Written by: Shannon Fujimoto Nakaya, DVM
Many Americans, especially post-baby boomers, do not have experience watching a person or animal age and die. For better or for worse, there is a general avoidance of aging and dying in our society. Humans will go to great lengths to preserve their youthful appearance, function, and even sexuality. When age does grab a hold, elder care more often occurs in hospitals, nursing homes, care homes, and retirement homes rather than just home. As a society, we have therefore become distanced from aging, caring for elders, and dying.
The avoidance of aging and dying appears to apply to animals as well. One of my pet peeves (pardon the pun) is when the ignorant passerby sees me toodling with an older or handicapped animal and offers unsolicited commentary and opinion to the theme of, "poor dog" or "poor old dog." The presumptions beneath such a comment greatly offend me for these animals might be slow, gimpy, or handicapped, but they are also well attended to, cared for, and loved. People who offer similar comments about their friend's "poor old cat" should likewise beware that they may be trespassing into matters which they really may know nothing about. Most of the people I meet with animals that are older or have special needs are absolutely dedicated and determined that their animal should not be uncomfortable or unhappy or suffer needlessly. Most of my clients are balanced human beings who have formed a special connection with an animal companion and don't want to "pull the plug" prematurely. Moreover, they are wiling to make modifications to their routines in order to preserve comfort and dignity and quality of life for their companion. The bottom line is that the animals I meet might be old or convalescing or handicapped, but they are treated as royalty, and in spite of their condition, there is nothing poor about their lives.
Given a choice, most of us, and our animal companions would probably choose to be young rather than old, able bodied rather than handicapped, healthy rather than ill, attractive rather than plain. There are some realities that we don't get to vote on. In these situations, we can either make the best of it or let it get the best of us. I choose to make the best of it, for myself and those I care about, and this includes helping my animal companions age gracefully.
There is a depth to relationships that go on for years. There is a familiarity rooted in years of coexistance and a comfort in that familiarity. When my canine companion and partner of 16 years developed dementia and couldn't travel to and from work with me any longer, I chose to scale back my caseload so that I could be with him to share in his periods of clarity and to help him through his periods of confusion. In the same way that I made a vow to my human partner, "in health and in sickness till death do us part," I made a promise to my canine companion.
Overview: How we can help patients to age gracefully.
- Realize that age in and of itself is not a disease.
- Accept that aging bodies do require more "maintenance."
- Early identification of changes or ailments often allows for gentler interventions which are easier on the rest of the body.
- Pay attention to what goes in: food, water, air, supplements, medications.
- Provide regular physical and mental exercise (tailored to individual ability and stamina).
- Maintain comfort.
- Give them a reason to keep living. Make them feel cared for and wanted. Being cared for by someone who cares deeply about you is a gift. Patients who are cared for by someone who is a good caregiver and cares deeply about them live better quality and perhaps longer lives.
Benefits to working with a veterinarian
- Note: there is a chapter on choosing a veterinarian in my first book, Kindred Spirit Kindred Care. It is important to share your goals with your veterinarian. Ask the veterinarian if s/he is willing and able to support those goals.
- Veterinarians can contribute medical insight into how your pet is faring and in some cases, prevent you from "jumping the gun."
- Example: I am asked to evaluate a patient for possible euthanasia. "She's old, she can't get up, she's been peeing in her bed." This all started a week ago. Before that, she was getting up and getting around. She would have occasional small accidents, but it has gotten so much worse in the past 4 days. During my examination, I discover that the patient has a fever. Her bladder area is tender and spasming. Her urine smells strong with a hint of putrid. Urinalysis and urine culture show that she has a severe bladder infection.
- Point: This is a treatable condition. Moreover, it a relatively simple treatment with high likelihood of working and with low likelihood of severe adverse effect.
- Point: Bladder infections can cause acute urinary incontinence.
- Point: Bladder spasms can affect mobility in older patients. So can fever.
- Follow up: Patient was treated with an appropriate antibiotic. Access to plenty of fresh water allowed her to flush out her system. Tempting foods were offered. Pain medication was added to improve patient comfort and encourage return of independent mobility. Initially, supportive care was provided in terms of helping her get up and out to pee several times/day and keeping her clean and dry. Bed wetting subsided within a couple of days. By the end of the week, she was back to where she had been the week prior to my call.
- Point: Not everything that can bring an older dog down is necessarily bad and untreatable.
- Point: Even "simple" conditions can have more dramatic effects on older patients when left untreated. If this patient's condition had progressed for a few more days before the people called me, it could have been a lot worse and she might not have recovered.
- Veterinarians can help to assess and manage diseases, illnesses, medications.
- Veterinarians can help to assess and manage pain, anxiety, hunger, hydration.
- Veterinarians can help to assess quality of life.
- Veterinarians can help to facilitate graceful passings.
As with any self-help or do it yourself or guidebook such as this, there is always the potential for misinterpretation and/or misuse. There is always the potential for someone to extract a phrase from my work, apply it in a different context, and use it to justify an action that I wouldn't myself advise. At some level, the risk may be even greater because I do not tell people exactly what to do; I merely provide information and suggest things that they might consider. Empowerment requires a leap of faith that they who you empower will not use it inappropriately. In both Kindred Spirit Kindred Care and Graceful Aging Graceful Exits, I choose to empower the humans who truly do care about their animal companions and desire to make informed, thoughtful, and selfless decisions on their pet's behalf. I hope that my sincerity as an advocate for the animals and the human-animal bond comes through and that the cases where that tone is misconstrued and misused are rare events at best.
This text is by no means a substitute for veterinary evaluation, assessment, and treatment. This text is meant to help people provide supportive and nursing care for their pets. Particularly with middle-aged and older patients, however, I often enough meet people who assume that their dog is "old" and therefore, whatever is ailing them must be bad and incurable. It would sadden me to learn that someone has skipped over a professional assessment and unwittingly short-changed their animal companion a straight-forward medical solution.