Chapter 36 Geriatric & Hospice Care

Owner education is a critical role of the veterinary technician or nurse working with horses at risk of laminitis. T or F

True

Palliative care is specialized medical care for animals living with a serious illness. T or F

True

The client's capacity to care for their pet is an important consideration in developing the treatment plan, since it relies on their active involvement. T or F

True

The speed with which the aging process occurs in animals vaies according to the size and breed. T or F

True

When managing pain in the geriatric patient, a preemptive, multimodal approach should be implemented. T or F

True

Older patients often have subclinical diseases that affect their nutritional status and health. T or F

True

Chronic sinusitis, horse

Sinus, clinical signs: purulent, unilateral nasal discharge, percussing the sinuses in middle of the nose makes a dull sound

The "A" in the acronym DISHA stands for ____________________

Activity changes

Sarcopenia

Age related loss of muscle mass

What are the 3 catagories of the the major physical and functional changes associated with aging in animals? Give examples of each

1. Behavioral changes- changed in sleep cycle, response to verbal commands and interactions with family or other pets. 2. Changes in appearance- such as gray, dull, dry hair coat, loss of muscle mass, development of cataracts and nuclear sclerosis. 3. Changes in daily functions- could reflect functional changes in musculoskeletal system (decreased activity and mobility) changes in vision, smell and hearing.

Dogs that weight___________________________more that their ideal body weight are generally classified as overweight, while thise that weigh _________________more that their ideal body weight are classified as obese.

10-20%, 20%

To maintain health and keep the horse comfortable, a geriatric horse should have its hooves trimmed every ________________________weeks and dental floating every_____________months.

4-5 weeks, 6 months

Aged horses are generally considered to be those older that _______________

20 years

Geriatric

A branch of medicine that deals with problems and tudy of health & disease in later life

Subpalpebral lavage system

A device placed for ease of treatment of ERU

The geriatric wellness exam should include all of the following except: A. a hearing test B. abdominal & rectal palpation C. a full orthopedic exam D. assessment of the cardiopulmonary system

A. a hearing test

Which of the following is NOT a change you would expect to see in an aging patient? A. decreased percent of body fat B. urinary incontinence C. loss of muscle mass D thickened foot pads in dogs

A. decreased percent of body fat

Hirsutism

Abnormally excessive hair growth, associated with Cushings in horses & ponies (Cushings-PPID)

Neovascularization

Blood vessel growth on cornea

Corneal edema

Bluish-white tint to the cornea

Which of the following is typically not an underlying cause of acute or chronic with loss in the geriatric horse? A. tooth loss B. inability of the GI tract to absorb nutrients C. neoplasia D. ERU

C. ERU

Which of the following is NOT a core competency of the veterinary hospice nurse role? A. medical caregiver B. educator C. mediator D. advocate

C. Mediator

Medical conditions appropriate for hospice or palliative care include all the following except? A. terminal diagnosis B. progressive, undiagnosed disease C. acute disability D. terminal geratric status

C. acute disability

Which type of feeding tube does not require anesthesia of placement? A. esophageal B. jejunostomy C. nasoesophageal D. gastrostomy

C. nasoesophageal

Cachexia is characterized by all of the following except: A. weakness B. anorexia C. weight gain D. perceived poor quality of life

C. weight gain

Discuss the importance of and activites associated with bladder and fecal hygiene maintenance in pets approaching the end of life.

Caregivers should provide hygiene care to prevent urine and fecal scald and trasmission, spread of infections. There is also a psychological benefit to hygiene maintenance, through prevention of the loss of dignity. Hair around anus and genitals can be trimmed to more easily clean and dry the skin. Baby wipes or mild soap and water can be used to clean aroung genitals and anus. Area should be rinsed well and completely dried. A moisture barrier ointment can be applied.

Hypopyon

Cellular debris in the eye

Neurologic deficits, horse

Cervical fractures or OA compressing spinal cord. Clinical signs: depression, dragging toes, ataxia, difficulty standing, reluctance to turn neck.

the development of hypertrophied external abdominal oblique muscles as a result of increased effort on exhalation is typically seen in horses with______________

Chronic heaves (exhalation)

PPID/ horses

Chronic high blood cortisol levels, clinical signs: decreased athletic performance, lethary, delayed shedding, loss of muscle mass, laminitis.

Which of the following is NOT a change you would expect to see in an aging patient? A. decreased skin elasticity B. decreased ability to combat infection C. Decreased cardiac output D. decreased calculus accumulation

D. decreased calculus accumulation

All of the following are considered rehabilitative therapies except A. laser therapy B. acupunture C. pulsed electromagnetic field therapy D. subpalpebral lavage

D. subpalpebral lavage

Fungal Ulcers

Difficult to treat, condition requiring medications several times a day.

Discuss ways to increase comfort in sleeping areas for elderly dogs and cats

Dogs- beds should be comfortable and supportive, easy to get in and out of, large enough for them to stretch out. Should be a warm area, electric heated beds may be welcomed. Adaptil diffuser may help dome dogs relax at night, items containing owner's send may help some dogs relax. Cats- Beds shoudl be comfortable and padded, easy to get in and out of and large enough to stretch out. A ramp of steps if cat prefers to rest in raised places. Warm areas for sleeping. Feliway diffuser may reduce anxiety and help cats relax better at night.

Discuss ways to improve acess to food and water for elderly dogs and cats

Dogs-raising bowls off the ground will help with joint and spinal problems, eat and drink more comfortably. Non slip matting under foot will prevent a dog from slipping whe eating and drinking. Cats-Raise bowls by a few inches to enable cats with joint ands spinal problems to eat and drink more comfortalby. Cats used to being fed on elevated surfaces may need a ramp or steps toa access food and water or move to a more acessible location.

Two common neurologic diseases of older cats are degenerative mylopathy (DM) and intervertebral disc disease (IVDD) T or F

False - DM and IVDD are diseases of older dogs

Chronic renal failure is common in aging cats, with up to 75% of cats >12 years of age affcted. T or F

False- 28% in cats older than 12 years of age.

Cognitive dysfunction is a neurodegenerative disorder of senior dogs and cats that is characterized by rapid cognitive decline over a short perior of time. T or F

False- A gradual congitive decline over a LONG perior of time.

Eye pain and swelling in an aged horse requires treatment but is usually not serious. T or F

False- A horse with eye pain an swelling is treated as an emergency.

In general, a dog needs more energy from food as it ages. T or F

False- Canine maintenance energy requirements decrease by approx. 20%

Aortic saddle thrombus is believed to cause moderate pain in animals. T or F

False- Causes severe to excruciating pain

Small, meduim and large dogs are classified as senior at 9 years of age. T or F

False- Considered to be senior life stage at 7/ dependent on size and breed

Geriatric horses often develop degenerative joint disease in the coxofemoral joints, stifle, and lumbar vertebrae. T or F

False- Geriatir horses often develop chronic lamintic, dental diseasee and eye problems.

The most common initial sign of EOTRH reported by horse owners is lengthening teeth with sharp area. T or F

False- Most common initial sign is horse's reduced ability to grasp apples and carrots.

In a horse with heaves, wheezes will be heard on both sides of the chest, especially during inhalation. T or F

False- Wheezed heard on both sides of the chest, especially during EXPIRATION

A 14 lb, 6 year old dog is the equivalent age of a 52 yr. old human. T or F

False- equivalent age of 40 year old human

Rehabilitation is often capable of halting the loss of muscle mass that occurs in geriatric patients, but it cannot reverse it. T or F

False- rehabilitation is often capable of halting and REVERSING muscle mass

Agins is considered a disease process. T or F

False-Aging is not a disease process but is a decline in reserves and strength & other changes in body systems, increasint the likelihood of disease

It is imperative that both euthenasia and natural (unassisted) death not be discussed too soon after the caregive/hospice-provider relationship has been established. T or F

False-should be discussed as soon as a caregive-hospice provider has been established

Geriatric horses with poor body condition as a consequence of inadequate caloric intake may require dietary changes or supplementation. What specific dietary changes can be employed to maintain body weight in these patients?

Feed horse individually to ensue the horse is receiving enough food and to assess appetite. Feeding free choice high quality hay with supplentation of alfalfa will aid in maintating weight. Feeding an equine senior feed or calorie dense diet can help maintain weight if a horse has lost teeth.

Considerations for equine euthanasia are often multifactorial, but are usually related to failure in either the ____________________system or the __________________system.

GI system or the orthopedic concerns

A Great Dane that is 8 yrs olf age is considered to be a _______________

Geriatric

Hyphema

Hemmorage in the eye

Anterior uveitis

Inflammation in the front champer of the eye

The signs of PPID in horses include hirsutism, abnormal sweating, polyuria, polydipsia and ___________________

Laminitis

Cachexia

Loss of lean muscle mass, a condition of physical wasting away due to the loss of weight and muscle mass that occurs in patients with diseases such as advanced cancer or AIDS

Fratility

Multisystem impairment associated with increased vulnerability to stressors and describes the condition of individuals at increased risk of adverse health outcomes.

Pretreatment with a(an) ________________________________is recommended in horses with a history of vaccine reactions.

NSAID

A geriatric horse with a long, wavy hair coat that does not shed completely in the spring is likely to have____________________

PPID ( used to be called cushings)

PPID in horses is treated with the dopamine agonist________________________

Pergolide

Heaves/horses

Recurrent airway obstruction-equine asthma, clinical signs: tachypnea, dyspnea, nostril flare, dry cough

Enucleation

Removal of an eye

Wave Mouth

Severe malocclusion of all teeth, commonly effects geriatric horses, causes extremem difficulty chewing food

Wave mouth, horse

Severe maloclusssion of all teeth. Clinical signs: difficulty chewing food, chews slowely

Senescence

The condition or process of deterioration with age

Discuss ways to hlep animals with severe cognitive dysfunctuion or anxiety function optimally within their environments.

The environment shoudl remain stable and unchaged, Hightly anxious animals especially cats, may cope best when restricted to single room containing food, water, litter box, resting and hiding places. It is important to keep furnutre and resourse in the same place to avoid big changes to the scent profile of the room. Maintaining a consistant routine ensuring that important events occur in the same order and approx. times everyday also helps.

A giant-breed dog ages more rapidly that a small breed dog or cat. T or F

True

Decreased skin elasticity and brittle claws have been noted in apparently healthy older cats. T or F

True

Heaves in horses is often related to a dust or mold allergy. T or F

True

In an aged horse, laminitis usually develops as a secondary condition to a pre-existing problem. T or F

True

It is notoriously difficult to maintain weight and body condition in older horses. T or F

True

It is recommended that dogs and cats in the 25% of the predicted life span have routine healthcare visits, inclding a minimum laboratory database every 6 months. T or F

True

Mouth size is a significant rish factor for periodontal disease in dogs. T or F

True

Hospice

a facility or program designed to provide a caring environment for meeting the physical and emotional needs of the terminally ill

the most common abnormal heart rhythem in geriatric horses is_______________

atrial fibrillation

Physiologic changes that occur in dogs and cats as they age are catergorized as changes in __________, ________________, and ____________________

behavior, appearance, and daily function

PPID in horses causes a colleciton of clinical signs resulting from chronic hgih blood______________________levels

cortisol

In emaciated or geriatric patients, when compatible history and physical examination findings are present, it is reasonalbe to assume 7%_______________and treat accordingly.

dehydration

Acute laminitis, horse

disruption of bloodflow to laminae that secures coffin bone to hoof wall. Clinical signs: Pain, inflammation, enzymatic activation, vasular derangemnt and lamellar destabiliztion

Pituitary pars intermedia dysfunction (PPID) was formerly known as __________

equine cushings disease

Equine recurrent uveitis

eyes, inflammation and degeration of one or both eyes. Clinical signs: Swollen and painful eyes, blepharospasm, corneal edema, iris color change , neovascularization, anterior ureitis

Recumbent patients require soft bedding, impeccable hygiene, and_______________ to avoid complication such as bed sore, muscle stiffness and atelectasis.

frequent turning

The most important goal of palliative care and hospice if to help patients achieve__________________________

good quality of life

A geriatri horse that lives in a barn with poor air circulation, has a history of allergic reactions, and exhibits tachypneaand dyspnea may be exhibiting signs of _________________________________

heaves

Many veterinarians recomment that healthy geriatric small animals ___________________________, should be examined ______________time(s) a year.

in the last 25% of their predicted life span, 2

Laminitis

inflammation of the lamina within the hoof, devasting and sometimes fatal

Incontinence

involuntary discharge of urine or feces

Position for bladder expression may vary patient to patient. For instance the bladder can usually be expressed when a patient is in ____________________recumbancy, or when it is ________________________________

lateral, standing with support

The most common central nervous system tumor in older pets

meningioma

An important aspect of treatment for horses with heaves is ___________________

minimizing contact with allergens

A systolic murmur auscultated on the left side of the equine thorax suggests a common valvular disease of the geriatric horse known as _________________________

mitral regurgitation

The reluctance of a horse to touch its nose to its shoulder is generally indicative of pain affecting the ____________________________

neck

Common tumors in horses include squamous cell carcinomas, which often develop on the _______________or_______________and melanomas, which often develop around the _______________area

prepuce or penis, rectal