The Future is Getting Older

Dr. Ernest Ward, Jr.
Calabash, North Carolina

  
Super vaccines, heartworm preventatives, radiology, therapeutic diets, in-house laboratories, advanced patient monitoring, highly trained staff, space-age surgical techniques and instruments – veterinary medicine has certainly come a long way in the past forty years! As the science of veterinary medicine has progressed, so have the life expectancies of our patients. The average life expectancy of a dog in the 1960’s was just 7 years while today 15 years is increasingly common. That’s an increase of almost 25% every 10 years for the past three decades! While no one expects this longevity trend to go on forever, the fact of the matter is that these accomplishments have been largely accomplished without a conscious effort on the part of veterinary practitioners. Fewer than one in ten practices currently have a formal senior care program. Imagine how our patients and practice revenue could benefit from a planned senior program in our practices. Creating a senior care program that gets results is easier than you might think.  

How Many Senior Pets Are There?

According to the US Pet Ownership and Demographics Sourcebook (AVMA 1996) estimates, 28.1% of dogs and 25.4% of cats are over eight years of age. That equals 30 million senior dogs and cats. Veterinary expenditures are directly related to pet’s age. For example, according to Idexx Informatics data, a two-year old dog contributes an average of $184 per year to your practice while a ten-year old provides $277. With these numbers in hand, is it any mystery why senior care is so important to your practice? By extending the lifespan and health of our older patients, we positively impact our practice income and fulfill an important part of our veterinary oath – to use our scientific knowledge and skills for the protection of animal health.  

Define Senior

What constitutes a senior pet? At Seaside Animal Care, we began by holding a staff brainstorming session followed by client surveys to develop our definition of senior.   A senior pet is defined as any pet “over 50” in human age equivalents on our pet age chart. But what about those pets that were “65” or older; what should we call them? During brainstorming, we discovered that the term geriatric evoked considerable negativity. We then listed our favorite ten senior terms and created a client questionnaire. We found that our clients also disliked geriatric and that prime and senior prime and super senior scored favorably. We defined any pet “over 65” as a “Senior Prime” and those “over 75” as “Super Senior”, thus avoiding the negative term “geriatric”. By involving our staff and clients in developing our senior care program, we ensured that a unified, comfortable approach was employed.  

Develop a Plan

Senior Care is not a rigid “one size fits all” program. Instead, it is the realization that senior pets have special needs. These needs will vary by breed, age and lifestyle. Research proves that if a person lives to age 65, the likelihood of surviving to 80 and beyond is only about 35% hereditary (Finch and Tanzi, Science, Vol. 278, 17 Oct 1997). Diet, lifestyle and medical care largely influence our life expectancy beyond 65. The same is true for dogs and cats. We must establish guidelines for routine veterinary healthcare that reflect our commitment to making our pets healthier longer.   Some basic recommendations for the care of older pets include twice yearly physical exams, annual blood and urine tests, and chest radiographs and ECG every one to two years. Our clients expect this. In a recent client survey, 75% felt their senior pet should be examined more than once yearly (Pfizer Client Survey, 1998). As pets age, the frequency of these services should increase. The reason these tests are important in asymptomatic pets is simply because they can not tell us if they’re feeling lousy, have increased thirst or fatigue after walking around the block. Unfortunately, by the time dogs or cats are showing obvious clinical signs, it’s often too late.   Our goal as doctors is to compress patient morbidity through medical intervention. Early disease recognition and treatment helps us extend the quality of our patients’ life expectancy. For example, let’s say you just diagnosed a cat with kidney disease. By modifying the diet and providing fluid therapy, you may not make the pet live longer – but you can make it feel better longer. It’s important to note that it’s not just about our patient’s life span – it’s about their health span. At Seaside Animal Care, PA, we created the “Prescription For a Lifetime of Good Health” and “Senior Prime Time” programs to address these issues. By evaluating the unique needs of senior pets, you can develop a plan that will positively impact both the health of your patients and your bottom line.     

Start With Staff Training  

In order to develop a successful senior care program, you must assemble a team of veterinary healthcare experts. Each week, the staff of Seaside Animal Care, PA participates in four hours of staff training. We take this opportunity to thoroughly educate our staff on the recognition, diagnosis and recommended treatments for the eight common senior diseases. We go into detail about the pathophysiology, rational for diagnostic testing, treatment protocols and disease prognosis. Unless your healthcare team has the didactic tools to work with, they will never truly “buy-in” to senior care. This requires the effort and dedication of the doctors and staff to become medical experts.The public demands it. As our population ages and enters the human healthcare system, they are exposed to advanced medical care, and expect the same for their pet loved ones. According to the 1999 KPMG mega-study, this new type of older client spends more for veterinary medical services than younger clients. Unless we elevate both our hospital staff and ourselves, we will miss this opportunity.

By starting from within, you can raise awareness of the special needs of senior pets – medical, diet and emotional – and more effectively educate your clients. Require complete physical exams, blood and urine tests, radiographs, ECG and blood pressure analyses for all staff pets over seven years of age. You may be surprised at what you find! Once your staff understands the importance of senior care and witnesses the benefits first-hand, your senior care program will soar.  

Getting the Word Out  

Once you’ve developed a plan and have your team fired up, you’ve got to get the word out to your clients. There are several simple steps for promoting senior care to your clients.  

  1. Change Post-card Reminders – Instead of emphasizing vaccinations, try replacing the list of vaccines with a simple heading such as “Annual Examination and Health Check” or “Yearly Physical Examination, Vaccinations and Tests”. Be sure that your staff understands these changes and can answer any client questions.
  2. Newsletter – Send a special edition of your newsletter and address senior care issues and what your hospital can do. Send it to your entire clientele to spread the news to clients and non-clients alike. According to a recent Pfizer survey, only 43% of clients thought their veterinarian could improve their senior pet’s quality of life. Set the record straight that age is not a disease! We can help!
  3. Appointment Scheduling – When scheduling annual visits, be sure to identify senior pets. If a pet is over seven, inform the client that the doctor will likely perform blood or urine tests based on the exam findings and to withhold food and water four hours before the visit. By initiating change during appointment scheduling, you can prepare the client for changes in their pet’s needs and promote better care.
  4. Personalized Mailings – Send a letter to all pets over seven congratulating them on reaching this milestone and inform them of common signs of diseases, their diagnosis and treatment. Ideally, send dog- and cat-specific letters addressing their unique needs.
  5. Pet Health Fair – Hold an Open House and Pet Health Fair. At Seaside Animal Care’s annual event, we target common conditions such as periodontal disease, diabetes and obesity. Have “Screening Stations” to look for and discuss these common age-related disorders. It’s a blast!

  Reinventing the Annual Visit  

With changes in vaccine protocols just around the corner, the primary driving force for our annual veterinary visits appears in jeopardy. But is it? We must refocus the purpose of the annual visit from “vaccine-centered” to “health-centered”. Health-centered visits encompass the total well being of the pet – from appropriate vaccines to diet, lifestyle, diagnostic tests and more. By emphasizing other medical services, we will not only replace lost vaccine-generated income but exceed it by providing more complete medical care for our patients. Sure, we will lose some “C” clients who come in only for vaccinations, but we will create a stronger bond with our good clients who appreciate, and are willing to pay for, our medical expertise. Don’t be afraid to offer additional services to senior pets because of increased price. The KPMG study revealed that 74% and 58% of clients would continue to use their veterinarian if fees were raised 10% and 20%, respectively. Use that 10-20% creatively and convincingly and reap the rewards while benefiting your patients.   Let’s look at Licorice, an indoor dog who has never missed an annual vaccination visit. Licorice’s owner has heard that pets may not need certain vaccines every year, but trusts Dr. Goodvet’s judgment. Upon review of the record, medical history and physical exam, Dr. Goodvet explains that with the improvement of vaccinations over the past several years, Licorice does not need a distemper vaccine this year. Dr. Goodvet points out that Licorice has not had any blood or urine tests since his neuter over ten years ago. Many medical conditions cannot be detected on physical examination alone. He goes on to explain that conditions such as kidney and liver disease, diabetes and Cushing’s disease can only be diagnosed with lab tests. Dr. Goodvet recommends replacing the distemper vaccine with some basic blood and urine tests. The great news is that it will cost only $32 more than she would have normally paid! In fact, using Dr. Goodvet’s modern in-clinic laboratory, we can have test results by the end of the appointment - no need to worry or anxiously await a phone call! Licorice’s proud owner is relieved that he doesn’t need all those shots and that she can help her best friend live longer and healthier.  

Why We Do It  

Senior Care is the wave of the future. With the numbers of senior pets growing and the changes we are facing, you can’t afford to miss this opportunity. Over 25% of all pets in the United States are now over eight years of age – that’s 30 million pets. We can’t ignore 30 million pets!   By helping pets live longer and healthier, we increase our practice income and fulfill an important part of our veterinary oath – to use our scientific knowledge and skills for the protection of animal health.   We cherish our ability to help pets and people and the pursuit of scientific and medical knowledge. By combining these two vocations, we have the ability to elevate our staff, patients, clients, profession and ourselves to new heights. Embrace the bond and remember, it’s not about Life Span – it’s about Health Span. It’s a great time to be a pet!

SixSteps of a Successful Senior Visit
 

  1. Appointment Scheduling – Identify senior pets when scheduling the appointment. Prepare the client for common senior care procedures such as blood and urine tests.
  2. Appointment Welcome – The receptionist should have the client complete a senior pet questionnaire while waiting and address any initial concerns. Additionally, the receptionist should discuss common procedures and conditions.
  3. Technician – The technician should review the questionnaire with the client and suggest appropriate tests and lifestyle changes.
  4. Veterinarian – The veterinarian should review the medical history and perform a physical exam concentrating on senior care concerns such as periodontal and heart disease, obesity and osteoarthritis.
  5. Discharge – The technician and receptionist should review exam findings and encourage testing if the client declines. Reinforce the benefits of early disease recognition and intervention.
  6. Follow-up – Have the technician call the client 48 hours after the appointment to review recommendations, ensure compliance and enforce the value of services. Review importance of testing with clients that initially refused and address any reservations.

Eight Senior Diseases Your Staff Should Understand

1.       Periodontal Disease

2.       Osteoarthritis

3.       Cognitive Dysfunction Syndrome (CDS)

4.       Heart Disease

5.       Diabetes mellitus

6.       Liver and Kidney Disease

7.       Thyroid Disease

8.       Cancer

How Old Is Your Cat?

 

Cat’s Age

Human Equivalent

Adult Cat

5

30

6

35

7

40

Senior Cat

8

45

9

50

10

55

11

60

12

65

Senior Prime

13

70

14

75

 

Cat’s Age

Human Equivalent

Super Senior

15

80

16

85

17

90

18

95

19

100

20

105

21

110

22

115

23

120

24

125


Senior Pet Guidelines 

Medical Needs of Senior Dogs

Test

Frequency

Reason

Senior

Senior Prime

Super Senior

More frequent doctor examinations

Every 6 months

Every 6 months

Every 3-6 months

Detect early signs of diseases such as cancer, heart disease, cataracts, arthritis and more.

Blood tests

Yearly

Yearly-every 6 months

Every 6 months

Identify liver, kidney and pancreatic diseases, diabetes, anemia, leukemia, thyroid disease, evidence of cancer, etc.

Urinalysis

Every 6 months

Every 6 months

Every 3 months

Earliest evidence of kidney disease and failure, infections, diabetes and some forms of bladder cancer.

Baseline x-rays and/or EKGs

Yearly

Even Years

Yearly

Detects heart and lung disease, abnormal heartbeats or rhythms (arrhythmias), and cancer.

Blood Pressure

Yearly

Even Years

Every 6 months

High blood pressure may lead to strokes, eye and kidney disease. Often secondary to heart, thyroid or kidney disease.

   

Medical Needs of Senior Cats

Test

Frequency

Reason

Senior

Senior Prime

Super Senior

More frequent doctor examinations

Yearly Until Age 9, Then every 6 months

Every 6 months

Every 3-6 months

Detect early signs of diseases such as cancer, heart disease, cataracts, arthritis and more.

Blood tests

Yearly

Yearly

Every 6 months

Identify liver, kidney and pancreatic diseases, diabetes, anemia, leukemia, thyroid disease, evidence of cancer, etc.

Urinalysis

Every 6 months

Every 6 months

Every 3 months

Earliest evidence of kidney disease and failure, infections, diabetes and some forms of bladder cancer.

Baseline x-rays and/or EKGs

Yearly

Yearly

Every 6 months

Detects heart and lung disease, abnormal heartbeats or rhythms (arrhythmias), and cancer.

Blood Pressure

Yearly

Yearly

Every 6 months

High blood pressure may lead to strokes, eye and kidney disease. Often secondary to heart, thyroid or kidney disease.


Ten Questions to Increase Diagnostic Testing

1.       Have you noticed any changes such as increases or decreases in Scooter’s water consumption or urinations?

Subtle increases in thirst and/or urination are a common sentinel for many diseases. Kidney and liver disease, diabetes mellitus and Cushing’s disease are just a few of the conditions with increased thirst and urination as common clinical signs. While few pet owners know exactly how much water their pet is drinking, most will know if they are having to fill up the water bowl more than usual. When you discover that a pet is drinking more water or urinating more often, this is a direct cue to run blood tests and urinalysis.

2.       Does Scooter seem to have the same stamina or energy that he had this time last year?

You will only detect decreased energy on a physical examination when a patient is near death. Decreased stamina and activity levels are best detected on history. Loss of stamina can often be attributed to cardiovascular disease, hypothyroidism, anemia, leukemia, neoplasia and arthritis. If your patient’s stamina is declining, blood tests and urinalysis along with x-rays and ECG may be indicated.

3.       What type of diet is Scooter on? Is he eating the same amount of food as he did this time last year? Does he get any ‘extra goodies’ like table foods or treats?

It seems as though we never see a patient who eats table scraps! However, persistent questioning in a humorous manner can loosen even the tightest lips! Listen to your clients. If they are feeding a popular canned cat food to a 14-year-old cat, shouldn’t you warn them about the dangers of improper diet and kidney disease? What about running some routine blood and urine tests to see if there is any early evidence of disease? A simple question such as this can save literally hundreds of lives. Giving age-specific diet recommendations is simply in the pet’s best interest.

4.       Have you noticed any changes in Scooter’s sleep habits? Does he sleep more or less or have his sleep patterns changed?

This is definitely one that you cannot determine on a physical examination! Yet changes in sleep habits can be associated with Cushing’s disease and Cognitive Dysfunction Syndrome (CDS) while increases in the duration of sleep can be attributed to the same diseases that cause decreased stamina. Blood tests are often recommended to determine if there is an underlying disease causing Scooter’s irregular sleeping. Take the time to inquire about your patient’s sleep habits and you may ‘uncover’ some disorders.

5.       Does Scooter ever have ‘accidents’ in the house or have his bathroom habits changed?

Many clients feel that as pets age, it is normal for them to have increased ‘accidents’ in the house. Urinating in the house may be the result of kidney or liver disease, neurogenic or hormone-responsive urinary incontinence and CDS. When we are told that the patient is having more accidents than usual, we often recommend blood tests and urinalysis to make sure that Scooter is not experiencing this problem as a result of some primary disease.

6.       How is Scooter’s breathing? Does he have any coughing or periods of unexplained heavy breathing or panting?

Pets experiencing breathing problems always deserve closer investigation. When we hear that a pet is “breathing hard” despite a normal physical examination, we always recommend thoracic radiographs. Remember that not all pulmonary and/or valvular disease, especially early in the disease course, is associated with a heart murmur, crackles or rales. A chest x-ray will enable you to identify heart and lung disease that eludes the physical examination.

7.       Have you noticed any new growths or ‘lumps or bumps’ since Scooter’s last exam?

No matter how thorough you are, Mrs. Smith will always find a lump or bump that you failed to detect during the physical examination. Save yourself the trouble, not to mention the embarrassment, by simply asking Mrs. Smith to point out any abnormalities before your physical examination. We perform a large number of fine-needle aspirations and histopathology submittals on these ‘lumps and bumps’ that our Mrs. Smiths show us. If you dismiss that new lump as just another fatty tumor and do not perform a fine needle aspiration, it may be your colleague down the street who diagnoses the mast cell tumor or, even worse, your patient suffers the ultimate consequence of undiagnosed neoplasia. Until I develop magical fingers that can diagnose a mass by feeling it, I will continue to recommend some form of histopathology to prevent this from happening to my patients.

8.       How are Scooter’s joints holding up? Have you noticed any arthritic discomfort or an increase in any aches and pains?

When Scooter shows up in your exam room, he is pumping enough epinephrine to keep the Rockettes kicking all night long! If Scooter walks into your hospital with an obvious limp, you can bet that his pain is so severe that he cannot overcome it despite his nervousness. If we fail to ask our clients about Scooter’s aches and pains, we will only learn about it when it is too late. Don’t wait until you or Mrs. Smith actually observe lameness; detect it early, perform x-rays, diagnose and treat. Improve Scooter’s golden years by decreasing those annoying aches and pains of age!

9.       Have you noticed any changes in Scooter’s attitude or mental status? Does he greet you the same as always; have his attitudes towards other pets or people changed; does he follow you around the house more than usual? Does he need more help on the daily crosswords than he did last year?

As our recognition and treatment of CDS improves, subtle changes in mental status will be the first red flags observed. When we hear our clients talk about “old dog changes”, we should take this opportunity to discuss age-related conditions and recommend blood and urine tests to search for any underlying medical conditions that may be contributing to these ‘changes’. Our efforts will be rewarded as we witness higher quality of life as well as increased longevity of our patients.

10.   How is Scooter’s breath? Does he give Godzilla a good name or are you scared to find out?

This is the really easy one. By now, most of our clients have been informed of the benefits of good oral hygiene in their pets. In contrast, only 3-5% of our total practice income is derived from dental services. By repeatedly addressing dental hygiene and focusing in on the most obvious negative aspect of poor oral health, we can improve those percentages. We can further increase our diagnostic income by promoting good oral care by performing pre-anesthetic blood panels and dental x-rays.

These questions are meant not only to improve your practice’s bottom line, they are meant to improve our patients’ well being. Good medicine is good business. Our hospital experienced a 250% increase in the number of Routine Health Screens in the first six months of implementing this program! Additionally, we are now diagnosing one to two cases of Cushing’s disease per month and our client awareness and subsequent treatment of CDS is growing rapidly. Take the time to develop a standardized pre-exam questionnaire and benefit both your practice and your patients!