition score/muscle condition score (many medical conditions can cause muscle loss, including kidney disease).
• Assess hydration levels – evidence of a skin tent, sunken eyes, or tacky or dry mucous membranes indicate dehydration.
• Make notes on file and notify the veterinary surgeon of any abnormalities.
• Blood and urine test if directed by the veterinary surgeon. Nurses can take bloods and carry out tests for blood and urine. The veterinary surgeon needs to report results, because we cannot diagnose.
• Ask clients to keep a diary at home so anything abnormal can be investigated promptly.

Making a senior wellness clinic pre-consult questionnaire for the client to fill out in reception is beneficial to use your time in consult.

Conclusion

To conclude, nurses are a vital part of the practice. Running senior wellness clinics not only empowers RVNs like the author to use their skills and knowledge, but clients and senior patients also benefit.