Using staff to gain senior care client compliance - DVM
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Using staff to gain senior care client compliance


DVM Best Practices



Using staff to implement and manage a senior care program will help improve client compliance as the entire veterinary team continuously educates owners on the needs of their aging pet.
Senior care will become a critical medical and financial resource embraced by successful practices in the 21st century. Veterinarians commonly encounter senior patients as supported by the 1997 American Veterinary Medical Association study which reported 28.1 percent of dogs and 25.4 percent of cats in the United States were 8 years of age or older. Advances in diagnostics, therapeutics and nutrition coupled with the powerful bond between owners and their older pets creates unique and interesting opportunities for today's practitioner.

Owners are critical components to the successful senior program. Comprehensive histories are especially critical in senior medicine. Owners should be instructed to note changes in water consumption, appetite, body weight, activity level, skin masses and especially behavior. Owners are in the unique position to note subtle changes in daily routines. Behavior changes should not be discounted as "senility" without our best diagnostic efforts.

Early detection leads to earlier intervention. Complete diagnostic efforts are critical because senior pets frequently have abnormalities in multiple body systems. Routine monitoring is especially helpful so trends can be followed and diseases recognized as soon as possible. Routine monitoring of clinicopathologic data is critical in the management of geriatric patients.

Gaining owner compliance is often the most difficult component of veterinary medicine and senior care is no different. Our practice earns compliance through a five-step process, which takes very little time (usually five extra minutes) yet reaps huge rewards for the patient, the client, and the veterinary team.

Definition of senior Defining a senior pet is somewhat arbitrary since genetics, nutrition and environment influence health and vary between patients. Guidelines proposed by Drs. Richard Goldston and Johnny Hoskins use body weight as the determining factor thus emphasizing the importance of weight control in older patients.


Table 1: The metzger animal hospital age analogy chart
Clients and the entire veterinary staff should be aware of the practice's definition of the senior pet for successful implementation of the program. The distinction between senior and geriatric is an important one because owners frequently classify their older pets as senior and avoid using the term geriatric. It appears owners feel the term geriatric implies an older pet with serious medical problems. The Metzger Animal Hospital Age Analogy chart (Table 1) is the critical education piece for our practice's entire senior/geriatric program. Perhaps senior could be defined as the "early" age range for older pets and geriatric the later. Therefore, according to Table 1, an 85-pound Golden Retriever becomes a "senior" at 7.5 years and geriatric at 10 years of age emphasizing the distinction between senior and geriatric. This classification increases diagnostic opportunities, as owners become educated about senior diseases and our early detection recommendations including routine blood profiling.

Common senior diseases Diseases common to senior patients are frequently the same diseases common to their senior human counterparts. Clients frequently recognize the common geriatric diseases such as diabetes, heart disease, hypothyroidism and cancer. Educating clients about senior diseases also educates about diseases senior citizens might encounter.

Common canine senior diseases include: Degenerative joint disease, obesity, dental disease, cardiovascular disease, cataracts, keratoconjunctivitis sicca, prostate disease and incontinence. Others commonly encountered include neoplasia, hyperadrenocorticism, hypothyroidism, anemia, hepatopathy, immune-mediated diseases, chronic renal failure and diabetes mellitus.

Common feline senior diseases include: obesity, dental disease, hyperthyroidism, chronic renal failure, cardiovascular disease, neoplasia, anemia, hepatic lipidosis and diabetes mellitus.

Comprehensive health screening is very important in the early recognition and successful management of many of these diseases.

Defining the senior health program Clients should become familiar with the definition of a senior pet and understand the medical benefits of early disease detection. Recommend testing patients when they enter their senior years according to the age analogy chart. Many senior patients require anesthesia for surgical or dental procedures. This is an excellent time to recommend health profiling to improve anesthetic safety and establish baseline values. Explain in layman's terms the components of your program. Use analogies, as most clients are familiar with blood testing, ECG and blood pressure through association with human medicine. The minimum senior canine database, accessible to all practitioners, includes the CBC, biochemical profile with electrolytes, and complete urinalysis. The minimum senior feline database, accessible to all practitioners, includes the CBC, biochemical profile with electrolytes, complete urinalysis and total T4. Practices should include electrocardiography and blood pressure measurement if available. Other components of the senior health program might include radiography, ultrasound, endoscopy, ocular tonometry, endocrine testing (ACTH stimulation, low dose dexamethasone suppression, free T4 by equilibrium dialysis) and others, depending on the particular case.

Senior health program benefits Earlier detection allows earlier intervention and therefore, improved treatment success. Senior profiling improves anesthetic safety by permitting the postponement of anesthesia or altering the anesthetic plan. Furthermore, pharmaceutical safety is increased through detection of underlying diseases, which may preclude the use of certain drugs. Many dietary recommendations are based on disease diagnosis making senior profiling an important dietary database. Finally, earlier disease management by improved anesthetic, pharmaceutical and dietary recommendations offer our patient's and client's the best medical management possible. But how do we make clients understand and say "Yes?"


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