Geriatrics Flashcards
senior pets represent what percent of patients?
30-40%
>will likely increase over time
what is gerontology?
-Scientific study of aging in all aspects
-Important human discipline
-Emerging in vet med
what is the aging process?
Sum of an animal’s anatomic, metabolic, and behavioural changes as it grows older
4 levels at which we can view the aging process
Cellular
Organ
Organism
Population
Variation of aging between and within species is dependent on
cell senescence
damage theories of the aging process
Cellular wear and tear
>free radical oxidative damage, protein glycosylation, accumulation of metabolic byproducts, auto-immune, etc
genetic theories of the aging process
Intrinsic programming (apoptosis)
Increased susceptibility to cellular damage
general considerations for geriatric medicine
Increased risk for dehydration
Blunted fevers and inflammatory responses
Reduced drug metabolism
Spectrum of client attitudes
Treat on out-patient basis if possible
canine geriatric diseases, common
Heart failure
>mitral valve insufficiency, cardiomyopathy
Neoplasia (may cause any sign)
Chronic kidney disease
Hyperadrenocorticism
Diabetes mellitus
>these 3 give PU/PD
Chronic bronchitis (cough, DDx CHF)
Other common disorders still occur
common feline geriatric diseases
Chronic kidney disease
Neoplasia
Hyperthyroidism (HT)
Diabetes mellitus (DM)
Others: FIP, FIV
Other common diseases still occur
common complaint in feline geriatrics
PU/PD is a frequent complaint
>Consider DM, CKD, HT
Most sick cats are inappetent
only common geriatric feline diseases which may cause polyphagia
DM and HT are the only common diseases which may cause polyphagia
common geriatric disorders for both cats and dogs
Dental problems
Degenerative joint disease
>Especially in medium and large dogs
>Feline osteoarthritis is especially challenging for owners/vets to identify
Incontinence/inappropriate elimination
>Senility, neuromuscular, bladder, prostate, primary sphincter incompetence, PU/PD
Cognitive dysfunction syndrome (CDS)
what feline geriatric condition can be hard to identify?
Feline osteoarthritis is especially challenging for owners/vets to identify
what is it important to exclude in a case of cognitive dysfunction for geriatrics?
medical causes
What is DISHAA
cognitive dysfunction syndrome
- disorientation
- social interactions
- sleep/wake cycles
- housesoiling, learning, and memory
- activity
-anxiety
what is sarcopenia syndrome
-“Syndrome characterized by progressive and generalized loss of skeletal muscle mass and strength with a risk of adverse clinical outcomes, such as physical disability, poor quality of life, and death”
-Muscle loss not due to a specific disease
-Decreased anabolism
what is frailty syndrome?
“Multi-system impairment associated with increased vulnerability to stressors and increased risk of adverse health outcomes”
Humans: ≥ 3 of 5 phenotype criteria
-Weakness
-Slowness
-Low level physical activity
-Self-reported exhaustion
-Unintentional weight loss
what is chronic kidney disease? what is the pathogenesis?
Renal mass decreases > surviving nephrons cannot autoregulate and systemic arterial pressure is transmitted to the glomerulus > glomerular hypertension and hyperfiltration
-Tublulointerstitial fibrosis
-Ascending loop of Henle has reduced sodium reabsorption with age
>Sodium loss is increased
>Medullary hypotonicity
-Tubular cells are frail in the aged kidney
>Progression to acute tubular necrosis and AKI can occur more easily
common urinary issues in geriatrics
-UTI can be common in the geriatric population
-Incidence of bacteruria has been shown to increase with age
>Changes in anatomy (vaginal and urethral atrophy)
>Changes to composition of urine
>Changes to frequency or amount of voiding
common neurologic changes in geriatric dogs
Decrease in frontal lobe volume, increase in ventricular size (dogs)
common neurologic change in geriatric cats
Neuronal loss, cerebral atrophy, increase in ventricular size (cats)
common neurologic changes in both cats and dogs
-Microhemorrhages/infarcts in periventricular vessels
-Increase in reactive oxygen species
common geriatric conditions of the liver in dogs and cats
-Liver size and weight decrease with age
-Decline in regeneration rate and detoxification
common geriatric changes of cat and dog cardiac system
-Reduced response to Beta-adrenergic stimulation
-Increase in myocardial and vascular stiffness
common geriatric disorders of cat and dog resp system
-Decline in muscle strength
-Calcification of ribcage cartilage
>Reduced chest wall compliance
-Decreased ability to clear particles from airways
-Respiratory resistance increases and lung elasticity declines
-Pulmonary immune responses are exaggerated with age
what does ‘geriatric’ refer to?
at life expectancy and beyond
most common causes of canine mortality
neoplasia, musculoskeletal, neurologic
expected changes in an animal’s routine / behaviour as an animal become geriatric
-Decrease in activity, sleeping more during day
>Frailty
-Eating more slowly (reduced taste and smell)
-Decreased adaptability (including diet)
-More heat and cold intolerant (impaired thermoregulation)
-Decreased attentiveness, some loss of training (hearing and memory loss)
expected change in weight and body composition as an animal becomes geriatric, and important consideration
Weight loss
-Decrease in lean body mass (muscle) and increase in fat (dogs and humans), begins in middle age
-Part of frailty & sarcopenia syndromes
-Do not attribute weight loss as an aging change without ruling-out specific disorders
expected change in dog’s hair as it becomes geriatric
thinning, loss of lustre, graying (muzzle)
>Due to loss of tyrosinase of hair bulb melanocyte
>Graying < 4 years associated with anxiety & fear
expected change in cat’s hair as it becomes geriatric
some loss of lustre
-Increased matting, scale, and greasiness reflect reduced grooming and are often a sign of illness
changes in nails, footpads, sebum as animal becomes geriatric
-Nails longer (dogs) or thicker (cats)
-Footpads thicker and hyperkeratotic (dogs)
-Change in sebum production
-Photodamage
changes in skin of geriatric cat, and why this is important to keep in mind for PE
Skin less elastic in cats
>Careful with overestimating dehydration
what should be done with masses in the geriatric if there is a chance of malignancy?
Biopsy or remove if any chance of malignancy, especially cats
disorder in geriatric dogs that can affect the skin
cushings/ hyperadrenocorticism
muskuloskeletal changes common on PE of geriatric
-Stiff gait, joint crepitus (esp. large-breed dogs)
>Articular and periarticular causes
-Sarcopenia (esp. epaxial muscles)
-Hind limb tremors from muscle weakness
-Be wary of new lameness
respiratory changes in geriatric animals
-Increased respiratory effort, breath sounds, crackles in dogs
-Worsening cough from tracheal collapse and associated disorders in dogs
cardiovascular change common for geriatrics
Mitral murmur (esp. small breed dogs)
digestive changes common in geriatrics
-Dental lesions
-Abdominal palpation organomegaly & masses
-Perianal adenomas in dogs
genitourinary changes common in geriatrics
-Kidneys (esp. cats) for reduced size and irregularity
-Testicles/prostate in males
-Mammary tumors in females
endocrine changes common in geriatric cats
Thyroid nodule in cats
nervous system changes common in geriatric dogs and cats
-Some dogs show tremors and motor hesitancy
-Degenerative myelopathy in G. shepherd dogs
-Feline audiogenic reflex seizures (FARS)
-Cognitive dysfunction
ear changes common in geriatric dogs
-Recurrent/chronic otitis externa usually develops at younger age – beware ceruminous gland carcinoma & other tumours
-Hearing loss
>Often begins with impaired ability to hear middle- to high frequency sounds
eye changes common in geriatrics
-Lenticular sclerosis and cataracts
-Iris pigment changes
-Iris atrophy
>May affect pupillary light reflex
-Eyelid tumors
>Common and benign in dogs
>Rare and malignant in cats
difference in eyelid tumors in cats vs dogs
-Common and benign in dogs
-Rare and malignant in cats
geriatric nose changes
-Decrease in smell may be partial (hyposmia) or complete (anosmia)
-Can lead to:
>Decreased appetite
>Malnutrition
>Weight loss
-Nasal hyperkeratosis (cocker spaniels, labs)
-Assess for any nasal deformation or discharge
>Concern for nasal adenocarcinoma
For clinical pathology blood values: Within reference intervals, compared to adults, senior dogs:
RBC count lower (Fe metabolism?) “anemia of the elderly”
WBC (both neutrophil and lymphocyte) counts lower but normal (dogs)
increased Platelets
increased Globulins, urea, creatinine, Ca, P, liver enzymes, cholesterol, K, AnGap
decreased Albumin, glucose, Cl, Fe
decreased Sp. gr., increased proteinuria
expected changes on radiology for geriatrics
-Increased peribronchial, interstitial changes
-Pulmonary osteomas (especially collies, boxers)
-Lazy heart in cats
-Knobby aorta in cats
does early detection of a disease always result in improved treatment?
-Early detection may not always result in improved treatment because disease may be advanced by time sign first appears
veterinary cancer society: signs to look for for early detection of disorders
1) Abnormal swellings that persist or continue to grow
2) Sores that do not heal
3) Weight loss
4) Loss of appetite
5) Bleeding or discharge from any body opening
6) Offensive odor
7) Difficulty eating or swallowing
8) Hesitation to exercise or loss of stamina
9) Persistent lameness or stiffness
10) Difficulty breathing, urinating or defecating
reccomendations for frequency of geriatric labwork
Annual/Bi-annual geriatric laboratory profiling
minimum labwork for geriatric dog profile
CBC, biochemistry profile, urinalysis
minimum labwork for geriatric cat profile
CBC, biochemistry profile, urinalysis, total T4
nutritional supplements to help slow down aging
-Antioxidants (including SAMe)
-Phosphatidylserine (membrane phospholipid)
-Apoequorin (Ca buffering protein)
-Liver antioxidant if liver enzymes increased
benefits of Diets high in medium chain triglycerides (e.g. coconut oil)
-Promote ketone formation (energy for brain)
-Improve mitochondrial function
-Decreased brain amyloid
Drugs for cognitive dysfunction
-Selegiline (L-deprenyl, Anipryl)
>MAO B inhibitor
>Enhances dopamine and catecholamine action
>Shown to improve signs consistent with CDS in dogs
>May require >2 weeks before improvement is seen
-Anti-oxidants
Therapy and Prevention: Anxiety and Night Walking
-Melatonin
>30 minutes before bedtime
-Diphenhydramine, trazodone
>Promote sedation
Anxiolytics
what type of interactions are especially important for aging pets?
Interactions that support the human-animal bond are especially critical in aging pets
what is the hayflick limit
The Hayflick limit is the concept that a normal cell can only divide so many times before it stops
Cellular wear and tear can occur from
metabolic by-products, inflammatory cytokines, microenvironmental insults, and immune mediated etiologies
Feline osteoarthritis is underestimated due to :
challenges in identifying clinical signs
Sarcopenia syndrome encompasses :
muscle loss not due to a specific disease
environmental _____ enrichment is an important aspect of geriatric medicine
enrichment
>Sensory, socialization, novelty, alternate types of exercise, etc
Management of cognitive dysfunction can include:
Medications such as Selegiline
Environmental modifications and enrichment
important types of enrichment
environmental:
-sensory, socialization
-need novelty in environment, and alternate types of exercise
