In human healthcare there is a distinct difference between the words ‘senior’ and ‘geriatric’. Senior, a classification by biological age, is in most jurisdictions correlated to patients who have reached 65 years of age or older. The term geriatric, however, is applied only to patients exhibiting a defined and accepted physiological state. You may be as old as 75 and still not considered geriatric unless you are displaying specific recognised symptoms.
This distinction is important for clinicians because it helps communicate certain physiological information that is not necessarily associated with one’s disease state – information that can be easily overlooked or glossed-over when generating a patient problem list. A geriatric diabetic is vastly different to a non-geriatric diabetic, for example.
In many cases, identifying and categorising the physiological changes that don’t fit in neatly as a symptom of a particular ‘diagnosis’, helps to improve patient care. For patients in the geriatric state, it is also often these changes that impact heavily on quality of life. These changes include things such as sarcopaenia, weight loss, cognitive and behavioural changes, weakness, balance issues and social withdrawal.1
Whilst veterinarians are less likely to make a song and dance about this definition, often using the terms a bit interchangeably, the concepts can be readily applied to the veterinary space. Doing this forces us to look more intently at the patients coming through our doors.
I think many practices now have robust senior wellness programs already in place but how many of us have a geriatric program for them to transition into, one that focuses on active management of these changes? Or one step better, a system for delivery of formal palliative support at end stage?
In order to do these things well in a clinical setting, we need to upskill, learn from the human literature, better utilise our valuable nursing and reception team members, and reach for support from allied health fields, including those experienced in addressing the psychosocial factors associated with care. Care is always a team effort.
Acting on the transition
So how do we start to educate our clients about this topic? A great place to start is within those senior wellness checks. Here we should be talking not just about increased monitoring and looking for ‘disease’, but about looking for ‘aging’. Whilst it’s true that age is not a disease, it is a process and one where we can exert influence. We should be introducing terms like ‘frailty’ into our communication and better explaining the biological changes that occur as the body ages so owners can deliver more appropriate care at home. This is a time to encourage active intervention for declining mobility and cognition and discussing ways to focus on quality of life. We should be helping owners to assess the home environment for its suitability and building a safe space for open communication around values and goals of care.
There are a growing range of tools available out there for helping both veterinary teams and owners to discuss and communicate about geriatric and end stage care. Whilst not all tools are appropriate for all clients or indeed for all situations, they can be a great starting point for any clinic interested in developing a geriatric medicine program.
Here’s just a few of our favourites and as always, get in touch if you want to chat to any of our team about anything palliative care!
Quality of Life Assessment Chart – Download here
There are a range of these available for you to use with clients, all with varying takes on the same theme – how do we get owners thinking about the factors which most affect quality of life? We’re plugging our own Sunset version here because it’s not too long or complicated and can be a great conversation starter and/or good homework for clients post a consult. As with all scales and scoring systems, pick your clients carefully. These tools don’t suit everyone and trends are more useful than individual scores.
Canine Cognitive Dysfunction Rating Scale – Download here
A great questionnaire to send clients home with following a senior check before any symptoms are presenting. Shout out to the Regenerative Neuroscience Group, University of Sydney for this rating scale that reminds us to ask the right questions.
Client Specific Outcome Measure Questionnaire – Download here
We all know how hard it can be to convince some owners their pet is painful and isn’t just ‘slowing down’. The CSOM questionnaire is a useful tool designed to help identify behavioural change associated with osteoarthritis and to track treatment success following implementation of a pain plan. This was developed by the Comparative Pain Research Lab at NC State University and we think they’re legends!
Serious Veterinary Illness Conversation Guide – Download here
Modified from Harvard Medical School resources for use by Veterinarians, this is a great cheat sheet for how to have tough conversations. Developed by the awesome Dr Katherine Goldberg, this guide helps vets create an environment for goal-concordant care planning, even when conflict and emotional demands are high.
- Gardner M. DVM360. [ONLINE] Available at: http://veterinarymedicine.dvm360.com/senior-vs-geriatric-semantics-or-significant. [Accessed 19 July 2019].
- Sunset Home Veterinary Care. 2014. QOL Assessment Chart. [ONLINE] Available at: https://sunsetvets.com.au/wp-content/uploads/2018/10/QOL-Assessment-Form.pdf.
- Regenerative Neuroscience Group, University of Sydney. Canine Cognitive Dysfunction Rating Scale. Available at: http://rng.org.au/wp-content/uploads/2014/09/CCDR-scale-revised.pdf. [Accessed 19 July 2019].
- Comparative Pain Research Lab. North Carolina State University. 2017. Client Specific Outcome Measures Instructions. Available at: https://cvm.ncsu.edu/wp-content/uploads/2017/11/CSOMf-instructions.pdf. [Accessed 19 July 2019].
- Dr Katherine Goldberg. 2015. Serious Veterinary Illness Conversation Guide. Available at: http://files.dvm360.com/alfresco_images/DVM360//2019/05/09/4b7bcc90-1a3f-4098-bf07-31d99a40f096/SERIOUS_VETERINARY_ILLNESS_CONVERSATION_GOLDBERG.pdf. [Accessed 19 July 2019]