AAFP–AAHA: Feline Life Stage Guidelines

Abstract

Cats have become the most popular pet in the United States, yet statistics about veterinary care for cats remain troubling.1 Although most owners consider their cats to be family members, cats are substantially under-served, compared with dogs.In 2006, owners took their dogs to veterinarians more than twice as often as cats, averaging 2.3 times/year, compared with 1.1 times/year for cats, and significantly more dogs (58%) than cats (28%) were seen by a veterinarian one or more times/year.2 Cat owners often express a belief that cats ‘do not need medical care’. Two reasons for this misconception are that signs of illness are often difficult to detect, and cats are perceived to be self-sufficient.2 One role of the veterinarian is to develop a partnership with cat owners that will pave the way for a lifelong health care plan. These guidelines aim to outline an evidence-based life stage wellness program to aid the veterinary medical team in delivering the best comprehensive care for cats. Specific goals are to provide:Distinct life stages (age groups) in cats are not well defined, in part because individual animals and body systems age at different rates, a process that is influenced by many factors. These guidelines follow one convenient classification (see box on the next page). These age designations help to focus attention on the physical and behavioral changes that occur at different stages (eg, congenital defects in kittens, obesity prevention in the junior cat). It must be recognized, however, that any age groupings are inevitably arbitrary demarcations along a spectrum, and not absolutes.Supporting references for specific recommendations are supplied where possible, and any previously published guidelines on particular topics are referred to where relevant. Readers should note, however, that the guidelines panel was hampered in its efforts by the relative paucity of disease incidence data by age group that is available, and there is an urgent need for research to guide the future of evidence-based feline health care.3To achieve optimum feline health care, veterinarians must help owners to understand and appreciate the importance of regular preventive care for their cats at all ages. A consistent message from the entire health care team is crucial, beginning with the first kitten visit and reinforced during subsequent visits. Early detection of clinical abnormalities and behavioral changes can improve disease management and quality of life.5,6The panel supports the recommendations of the American Association of Feline Practitioners (AAFP) and American Animal Hospital Association (AAHA) that a minimum of annual wellness examinations and consultations for all cats is justifiable. More frequent examinations may be recommended for seniors and geriatrics, and cats with medical and behavioral conditions.Semi-annual wellness exams are often recommended for all feline life stages by veterinarians and veterinary organizations. Their reasoning includes the fact that changes in health status may occur in a short period of time; that ill cats often show no signs of disease; and that earlier detection of ill health, body weight changes, dental disease, and so on, allows for earlier intervention. In addition, semi-annual exams allow for more frequent communication with the owner regarding behavioral and attitudinal changes, and education about preventive health care. Further research is needed to identify the optimal examination schedule to maximize the health and longevity of the cat.The panel members concluded that preventive veterinary care can improve quality of life, detect illness earlier and, therefore, reduce the long term expenses associated with a cat’s health care. They believe that cat owners are willing to seek more veterinary care when it improves quality of life and detects illnesses earlier, thereby reducing the long term expenses associated with their cat’s health care. Improved client communication and education of the benefits of regular veterinary care are essential to achieve that goal (Fig. 1).The reasons pet owners have cited for not seeking care were that they did not know it was necessary, the veterinarian did not recommend it, and the need or benefit was not well explained.7 Other obstacles include the cat’s stress or fear associated with veterinary visits and the practical difficulties of transporting cats to receive veterinary care. Suggestions for overcoming such barriers are provided on page 77.It is not the intent of the panel to reiterate the basics of the veterinary visit, but instead to offer a checklist to assist the veterinarian (see Table 1). Where relevant, aspects of feline behavior, nutrition, and various disease prevention and detection strategies are expanded on in the text.History-taking includes the use of open-ended questioning (eg, ‘How has [cat’s name] been doing since the last visit?’).8 This approach is often combined with a template or checklist, such as given in Table 1, to ensure important aspects are not overlooked.When performing the physical exam, particular attention should be paid to:Although specific data documenting benefits are not available, the panel concluded that regular wellness examinations and collection of the minimum database (MDB; Table 2) can be valuable, allowing early detection of disease or trends in clinical or laboratory parameters that may be of concern. Additionally, it provides a baseline for interpretation of data recorded at subsequent visits.Specific recommendations about age and frequency of laboratory testing depend on many factors.5,18,24 One consideration in determining this frequency is that the incidence of many diseases increases as cats age. Guidelines for management of mature, senior and geriatric cats may be found in the AAFP Senior Guidelines.5 Retroviral testing is discussed in detail in the AAFP Retrovirus Testing Guidelines.22 Measurement of blood pressure is discussed in detail in the ACVIM guidelines.25 Although limited incidence studies have been performed to identify the age of onset of hyperthyroidism in cats, the panel recommends that veterinarians strongly consider T4 testing in the apparently healthy mature cat. More robust incidence data is needed to develop firmer recommendations.Energy and nutrient needs vary with life stage, sterilization status and activity, and so general feeding recommendations provide only a starting point. Individual intakes must then be adjusted to maintain the desired weight and body condition score (Fig. 2).Satisfactory diets for cats contain all the required nutrients in proper balance, are palatable and digestible, and are free of spoilage and contaminants. The specific source of nutrients in feline diets is irrelevant when these criteria are satisfied.26 Both canned and dry food have been found to support health during all life stages.27 The presence of a label guarantee that the food was tested using feeding trials provides the current best initial evidence that a diet is satisfactory.The panel examined published peer-reviewed evidence-based studies in healthy, client-owned cats for any significant health effect of: feeding canned versus dry food (including contribution to dental health); providing a variety of foods versus a consistent diet; feeding high protein, low carbohydrate versus lower calorie and high fiber diets; feeding raw diets; providing dietary supplements, or access to grass or plants. Based on the available data, specific recommendations in favor of any of these practices cannot be made.Despite the concern surrounding the effects of carbohydrate in dry foods, current evidence suggests that housing and activity (which may be a marker of welfare)28 are more significant predictors of health.29–32 Evidence does not support the carbohydrate content of foods as being harmful or an independent risk factor for diseases such as obesity or diabetes.29,33With regard to home-made foods, the veterinarian should discuss and share evidence about nutritional balance, risks associated with preparation and feeding of foods raw, and advantages of using food formulated for cats, referring clients to additional resources if required (Table 3).A variety of feeding styles can maintain good health in client-owned cats, including free choice or provision of meals. In addition to monitoring intake, considerations include:Obesity may occur at any age, but is most commonly encountered in middle age.32,36 The risk of obesity may be reduced by environmental enrichment, increasing opportunities for activity, and individualizing food intake. The energy density of cat foods varies widely, based on the moisture and fat content of the diet. This information should be helpful in determining a guideline of how much to feed.Tips and items for discussion with clients include:An outline of behavior and environmental items for discussion at each life stage is presented in Table 1. The following discussion elaborates on those items, where applicable. For detailed recommendations about normal cat behavior and management refer to the AAFP Feline Behavior Guidelines.10Parasite control is important in cats of all ages. Prevention includes both animal and environmental control. The Companion Animal Parasite Council (CAPC) guidelines contain recommendations about prevention of ecto- and endoparasites, fecal testing, and more.20 The United States Centers for Disease Control and Prevention website (see Table 3) also provides information on a variety of zoonoses. Items for discussion are listed in Table 1, and a few specifics are expanded on below.Table 1 outlines the vaccination priorities to consider when designing a comprehensive, life stage-targeted wellness plan for a cat.Diseases of the oral cavity are extremely common,53 yet most owners are unaware that dental disease can threaten the health and welfare of their cat. The AAHA Dental Care Guidelines for Dogs and Cats provide details of dental care and dental charting.54 Points of note include:Although the panel’s objective to provide evidence-based guidelines for health care related to life stage was not fully realized, the profession could develop more accurate recommendations through further research and through cooperation and data sharing. More robust data about disease incidence by age would assist practitioners in determining the value and desired frequency of routine wellness testing. In the meantime, we must rely on the available data, personal knowledge and experience to help owners maintain their cat’s health during its lifetime.The AAFP and AAHA would like to thank Boehringer Ingelheim, Merial Ltd, Pfizer Animal Health and IDEXX Laboratories for their sponsorship of these guidelines and their commitment to help the veterinary community develop projects that will improve the lives of cats.