125 | This is why our senior cats and dogs are often overlooked - and what you can do about it as a vet nurse
I want to start today’s episode with a conversation I had a few weeks ago - a conversation that actually inspired me to sit down and record this episode.
I was teaching a medical nursing clinic day for a group of practices. It was actually the second time I'd delivered the day for them, and this time, I got a glimpse of what happened after the first one.
During one session, I asked which clinics people were most interested in running. One nurse raised her hand and mentioned hyperthyroid cats and setting up clinics to support these patients. After a bit of chatting, it turned out that her head nurse had come to the first day I delivered a few months before - and she'd gone back to practice and set up senior pet clinics.
Those clinics had got busy. So busy, in fact, that they'd needed to train more nurses (including the lovely delegate I was talking to) to set up and run hyperthyroid clinics.
Why? Because a huge number of the cats coming through those senior clinics were hyperthyroid. And these were the cats whose caregivers had booked them in thinking they weren’t sick, just needed a ‘routine’ review.
Now, I'd put money on most of those cats not being new to the practice. They'd probably been in for boosters - or maybe not - or flea and worming. Maybe the odd nail clip, but not necessarily a full discussion about the considerations that come with having an ageing pet.
As soon as client awareness, education and support around that topic increased, more patients were diagnosed with underlying chronic disease. That means faster treatment and, hopefully, better outcomes for our patients.
So that’s what this episode is all about - our senior dogs and cats. We’re going to talk about why they deserve so much more of our attention than perhaps our clients may perceive, the diseases they’re at risk of and why, what the research shows about screening, and - most importantly - what you can start doing in your own practice to support these patients.
If you want to build new nursing skills with your senior patients, have confident discussions with your clients about senior health, or brush up on what to look out for when seeing seniors, you’ll find it all in this episode.
So what makes a senior pet senior, and why is it so important they’re on our radar?
When we’re talking about senior pets, the first thing we need to establish is which patients fit into that category.
This varies by species.
For cats, according to the AAHA/AAFP lifestage guidelines, they’re classed as mature adults from around 7-10 years old. They’re seniors at 11-14, and ‘super senior’ from age 15 onwards.
To put that in perspective and offer a human comparison (which I often find useful for clients), a senior cat is roughly 60-72 in human years, and a super senior cat is into their mid-seventies and beyond.
And actually, if we think about mature and senior humans, most of our routine screening - mammograms, bowel cancer, prostate cancer etc.- begins at, or even before, that senior cutoff point. So if that’s the case for humans, why wouldn’t it be the case for our patients?
Dogs are a bit trickier, because there is huge variation in their breed and size - and with that, their normal lifespan. So the general rule is that a dog is senior for roughly the last 25% of their expected lifespan - meaning a small breed dog may not be senior until they reach 10, but a giant breed will hit that stage at 5-6. It all depends on your patient's size.
Now that we know what makes a senior, let’s talk about why seeing these patients matters.
Older pets make up somewhere around 30 to 40% of the patients in general practice - and if we think about it, that's a big chunk of our caseload. And yet, if you think about how we structure care in most practices, it's heavily weighted towards our younger patients.
We've got puppy parties, kitten clinics, second vaccine appointments, weigh-and-worms, neutering chats, little take-home packs with samples and leaflets… I could go on. And all of that is great - we are brilliant at the start of life.
But we see our senior patients far less (despite there being around 2.2-2.5 times as many seniors as paediatric patients).
A lot of the time, our oldest patients often get the same annual booster they had when they were three or four - and that’s assuming they’re still coming in for vaccinations, as we know that preventative healthcare frequency tends to reduce in our older patients.
And cats in particular get a raw deal here (and I will say now, a lot of the data we’re talking about today is weighted towards cats - because we’ve got more evidence looking at this - and as a bit of a mad cat nurse, I think this is especially important).
Cats have historically been seen by vets around half as often as dogs - some of that is because cats do not cope as well with things like the journey, the visit, the actual treatment, etc., but some of it is a belief that cats are self-sufficient because they’re so good at hiding illness.
The reality is that if we’re not seeing our patients regularly, we’re not able to pick up on those subtle signs of disease - and there are definitely going to be more of those subtle signs in our senior patients.
So what diseases are our senior cats and dogs at risk of, and why is this important for us as veterinary nurses?
Ageing brings on a predictable set of physiological changes that affect almost every
body system. Understanding these changes is what allows us to monitor our patients
effectively and detect problems early - so we’ll look at each of these systems together now.
Starting with the kidneys…
Chronic kidney disease becomes increasingly common with age, especially in cats. And the kidneys are annoyingly good at compensating because they’ll hypertrophy and overwork as much as they can until they can’t do that any more - this means that, by the time creatinine rises above the reference range, a big proportion of nephron function may already be gone.
Then there's the endocrine system.
Hyperthyroidism in our cats (as the cats from that nurse’s clinic have clearly demonstrated), hypothyroidism in dogs, diabetes mellitus in both species, and other endocrinopathies like hyperadrenocorticism are all commonly seen in our seniors.
Closely related to these is hypertension.
Chronic kidney disease, adrenal disease and hyperthyroidism are all commonly associated with systemic hypertension. Hypertension is also a condition that we often don’t diagnose early enough, because by the time our patients are showing obvious signs, there’s been a LOT of underlying target organ damage - particularly to the eyes and CNS, but also to the kidneys and the heart.
Speaking of the heart, this is also impacted by ageing - as are a whole host of other body systems.
The heart has less reserve as it ages, and we hear more murmurs. The joints degenerate, and osteoarthritis becomes incredibly common (up to 90% of senior cats have it, and over 80% of dogs aged >8 years). Muscle mass begins to reduce, and periodontal disease progresses - often causing significant dental pain.
On top of this, we see CNS changes - with things like cognitive dysfunction syndrome common, bringing with it changes in sleep, awareness, interaction and toileting habits. All of which can be challenging for clients to manage and very detrimental to the human-animal bond.
The immune system slows down too. Healing takes longer, and cancer becomes much more common. Add in reduced vision and hearing, which can change how a patient behaves and how they cope with being handled, and you can see how much is going on.
And our patients rarely have just one of these changes - they often exist in combination.
A research group in Liverpool followed a group of middle-aged cats, examining them every six months for up to seven years. 96% developed at least one abnormality on examination, and 84% ended up with two or more conditions at the same time.
So if our patients aren’t just getting one of these problems, we can’t examine, treat or nurse these patients by disease - they need someone looking at the whole patient, identifying subtle changes, and flagging them with the vet - which is exactly where we come in as nurses and technicians.
Often these diseases are subclinical - so how do we find them?
I feel like we have all heard the phrase ‘age isn’t a disease’, and it is absolutely true. How often do we all hear ‘oh, she’s fine, she’s just getting old’ in a consultation?
In reality, age isn’t a disease - but it absolutely increases the risk of one.
But most of the time, those subtle changes occur so gradually that our clients and caregivers miss them. And I say this as someone who didn’t realise how much weight my own mature adult cat had lost, because seeing him every day meant I couldn’t appreciate how significant it was.
Our caregivers see their pet every day, so drinking slightly more or taking the stairs a little more slowly just becomes the new normal. It isn’t immediately obvious that there’s a problem.
Thankfully, we now know just how much of a problem there is - because there are a whole host of studies reporting how often we see subclinical disease in our ‘healthy’ senior cats and dogs.
One study demonstrated that 100% of apparently healthy cats aged >12 had abnormalities on their physical exam. All of them had dental disease, and almost all of them had orthopaedic disease, among other changes.
Over 90% had muscle loss, and there were multiple new diagnoses of hyperthyroidism and chronic kidney disease. Despite this, PUPD were very rarely reported during client questioning.
We see similar evidence in our senior dogs, too. A Belgian study screened 100 older dogs that were healthy according to their caregivers, but found that more than 20% had a heart murmur, more than 50% had at least one lump/bump or mass, and almost 40% were overweight. On top of that, around ⅓ of the patients had elevated creatinine on bloodwork.
That’s not to say our clients are ignoring health problems - most of the time the signs are so subtle, especially in the early stages of disease, that it’s really hard to spot those changes. Especially in a pet you see every single day - which is why we need to help detect those diseases as early as we can.
So your senior pet has a disease identified on screening - what happens next?
I am not here to say that vet nurses should do one senior pet clinic, help spot disease, send them to the vet, and then our role is done. Not at all - there’s so much we can do, and ongoing monitoring and re-screening is really important.
These patients often develop concurrent diseases, but on top of that, even seemingly healthy patients on their initial screening will go on to develop chronic disease.
In fact, a couple of studies from the team at Ghent University looked at the importance of follow-up screening in senior dogs and cats.
They found that, over two years of senior pet screening, >25% of mature adult cats, >50% of senior cats, and 47% of senior dogs developed new abnormalities. In the cats, CKD was the most common, followed by hyperthyroidism, then gut, liver and pancreatic disease, and cancer. Of the healthy dogs they followed, the most common new problems within two years were cancer, CKD, neurological disease and orthopaedic disease.
How often should we be seeing our senior patients for routine screening?
According to the AAHA and AAFP life stage guidelines, we should see senior cats for routine screening at least every six months, and more often for cats with chronic conditions. For super seniors, every three months is reasonable. Senior dogs should also be seen at least every six months.
For diagnostics, the guidance is at least annually, and ideally every six months, depending on the individual patient. And if you're wondering whether six months is overkill (or your clients are), the studies I’ve mentioned so far rechecked their patients every six months, which is how they diagnosed those new diseases.
The role of the veterinary nurse in senior health screening
Now, this is where our role comes in - because I genuinely think we have an enormous amount of potential to make a real difference to these patients.
A lot of the senior health assessment is history taking, weighing, body and muscle condition scoring, a thorough physical exam, sample collection and caregiver support. Nurse and technician clinics fit in so well here, working alongside the vet team and under veterinary direction for any diagnostics.
The signs are often subtle, and we want to use our role to gather as much information as we can - looking for those subtle clues, asking questions, encouraging them to share seemingly insignificant details (because often that’s where we find out the most valuable information).
I do just want to caveat this with a legal disclaimer quickly, though - because what you can do will depend on where you work and your local legislation. So if you want to run senior clinics or do more to support these patients, I’d recommend speaking to your vet team, determining which tasks count as veterinary-directed, and agreeing a framework for any clinics. That way, you, your vet, and your patient are all protected.
That being said, there’s a huge amount of value we can contribute here - so let’s look at how to run a senior clinic, start to finish.
What can (or should) a senior clinic look like, and how can we utilise our skills as veterinary nurses?
I want to finish with some general guidance on running successful senior clinics. This will vary depending on your clinic, your location, and your patient, but in general, we want to address the following areas:
Preparation
Opening
Information gathering
Physical examination
Diagnostics
Advice, support and education
Closing
Before they arrive
Preparation makes such a difference, so in addition to preparing your space, review the notes before the patient comes in.
Look at things like the patient’s previous weights, body and muscle condition scores, recent diagnostic results (if applicable), current medications and any previous clinic notes.
And if diagnostics are planned, check there's a clear plan from the vet on the record - including what samples are needed, where they’re going, and the specific test codes required.
Opening the consult
When the client arrives, introduce yourself and explain your role.
Then, if it's safe to do so, let the patient come out and have a wander around the room while you chat.
It helps the patient settle; it helps the caregiver relax - which will likely improve the quality of information you get from them - and you get to watch how the patient moves and interacts with their surroundings before you've even touched them.
It also makes your blood pressure and vital sign readings far more accurate, as they’ve had time to acclimatise before your exam.
Taking the history
This is where the research we've just talked about really changes how we work. If we ask closed questions like ‘have there been any changes?’, we will probably get something like ‘no, he's fine’ in return.
So my advice would be to start with open questions that get the caregiver describing their pet's life, such as:
‘Talk me through a typical day for her.’
‘Could you walk me through what his eating habits look like?’
‘When you think back to three months ago, how are things different now?’
I really like that last one because it gives caregivers permission to notice small things, and they often won’t appreciate the importance of these changes until they look back and compare them.
Then follow up with more targeted questions. We want to make sure we’ve asked about:
Appetite and enthusiasm for food
Water intake, and behaviour around the water bowl
Urination, accidents, how often the litter tray needs changing
Defecation - consistency, frequency, any straining or changes
Mobility - if you can, ask about specific tasks rather than asking whether they're stiff. For example, can he still jump onto the sofa? Or get in the car? Have there been any changes in grooming or use of sleeping/resting places?
Behaviour and cognition - For example, changes in sleep patterns, vocalising at night, seeming lost or confused, changes in how they interact with the family?
There are lots of tools we can use to help us, such as the DISHAA tool for cognitive dysfunction, or the LOAD questionnaire for mobility. I’ll leave links to both of these in the show notes below the episode for you.
I also wanted to share a tip from the senior care guidelines that I love: ask caregivers to send you videos of their pet moving around at home, and photos of where they eat, drink and sleep. This will give us a much more accurate picture of their daily life than a 15-30 minute consultation!
Performing a physical examination and running diagnostics
Next, we need to perform a full physical examination, tailored to the individual patient. This should always include a bodyweight assessment, body condition score and muscle condition score at every single visit.
I also love calculating the percentage weight change, too, so that we’re not just focusing on the absolute grams lost or gained - we’re putting it in perspective for that individual patient.
To do this, take the patient’s previous weight, subtract their current weight, divide by the previous weight, and multiply by 100.
So if a 4 kg cat has lost 400 g, that's 10% of their body weight. Putting that in human terms, for a 70 kg person, that would be 7 kg - and if a human had lost 7kg without trying, we’d definitely be going to the doctor and getting some bloods done!
Also - always compare your examination findings with last time, and look at trends over time. This is really valuable, and many of our practice management systems will plot these vitals in graphs which allow us to spot changes easily.
Now we need to move on to diagnostics. These should always happen under veterinary direction - for example as part of a specific plan for that individual patient, or an agreed practice protocol for senior screening bloods/urine analysis.
This usually includes a CBC, biochemistry, T4, SDMA and blood pressure, alongside a urine dipstick and specific gravity - but of course, these tests will vary between clinics and individual patients.
If you can, measure blood pressure first, before any bloods or restraint, which can easily contribute to so-called ‘white coat hypertension’. Also, I like to pop some EMLA cream on at the start of the consult so it has time to work, or even send caregivers home with a small tube to apply before they come in. And think carefully about restraint and sampling sites because lots of these patients are arthritic and may be uncomfortable when specific areas are manipulated.
What about advice, support and education in our seniors - where do we fit in as vet nurses?
This is probably the biggest area we can make a difference with, and where the value of these consults really comes into its own. There is no way that a vet in a 15-20 minute consultation is going to be able to get a complete history, examination, diagnostics, AND then discuss all aspects of a senior patient’s life - it’s just not possible. So getting these patients in to see us for additional education, advice and support is vital.
These conversations should cover the patient as a whole, and not just any one disease they might have.
While the specifics of what we cover will vary from patient to patient, in general, we need to talk about things like nutrition, hydration, eliminations, behaviour, quality of life, and preventative care.
Nutrition
Is the diet still right for them? Are they eating well? Older pets can lose some of their sense of smell, and some have higher energy needs than we'd expect. Talk about hydration, including extra water bowls, water fountains or wet food.
Eliminations
An old cat with OA may find a high-sided litter tray too difficult to use, and that can look like inappropriate urination - often considered a behaviour problem - when, in this case, it's a pain and mobility problem.
The home environment
Can the patient still reach everything they need? Are any modifications such as ramps, non-slip rugs, raised bowls, or orthopaedic bedding helpful?
In multi-cat homes, older cats are often less tolerant of younger, bouncier housemates, so we also need to look at resource placement - even if cats have not had obvious signs of conflict previously, this may change with ageing.
Preventative healthcare and quality of life
We also need to encourage clients to keep preventative care going. Parasite control, vaccinations, dental care, grooming and nail trims don't stop being important just because a pet is older - if anything, they’re more important, because we can see immune dysfunction and reduced self-grooming/scratching as a patient ages.
Lastly, check in on quality of life. Too often, our clients hear ‘quality of life’ and assume we mean euthanasia - but in reality, quality of life and end of life are not the same conversation. For our seniors, quality of life should be a regular check-in at every clinic, and not something we only talk about when things are coming to an end.
The senior care guidelines also suggest we frame these clinics around the care and support we can give, rather than just ‘we need to test for hidden disease.’
While we will spot hidden disease in many of these patients, the ultimate goal of these clinics is to maintain comfort, routine, and quality of life for as long as possible.
Finally, we need to think about closing out the consultation.
Before they leave, ask yourself if anything needs to be actioned.
Does anything need raising with the vet? Does the patient need a vet appointment for a new problem? Do results need forwarding to the vet to interpret? Is there anything you need to check with the vet before the caregiver walks out of the door?
If the answer to any of that is yes, then make a plan before they go - so they know when to expect contact from you.
Then summarise the key points, and check for any last questions. Provide written information for them to refer back to, as well - having different handouts to give on things like home adaptations, or diet transitions, or water intake, can be really useful here.
Lastly, make sure the client knows what happens next. When will they hear from you? Is the next clinic in the diary? Do they know how to contact the practice if they're worried, both during the day and out of hours?
By following these steps, you’ll perform a thorough clinic, confidently, ensuring you’ve supported the whole patient - and their family.
So where do we go from here?
If you’ve been listening for a while, you’ll know that utilising our knowledge and skills within nursing is my ultimate goal for our profession.
So let’s bring together everything we’ve chatted about in this episode and look at how to do just that.
Going back to the very start of this episode, to that head nurse who came along to a CPD day, who went back to practice and started a senior clinic.
She took what she'd learnt and started seeing older patients in dedicated clinics. As a result, a whole group of cats who ‘seemed fine’ were referred on to the vet, diagnosed and treated. From that, there was an increasing need for more clinics - so more nurses in the team got the chance to use their skills in brand new clinics of their own.
If you'd like to do something similar, here are a few places you could start this week.
Have a look at how many cats over eleven, or senior dogs, haven't been seen in the last six months. And if you do this, let me know what that number is as a percentage - DM it to me on Instagram, because I’d be really interested to know, and I think the number might surprise you.
Chat to your vet team and your practice leadership about running senior clinics if you don’t do them already.
Create a simple clinic template, and then take it to your vet team for their feedback.
Talk to your reception team, because they're the ones booking these patients in. The way the clinic is described to caregivers makes a big difference.
And once you’ve got all of that together, start small, with just a couple of clinic slots - you can always grow it out from there.
The research is really clear that these patients have far more going on than meets the eye - and we are in such a great position to find it, support them, and help these pets have the best possible quality of life, for as long as we can.
Did you enjoy this episode? If so, I’d love to hear what you think. Take a screenshot and tag me on Instagram (@vetinternalmedicinenursing) so I can give you a shout-out and share it with a colleague who’d find it helpful!
Thanks for learning with me this week, and I’ll see you next time!
References and Further Reading
Blanchard, T., Mugnier, A., Boulet, F., Meynadier, A., & Priymenko, N. (2025). Epidemiological and clinical profiles of young and senior dogs fed a standard diet. Preventive veterinary medicine, 240, 106537. https://doi.org/10.1016/j.prevetmed.2025.106537
Dhaliwal, R., Boynton, E., Carrera-Justiz, S., Cruise, N., Gardner, M., Huntingford, J., Lobprise, H., & Rozanski, E. (2023). 2023 AAHA Senior Care Guidelines for Dogs and Cats. Journal of the American Animal Hospital Association, 59(1), 1–21. https://doi.org/10.5326/JAAHA-MS-7343
Herrera, K., Nichelason, A., Snyder, Z., Hetzel, S., McLellan, G. J., Crawford, L. K., & Cameron, S. (2026). Clinically important abnormalities are common in senior cats perceived to be healthy by owners. Journal of the American Veterinary Medical Association, 1–10. Advance online publication. https://doi.org/10.2460/javma.26.04.0326
Marynissen, S., Mortier, F., Duchateau, L., Smets, P., Daminet, S., & Paepe, D. (2025). Exploring the Importance of Repeated Health Screening in Healthy Older Dogs. Journal of veterinary internal medicine, 39(4), e70166. https://doi.org/10.1111/jvim.70166
Mortier, F., Daminet, S., Marynissen, S., Smets, P., & Paepe, D. (2024). Value of repeated health screening in 259 apparently healthy mature adult and senior cats followed for 2 years. Journal of veterinary internal medicine, 38(4), 2089–2098. https://doi.org/10.1111/jvim.17138
Pye, C. R., Dowgray, N. J., Eyre, K., Pinchbeck, G., Hughes, D. M., Moniot, D., Comerford, E., & German, A. J. (2026). Patterns of morbidity, multimorbidity, and mortality in aging cats: findings from seven years of the Cat Prospective Ageing and Welfare Study. Frontiers in veterinary science, 13, 1813450. https://doi.org/10.3389/fvets.2026.1813450
Quimby, J., Gowland, S., Carney, H. C., DePorter, T., Plummer, P., & Westropp, J. (2021). 2021 AAHA/AAFP Feline Life Stage Guidelines. Journal of feline medicine and surgery, 23(3), 211–233. https://doi.org/10.1177/1098612X21993657
Willems, A., Paepe, D., Marynissen, S., Smets, P., Van de Maele, I., Picavet, P., Duchateau, L., & Daminet, S. (2017). Results of Screening of Apparently Healthy Senior and Geriatric Dogs. Journal of veterinary internal medicine, 31(1), 81–92. https://doi.org/10.1111/jvim.14587
