Hello everybody, and thank you for joining me for tips and tricks for successful ageing cat clinics. So first of all, I thought I would just introduce myself so you understand why I'm here today and why I'm doing this talk for you. So my name's Kelly, and I am the veterinary nurse at the Feline Healthy ageing Clinic.

So the Feline Healthy ageing Clinic is based at the University of Liverpool within the Institute of Life course and Medical Sciences. And the Feline Healthy ageing Clinic is a research project funded by Royal Canon, and it aims to extend the quality of life in our ageing cats through research and education. So we see cats every 6 months.

We assess lots of different parameters, and we hope that all this information that we can gather can then improve the quality of life in our older cats, educate the veterinary environment and really make a difference for these older cats. So I'll just briefly go through what we do at the clinic. So we started in 2017 and we enrol cats between the ages of 7 to 10 years.

We don't exclude any cats that have any pre-existing conditions or anything like that. So the first thing we do when they're enrolled, we ask the owners to complete a questionnaire. We then have the cats in with us.

They're with us for about an hour and a half, and we do a full physical exam, a blood pressure check. We do floor blood tests, urinalysis if the cats are willing to give us a sample. We also do gait analysis.

So in that picture there on the right-hand side, under that kind of plastic sheeting is a pressure mat. And we try and get the cats to walk across this pressure mat up to 10 times in a straight line, which I'm sure you can understand, isn't easy. But with the help of treats, we usually manage to get at least a few walks.

And this pressure mat picks up the way the cats walk, the pressure that they put on each pad. The stride, like, all this kind of information and we can take that away and we can have a look and see how their their kind of movement is changing as they get older. We also do a retinal exam and take photos of the back of the eye.

And we do a muscle lumbar ultrasound and we do that to measure the muscle on the lumbar and see if we can measure any difference as these cats are getting older. So for cats that are over the age of 10, we then see them again at a 6 month point, and we do everything again. So everything we did at the enrollment appointment appointment, we repeat 6 months later, for these cats that are over 10.

For cats that are between 7 and 10, we see them every 6 months, but we do a shorter exam. So we do a questionnaire, a blood pressure check, and just a general shortness for physical exam with myself. And then every year, no matter what the age of the cat, we then see them again for that first appointment, like that first appointment, where we do all those things, the physical exam, the retinal exam, the gait analysis, all that kind of stuff.

So that's what we do at the clinic, and that's how we work. And that's kind of the gold standard kind of checkup process that you would do with these older cats. So, I thought I'd just touch on what I'm going to talk to you about today.

So I'll briefly go through some age-related diseases, and I'll give you some findings from the clinic that we found in the last 4 years. I'll then go through what you need to include in your ageing cat consultation and what to include in your owner questionnaire. I'll give you a couple of case studies as well of some of the cats that we see at the clinic, and then I'll go through some kind of tips and tricks to really make these ageing cat clinics successful.

So starting with age-related diseases and findings from the clinic. First of all, I just really wanted to say to you, what is ageing? So, ageing is the process of growing old and healthy ageing is the process of growing older without any age-related disease.

And as vets and nurses, what is our aim for these ageing cats? So, our aim is to improve the quality and length of their life through regular monitoring, early detection of disease, and the most inappropriate intervention. So, that's our aim, and I just want you to remember that aim throughout the talk today and really take that aim away with you when you start doing your ageing cat clinics.

So this poster on the left here, I'm sure you've seen these in your waiting room quite a lot. Now we know the average lifespan span for cats is about 14 years old. And this poster goes through the life stage of what age they are at certain life stages.

And we can see from the poster from this chart here that our cats are mature between the ages of 7 to 10. And in this mature age range is when we start to see age-related diseases developing, and this age range is where we really want to start seeing these older cats. So touching on some age-related diseases, first of all, we've got chronic kidney disease.

Clinical signs of chronic kidney disease. You've got things like your weight loss, inhabitants, the owners might see their cats vomiting. On an abdominal palpation, you might feel to kidney size, the cat may appear dehydrated.

The owners may also have noticed that their cat's drinking more, using the litter tray more often. On doing your blood pressure exam, you might also see some systemic hypertension. And on a urine sample, you might also see a lowSG.

So diagnosis for chronic kidney disease, you're gonna be doing your full history and exam, your full urinalysis, you might do a urine protein creatinine ratio as well on your urine. And you're gonna want to be doing a full biochemistry, SDMA and electrolytes alongside a haematology and definitely your blood pressure. And Irish the Irish staging guidelines are really, really useful.

I'm sure you may be aware of this. If not, have a look at the Irish website. I've put the link in the resources for you as well, but they do a really handy little booklet, which goes through the stages of kidney disease, what you would be seeing at each stage, what to do to diagnose the stages, and how to treat them and manage them.

Really useful little booklet. You can download it, and I think you may even be able to order a physical version as well. So definitely have a look at this website, really useful little booklet to have in your drawer or just saved on your computer for you to go to to for reference.

And prevalence of chronic kidney disease is around 8 to 9 years. So then we have hyperthyroidism. So our clinical signs of hyperthyroidism, weight loss, and a poor body condition score.

Owners may notice their cats eating more, drinking more, urinating more. They may also see some vomiting and diarrhoea. They may also notice some altered behaviour, so the cat may be more vocal than normal, maybe a bit more irritable than usual.

So these slight changes in behaviour that these owners might notice. On exam, you might feel a goitre. And you'll probably listen and have a high heart rate and potentially a heart murmur as well on your cardiac exam and maybe some hypertension alongside it with your blood pressure check.

So diagnosing hyperthyroidism, again, your full history in the exam. Do a goitre palpation, a full biochemistry, including your T4 and alongside a blood pressure as well. And having a feel of a goitre is something we should just be doing generally for these older cats.

And there's a nice little video here of a cat that we saw that had this palpable goitre. Nice little video where you can just see it kind of popping up there. And prevalence of hyperthyroidism sits at around 10 years.

And then we've got osteoarthritis. It is another common age-related disease that we see in our older cats. See clinical signs of osteoarthritis.

Quite a lot owner reported changes really for osteoarthritis. So the owners might be seeing altered activity levels at home, maybe going outside less, not jumping up on the furniture as easily anymore. General behaviour changes such as not wanting to be fussed, not wanting to be messed about with, maybe kind of just staying in one room, not really wanting to go near people, maybe a bit more aggressive or aggressive with other pets or other cats in the house.

They might be under grooming, so they may be struggling to reach certain areas and be under grooming, but they might also be over grooming in these really painful areas. You might see some lameness in these cats and on an orthopaedic exam, you might feel some reduction in motion of those joints, maybe some crepitus and just general stiffness as they're moving around. So diagnosing an osteoarthritis, you want to be doing an orthopaedic exam.

So having a feel of all those joints and asking the owner for any changes at home and just summarising these changes and see if they're linking to what you're doing alongside your orthopaedic exam. And if you're in any doubt, then obviously, radiographs can be good to help diagnose osteoarthritis. And your prevalence of this is around 6 to 7 years, so quite early.

So yeah, we really want to be looking out for this in our mature cats. Then we've got diabetes. So clinical signs of diabetes, drinking more, urinating more, maybe eating more.

These cats may have gained a lot of weight, and they might have been overweight for quite a while, and then all of a sudden they've lost a lot of weight. And you might also see some hind leg weakness as well with these cats with diabetes. So diagnosing diabetes, full history and exam, biochemistry, your fructosamine, and checking that urine as well.

And diabetes is quite commonly seen in cats that have been overweight. So they've maybe been overweight for quite a long time, and these are the cats that you are kind of more likely to see diabetes in. So it's really important that we keep an eye on these cats' weights as well.

And prevalence of diabetes, this is another early one, about 6 to 7 years. Then another big one, we see a lot of dental disease at the feline Healthy ageing clinic. So you've got a few different types of dental disease.

We've got our feline or resorptive lesions, so our falls. We quite often see these on the premolars, quite commonly on those lower premolars as well. So it's where a little hole forms in the tooth.

The gum kind of comes down to try and protect that hole, and it can be really, really painful. You've got general periodontal disease as well, so a buildup of plaque, some gingivitis forming, some gum recession. You might see some infection.

And then there's also the risk of fractures as well, at any age for these cats really. And over time at the clinic, so of the frequent, checkups that we did with these cats, over time, 82% of the cats had dental disease on on at least one occasion. So really high prevalence of dental disease, so really, really important that we're checking these cats' mouths.

Then we've also got hypertension. So we might see hypertension, either secondary to other age-related diseases like your kidney disease or your your hyperthyroidism, or it might just be standalone hypertension. So we're gonna do target organ damage.

So, the main one that we think about is those eyes. And the prevalence of hypertension sits around 10 years. And then another one to really think about, obesity.

So, obesity is a disease, and it's now classed as an incurable disease. And these cats between the mature age range are really, really likely to be overweight. It's really common in our mature cats.

It's gonna shorten their length of life, and no owner wants to be told that their cat isn't gonna live as long as they potentially could. And the prevalence of obesity, obesity, like I said, starts about 6 years is when it really does kind of get more common, and it's gonna worse in many age-related diseases like our osteoarthritis. We don't want to be putting any more extra weight on those joints.

So just briefly touching on the prevalence of age-related disease again there. So you can basically see that all these age-related diseases are starting between that 7 to 10 age range. So this is why it's really important that we start these ageing clinics at this age range to make sure that we're detecting these diseases nice and early.

So I thought I'd just show you some of the prevalence of these age-related diseases that we saw in the clinic. So of the 209 cats between the 7 and 10 years that we enrolled at the clinics on their first appointment, at that enrollment appointment, 58% of the cats had musculoskeletal disease. 3% of them we detected hyperthyroidism.

54% had dental disease. 11% we detected some kidney disease. 57% were overweight, which is quite a lot.

And if you look at the 57% that are overweight and the 58% that had musculoskeletal disease, this obesity is really not gonna be helping with this joint disease. And then 4% we did detect high blood pressure as well. And only 5% of cats that we saw had no conditions diagnosed at all.

So only 5% of these 209 cats were completely healthy and had no age-related diseases. So moving on, I'll now go through what you want to include in your ageing cat consultations. What to include in your owner questionnaires as well, really important that we get feedback from these owners, and then we'll also go through some case studies.

So, first of all, you've got your full physical exam. Obviously, your general kind of check up the coat condition, having a look in those ears, checking those eyes over, just a general kind of physical exam. We're also gonna want to be just making sure that there's no dermal masses or kind of any masses anywhere that we might be worried about.

Then we need to make sure we're weighing and doing a body condition score on these cats. If the cat is really anxious or really aggressive, and you're thinking there's only one thing I'm gonna be able to get done today, I've I've got a minimal chance of getting everything done. Prioritise weighing the cat.

You can get so much information from their weight, and it's really important that these older cats to be monitoring their weight. We also suggest that you calculate the percentage of weight change as well. This could give you a really good idea of what's going on, especially over time.

So to get this number, you want to take your current weight, divide it by the previous weight and then times by 100. That's gonna give you a number. And you're gonna take that number, take away 100, and that's going to give you the percentage changed in that cat's weight.

So over a 6 month period, anything over 5% of a weight loss, we'd be a little bit suspicious of. We'd maybe be asking the owners to get that cat weight again in another 4 to 6 weeks just to make sure there's nothing going on there. Anything over 10% of a weight loss, we'd probably be quite concerned about.

If the owner's not actively tried to get their cat to lose weight, and the cat's lost 10% of their body weight in 6 months, we're gonna be a little bit suspicious and we're gonna want to be doing some more diagnostics to find out what's going on there. Also, anything over 5% weight gain as well, we want to be keeping an eye on. We don't want that trend to continue because we don't want these cats to get overweight because it's just gonna cause more complications for them.

So calculating your percentage of weight change is a really, really simple little thing that you can do, but can just give us so much information. So definitely include these in your ageing cat consults. So we've got muscle condition scoring.

So, this was something that I'd never done until I started at the feline Healthy ageing clinic. And I thought, oh, this is really strange. I've never done anything like this before.

But it didn't take long for me to get used to it and kind of understand what a normal muscle mass was, and then how we would kind of realise if there was a bit of muscle loss going on. So, we tend to score our cats with 3 having normal muscle mass and not having severe muscle loss. So, you want to be feeling.

Over the top of the head of the cat, the shoulders, feeling down the spine, also having a feel of those causal thigh muscles as well, making sure that there's no muscle loss there. Have a go at just feeding cats, feeling the cat's muscles under anaesthetic. Any cat that comes into the clinic, kittens, any age cat, have a feel of their muscle, and you'll soon start to kind of get used to what's normal and start to pick up on what's kind of muscle loss.

But you might also see in some cats muscle loss. This cat here has some really bad joint problems in her hips. And you can really see that she's actually lost muscle in those cord or thigh muscles, like kind of triang typical triangle that you see in these cats.

So, muscle condition score is another one that I would definitely say to start getting used to do if you don't do them already. Listen to the heart. So you want to listen to the heart rate and murmurs.

Definitely listen more than once if you can, if you've got time. So we often find that the first, heart exam, the cat's heart rate is really high. We might detect a grade one murmur in these really high heart rates.

And then as we listen again, 1015 minutes later, the heart rates slowed down and that murmur's not there anymore. So definitely have a listen to the heart more than once, if you can. A blood pressure?

Always do a blood pressure. Having a feel for that goitre, like I mentioned before, and doing a retinal exam as well. So this could just be a general looking at the eyes, seeing if there's any changes.

So any melanin deposits that are starting to form in those eyes that we just need to monitor. You might see a bit of iris atrophy or maybe lenticular sclerosis as they're ageing. And you can also have a look with your ophthalmoscope as well, especially if you've got a cat with high blood pressure.

You want to be checking that retina. So we've got a fancy bit of kit that takes photos, but you don't need anything as fancy as this. Just generally getting used to using your ophthalmoscope.

If you don't do it already, nurses, it's definitely one that you can start introducing and getting used to doing and get some practise in because it's, it's nice and simple to do. And once you know what, what to look out for, it can make a real difference, and be a really useful little thing to be carrying out in your clinics. Like I say, especially if you're worried about high blood pressure.

Then we're gonna do an abdominal palpation, having a feel, make sure there's no masses in there that we're worried about. Check the kidneys, make sure they feel OK. Then your dental exam.

Definitely do a dental exam. If you've got the owner saying that maybe they're, they've noticed their cat's not eating very well and you're a bit suspicious that there's some dental changes, it might be worth leaving the dental exam till nearer the end, so you're not really gonna upset the cat. And but always as well remember to lower that bottom lip.

As you can see in that photo there, we've got a fall on that lower premolar. And it's quite easy just to miss that tooth if you don't pull down that lower lip. So do a full dental exam and always remember to just pull that lip down to have a good look at that lower pre-molar.

Watch them move around the room as well. You can do this when you're maybe taking the history from the owner, chatting through the questionnaire. Just allow the cat to walk around the room, see how they're moving.

Is there any stiffness, or are they not jumping up on the table as easily, maybe a little bit gingerly jumping down, or they land a bit awkwardly. So keeping an eye on their mobility as they move around, and then do an orthopaedic exam. So manipulating all those joints.

And I've got a little video as well on the next slide for you. And we also make sure we check their claw thickness as well. So if there's any thickness in the claws, they're not managing their claws as well anymore.

That could be a sign of a little bit of a change in their joint health. So this is the lovely Phoebe. So we're doing her orthopaedic exam here and we're just gently palpating the spine just to see if there's any reaction as we're doing that and then we just manipulate her neck very gently.

Moving it from left to right, seeing if there's any resistance there. She was so good. And then we're gonna have a look at those claws, see if there's any thickness on those claws that might be starting to occur as they're not looking after them as well anymore.

And then we want to manipulate the joints and have a feel of, of all the joints. Stretching them out, extension and flexion and just see if there's any resistance there. It's, it's really hard with cats though doing an orthopaedic exam because They just generally don't like being messed about with, do they?

So, it's hard to know if that joint palpation that's resistant is actually just because the cat is like, just get off me. I'm sick of you're touching me now. Or is there pain there?

So it's a really tricky thing to actually get real information from. It's really objective, but it's definitely worth doing because it can sometimes flag up some real pain as you're moving those joints around. And then blood tests.

We would do recommend doing a biochemistry, full biochemistry, electrolytes, haematology and a T4 as well. And then a urinalysis. So dipstick, sediment check, urine specific gravity.

And then if you're worried about any kidney disease, then we would suggest a urine protein creatinine ratio as well on that urine. We send out some urine collection kits to our owners before the appointment. So this is something that you can get into the habit of doing, and send out these kits to the owners before the exam if it's something that you want to make sure that you want to look at.

So the other big question is how often should we be doing these exams? How often do we need to see these cats? What should we be doing at every appointment?

So, in general, this is just a a little bit of a table on how you could kind of look at it. So, for the mature cats between the ages of 7 to 10, we'd probably be doing our clinical exam and our owner questionnaire and blood pressure twice a year. So that's what we do at the clinic.

So we'd recommend following suit, really, and doing the same, same kind of routine. And then your urin analysis and your blood tests every year. For your senior cats, so between the ages of 11 and 14, you want to increase that, urinalysis and blood test to twice a year to go inside with the clinical exam, the questionnaire and the blood pressure twice yearly as well.

As they're reaching their super senior years, so 14 years plus, we do, we'd probably recommend increasing the clinical exam and the owner questionnaire to 2 to 3 times a year. So this can just be a weight, and a general questionnaire from the owners to gain some information from them and just make sure that everything's doing OK. Just a muscle mass condition score, just see how everything's looking generally, and then your blood pressure and your blood tests twice yearly.

Obviously, if you've got cats that you've detected chronic kidney disease or another age-related disease, this will change the way that how often you see these cats, and you may move them over to a specific kidney monitoring clinic or something like that. But generally, this is the frequency that we tend to advise, and I've put this chart as well in your resources, so you've got it to hand. And then the other big thing that I think is really, really useful is gaining owner feedback.

This can really help you with your consults. There's some really good examples on the, there's a VEprofessionals.com has got a one all set up, ready to go, that you can download and use, really, really useful.

And there's also some on the Cat Care for Life website as well that you can use and adapt. Definitely have a look at those. You can create your own as well, really simple to do.

Just a little bit of time at the beginning of it, but just make sure that you're include things like the physical changes, activity changes, eating and drinking behaviour changes, toileting habits, and general behaviour changes as well in these cats. But, They're really useful for for supporting a diagnosis, especially things like osteoarthritis, where you might be worried that the, the orthopaedic exam was a bit flagged up a few red flags and you're thinking, oh yeah, I think there might be some joint changes here. And then you have a look at the questionnaire and notice that the cat's not been jumping up on the furniture anymore or it's just a bit more clumsy.

So they're really good for helping you support a diagnosis. But they also educate owners as well. Once they've looked through a questionnaire once and they know what to look out for, they, they're just automatically gonna to be more aware.

So, and owners love knowing this information. They love knowing what they need to do, what they need to be looking out for. So they're a really, really good way of educating owners on general ageing cap changes as well.

Definitely provide them before your consult if possible. We have a link that we send out to people, but you can post the questionnaire to them, you could email it over to them. You could provide a survey link if you're willing to just set up a survey online, you can do that as well.

But try and give it to them before the consult. So they've got a bit more time to spend, reading through it and making sure that they're answering it properly rather than being given in the consult and ticking through the list really, really quickly. So I thought I'd just go through some of the changes that we ask owners.

So our questionnaire, I've took some snippets from it, so I thought I'd just kind of show you some of the things that we add on to ours, so. Drinking habits, we generally ask them how often they see their cat drinking, and we just see if there's been any change with this answer, and see if they've noticed a change in their cat's drinking in the last 6 months. We ask them if they always finish all of their food, so if the cat is generally one of these cats that eats their meals over time, their ad lib eating, and then all of a sudden they're eating the food straight away and then we're hungry, we might be thinking, oh, OK, that's a bit strange.

And then we just ask them some general changes that they might have seen in their cats eating behaviour so they might be a bit more messier. Eating food more slowly, dropping that food when chewing, chewing on one side of the mouth, that's gonna make us think, oh, maybe there's something going on with the teeth, that maybe we're a little bit worried about. Sniffing food, then walking away could be a little bit nausea related as well, or asking for food, but they're not eating it when they're giving it.

So asking for changes relating to their eating behaviour is really useful to know. Toileting habits as well, asking them what the majority of the faeces is like, if there's been a sudden change and they're now having diarrhoea all the time. I'm kind of gonna wanna know why, what's, what's happened, what's changed there to cause that.

And then we asked them if they've ever missed the litter tray. Are they going over the side of the litter tray or maybe just not using the litter tray anymore at all. This could link to some illness that's happening, that's making them not confident enough to use the litter tray anymore, or maybe they're just a bit stiff and they can't quite get their bum over the edge, of the litter tray anymore.

And then asking if there's any frequency or size changes in the urine as well in the litter tray. We also ask them how much time the cat spends outside. Some of these questions are just general changes as these cats get older that we're just interested in and looking at.

But this can actually give us quite a lot of information. If they're feeling unwell or they're feeling in pain, they're probably gonna spend less time outside. They don't want that risk of coming face to face with another cat on the block or anything like that.

So that's a useful question to ask. And also asking them if there's anywhere different that they sharpen their claws in the last year. And this question's quite interesting because we did see that a lot of owners said yes, and they would often say that the cat scratches the bottom stair of their, stairs, and no longer using their vertical scratch post.

And this is quite common. So as cats get older and they maybe get some joint changes in their shoulders, that kind of thing, they don't want to stretch up and use a vertical scratch post anymore. So they then kind of choose somewhere nice and horizontal, which is quite commonly the stairs.

And we also asked them if they're having to clip their claws more frequently as well. Are you the owner having to manage their claws more than they would themselves? And some activity changes.

Really good to know about. So are they struggling maybe to climb on high furniture, sleeping more, eating more or less? They don't like being stroked as much anymore.

They may be grooming less or difficulty in getting comfortable when resting. So nice to see if there's any activity changes in general that they've noticed in their in the last 6 months. These, these questions and these changes can help support our diagnosis diagnosis and give us a little bit more information.

And then physical changes that the owner may have noticed, and some of these physical changes are what we would see anyway in our consult. But it's also good to know if this is something that owners picked up on and maybe when they picked this up on their cat as well. And then if they normally groom their cat or clip their cat's nails, do they have to do this more often?

Is the cat no longer looking after themselves as well as they used to? And then finally we give them this chart of behaviour changes to see if any of these have increased, decreased, not changed or not seen. Like I said before, a lot of these questions are generally related to behaviour changes in cats as they get older, and it's just general research that we're interested in.

But it can give us some information as well. Especially things like becoming more grumpy with people or other pets, appearing forgetful or confused, we might be thinking, oh, they're a bit more forgetful or confused than normal, if they've got some problems with high blood pressure or maybe some hyperthyroidism maybe there. And not using all of the inside space anymore is quite an interesting one.

So shrinking their environment. If they are in pain or they just generally feel unwell, they're not going to use the whole house. They're gonna keep themselves to themselves, stay in a quiet room.

So it's a really interesting question to ask. And if you see this flag up, it's probably one that you're gonna want to ask a few more questions about. And then I thought I'd just show you some of the common owner observed related changes that our owners have noticed in our ageing cats.

So 12% of our owners notice smelly breaths. And 12% of our owners noticed that their cats had more grey hair. 26% noticed increased sleeping, and 24% reduced outside activity, which is interesting as our cats get older.

19% were sniffing food and then walking away. And this was actually interesting. So, sniffing food and then walking away, linked with under grooming, was very commonly linked to dental disease when we found dental disease.

So the drive to eat. Would be there. They would go to the food, they would sniff it and they'd actually think, actually, I really can't go through the pain of eating this food right now and they'd walk away.

So it's quite an interesting finding. And then the last two are just really nice, aren't they, for our older cats that they want more attention and they have more affection towards us. And then the last little thing that I just want you to think about is quality of life assessments.

So these are really, really useful, especially for our older cats that are starting to suffer with some age-related diseases. They're really great for improving the welfare of the patient if we now realise that their quality of life is going downhill, we can intervene and start improving that welfare for them. It's also a nice way of giving support to the owners.

If the owners can see the quality of life changing in their cats and they can physically see it on some kind of assessment, it's just means that you'll just need to give the owner a little bit more support with those cats. It also helps when it comes to an end of life decision. If the owners can really see that their quality of life isn't well, that it just helps them and it makes it a little bit easier for you to approach that end of life decision as well.

And it just generally raises owner awareness. Now, we use something called vet metrica, which is from New Metrica. And it's an online assessment where the owners complete a questionnaire, we fill in a vet assessment.

And it does some fancy algorithm and it throws out some scores on emotional stability, physical stability, that kind of thing. It gives the owners a graph, gives us a graph. It's a really nice visual.

I'm pretty sure you do have to pay to have access to this, but, it's probably the best one out there, really, for quality of life assessments, in cats and the colour. But you can use it for dogs, cats, and it doesn't have to be older cats. It can be, animals that have maybe just recently been diagnosed with a, a terminally ill.

Patient and it's just another nice quality of life tool. So, if you can get use of that metrica, I would definitely recommend it. There's all out there as well available.

You've got the cat health and well-being questionnaire, from Lisa Freeman. And in the vet journal 2021, there was a systemic, systematic review of all the quality of life assessment tools that are out there for cats. So that's a really useful read, and it'll give you lots of information on what are the ones that you might want to use.

And you've also got the feline musculoskeletal pain index, which is online. It's free to use. Your owners will register and they will answer some questions.

And it's all based around their musculoskeletal changes. And it gives scores, on things like their arthritis and their movement and stuff like that. So it's a really nice tool to use.

But, it's just something to think about including in your assessments. It's just a nice thing to kind of make everything whole and just be able to have that conversation with the owners a little bit easier as well. So, case study, so this is Oliver, lovely Oliver.

He enrolled with us in September 2017, he was 7. When he enrolled with us, the owner had no concerns. There was nothing they were worried about on the questionnaire.

We noticed a bit of slight undergrooming along his mid back, and he was a little bit reactive to a spinal palpation and had some reduction in motion on his elbows when we did his orthopaedic exam. And he had some slight muscle loss on his caudal thighs. So we actually advised a joint supplement for Oliver.

To see if this would help his mobility and to see if it would just give him a little bit of support in that cartilage and see if he, the owner then noticed any changes when they came back to see us. So Oliver came back, and we assessed him again at his, annual appointment. So he's now 8.

And the owner actually reported that he had more matted hair and he was starting to sleep away from the family. He didn't really want to interact with the family anymore, which is upsetting for an owner. He had clumps of hair all along his spine, and he had a really stiff gait in the consult as well.

He had obvious muscle loss on his gluteus muscles, caudal thigh, and he was really reluctant to have that orthopaedic exam. And when we did that exam, there was definitely reaction on a spa spine palpation. Reduction in motion in his shoulders and his elbows, and there was obvious under grooming on his left hand, his right hind, his mid back and around his anus as well.

So he was obviously struggling with pain and finding it hard to groom those areas. So we referred him to as their own vet for some pain pain management and to start that process with them. And one thing that we do at the clinic, at the end of every consult, we look at our patients and we assess if they are younger, age appropriate or older.

And we assessed Oliver as being older than 8. And we actually had a look at the data that we collect and we had a look at any of the diseases that we may have picked up on the cats. And what we noticed was if we had assessed the cat as being older, they were likely to have an age-related disease, whereas if we assessed a cat as age appropriate or younger, they were less likely to have these problems.

So, kind of what we took away from that, really, and the advice we would give you from that is, if you look at a cat and the owner says, oh yeah, my cat's 7. And you look at the cat and you think, nah, you're probably more like 10. Treat that cat as a 10 year old cat.

Do your consult as if it's a 10 year old cat, not a 7 year old cat, because chances are you're probably gonna find something. Anyway, back to Oliver. So Oliver then saw us in October 2019, so a year later.

So he'd been on pain management. He was doing really well. His coat condition had massively improved.

The owner reported Oliver was spending more time outside again, finding it much easier to jump. And he was more affectionate with the family, which was a nice ending for Oliver. But it just kind of goes to show that we saw Oliver at the age of 7.

And detected these problems nice and early so we could get him on pain management and we could really improve his quality of life by by doing this, and he's still doing really well. We still see Oliver, er and he's still having his pain managed really, really well. So then we've got Houdini, the lovely Houdini.

So Houdini didn't just have one problem to contend with, he had many. So Houdini, we saw him in June 2017 when he enrolled, he was 10. Everything was normal apart from his creatinine being a little high but everything else was absolutely fine.

We then saw him in May 2018 at the age of 11, and he'd lost 8% of his body weight. So, obviously, this is over our 5% and close to our 10% of weight loss. So this made us a little bit suspicious, and we ran the bloods as we normally do, and his creatinine had increased.

So had his calcium and his USG was now 1.025. So he was then referred to his own practise for a chronic kidney disease workup, and he was then moved over to a renal diet.

And we also advised a joint supplement as well as he was unhappy on his orthopaedic exam. And his blood pressure, but everything else is fine. So he was now being treated as a cat with chronic kidney disease.

We then saw him in November 2018, so he's 11.5. His chronic kidney disease was nice and stable at stage two, he's doing really well.

His orthopaedic exam had much improved, but he'd gained a lot of weight. So we were, we told the owners just to be a bit aware of his weight. Don't let him gain too much weight because we don't want this to cause any more problems.

His orthopaedic exam obviously was a little bit suspicious, so, we didn't want him to gain this extra weight and put more extra, weight on those joints. And then we saw him in May 2018, so he's now 12. Everything was still stable, but he had increased weight even more.

So he was now a body condition score of 8/9. So we made the owners aware of the complications of having an overweight cat in the mature age range, and told them to try and get him to lose some weight. Then he came back to us in June 2021.

So he's now 14. His chronic kidney disease was stable, but his glucometer reading was now 33. So, obviously this was not good for Houdini.

He'd lost a body condition score, but he'd actually lost a lot of muscle mass as well. So we were concerned for Houdini now. His blood pressure was 160, so bordering on hypertension as well.

So he was referred to his own vets for a diabetic workup. So, Paul Houdini. He was dealing with chronic kidney disease, osteoarthritis, and diabetes.

So it's, he's just a really interesting case, just to show you that we're not always just dealing with one age-related disease and how we detected these things over time through his constant checkups and why it's really important that we're consistently doing these checkups and keeping a close eye on these older cats. And unfortunately, Mr. Houdini is not with us anymore.

Bless him. But he's just a really nice case study to, to look at and show you what can happen and it does happen, in your clinics. So Our final thing that I wanted to go through with you is just your tips and tricks for your successful ageing clinic.

So how do we make these clinics really successful? We've got the information of what we need to include. We know what we now want to ask the owners.

We're aware of diseases that we might see and how prevalent they are. Now we just need to make them successful. One of the big things that I think makes a huge difference to any kind of clinic with cats, not just your older ageing cat clinics, is cat friendly approach.

You're gonna have improved welfare for the cats during the exam. Your findings are gonna be more accurate. You're not gonna have, high glucose readings because of stress and high blood pressure readings and this kind of thing where you're less likely to anyway.

You've got less risk of injury for the staff. You're gonna have a general improved case outcome, that case outcome, less injury, more accurate findings, the cat's gonna be happier, your staff's gonna be happier, the whole case is just gonna have a much more improved outcome. And it's less stressful for the owner.

We know owners don't like bringing their cats to the vets. We know that it stresses them out because the cat gets stressed out. Even I don't like taking my cat to the vet, and I do everything possible I can to keep them as chilled as I can.

And, but it's still a stressful event for the owner. So by doing a cat friendly approach, the owners will see that you're taking that time for them, taking the time for their cat. They're gonna have more confidence in you, and it's just gonna build trust between you and the owner, which in turn is going to make them keep coming back, which is always a bonus.

So just briefly running through some cat friendly approaches, because I could do a full hour webinar on cat friendly handling. So choose a nice quiet room and make sure that you've got everything that you need in the room, so you're not in and out that door, trying to get things that you might need. You might need some syringes and needles.

Make sure everything is there, ready to go. Pop a towel on the table, spray it with some fellaway or some pet remedy. See if you can have something for the cats to choose to hide in, if they want to, if they don't want to be out in the open in that consult room.

These feline faults from Cats protection are really, I think they've got a different name now actually, but, you can still get them from Cats Protection. They're a really nice thing just to add into your consult room. Place the carrier on the floor, let the cat explore, maybe when you're taking history from the owner and having a good chat.

But also tell the owner that you're not in a rush, even if you are, and you've only got 5 minutes to complete this 15 minute consultation, and there's 5 people in the waiting room, just say to the owner, don't worry, we've got plenty of time, we're not in a rush, and you'll probably see instantly that the owner will just kind of take a breath and just be like, OK. If it's a top loading carrier, brilliant. You can take the lid off, examine the cat in the bottom of the carrier, maybe the blanket over the top of them, so they've still got some security.

Or you can literally take the cat out with the blanket as well, so they still feel secure. Leave the painful part of the exam until last. So if you're aware that the owner said that there's some painful teeth in there, leave that bit of the exam to last.

If your owners are in the consult room, try and face the cat towards the owner so they can see the owner, and you can even do things on the owner's lap sometimes, which I know sounds a bit awkward, doesn't it? But if the cat's really happy sitting on their lap, then do what you can on their lap. Definitely use treats.

We go through so many of these licky licks, it's ridiculous. But we actually get quite a lot done with these cats that are invested enough in eating the treats. So definitely use treats if your cat's willing to eat.

We were surprised how many cats were actually willing to eat during the exam. And make a note of the cat's temperament as well on the records. If your cat's really anxious and you had no idea how stressed this cat was going to be before you came into the consult room, make it on the records for the next time, either for you next time or for the next, member of staff that's going to see that cat, it just means that you can put some extra measures in place to make things a little bit less stressful for them.

Just generally blood pressure checking. So make sure you've got plenty of time for your blood pressure. If you know you've got a blood pressure coming in, make sure you've got at least 15 minutes to do your exam.

If you can have a double appointment, then amazing. Choose the, the correct cuff size as well. So we often find that a 3 centimetre cuff is too big and a 2 centimetre cuff is too small.

And actually these Hockinson penile cuffs. Yeah, human penile cuff, a 2.5 centimetre cuff is the perfect size.

And they're a really nice cuff as well. They've got a really nice Velcro fastening on there. We love them.

I shout about them all day long. So if you can get hold of one of these, definitely do. Minimal, minimal restraint again, and treats work really well to distract the cat.

And just make sure the forelimb or the tail is at the level of the heart. Avoid using alcohol to get better contact on that pore. We don't use alcohol at all.

We just use, the ultrasound gel. We got told this really handy tip. So we put the ultrasound gel in a a hand washed bottle.

We're not putting Carex on, the Doppler there to put on the cat. Well, it's ultrasound gel in that bottle. You know, when you're shaking that ultrasound gel out and it makes a horrible noise and the cat's looking at you thinking, what on earth are you doing?

That hand wash bottle literally pops out the perfect amount onto your Doppler. Doesn't make any horrible noises. And the cat's gonna be a lot less stressed as well.

So really nice little tip there. Take a minimum of 5 measurements and work out the average and just make sure you're releasing that cuff in between. So that's a quick review of the blood pressure.

And then blood sampling. So, you want to make sure that you're not really restraining these cats. Cats actually like having their legs on the ground.

So just generally tilt the head with two fingers and try not to hold those whiskers. As long as they've got their feet on the ground, they're less likely to struggle. So refrain from holding their legs if you can.

Maybe just a hand in front of the leg, ready to stop them if they do get a bit pawsy. If they're really pawsy, you can wrap them in a towel and do, you know, our typicalurrito. Be conscious of the older cats as well.

If you know they've got a sore neck or a sore spine, just try not, try to be a bit more gentle when you're tipping their head back. Again, we don't use spirit. It just smells so strong.

And cats hate strong smells. So as soon as they have this surgical spirit coming at them, they're like, Oh, and you kind of feel intense up straight away. Slowly insert that needle, and again, treats, treats, and use treats.

As I said, we go through so many of these, and we actually managed to get blood samples from a lot of our cats just using treats alone. This cat would absolutely flip if we tried to restrain her in any way, but she absolutely loved these treats. So we feed her all the way through.

We go through about 6 sachets of licky licks, but it means we can get a blood sample, which means we can monitor this cat, so. Give it a go. And if you give it a go, please do let us know because we love to share when people use these cat-friendly tips as well.

So let us know on our Facebook page or our Instagram page when you have a go at this, because, it feels so good as well when you've done it, knowing that you've not stressed this cat out and you've been able to get a sample, and they've been quite happily munching away on their treats. So, as cheesy as it sounds, teamwork makes the dream work. It really does.

Making everybody work together to make these clinics successful is the key. So use your nursing team to their full potential. If you've got a nurse that likes to be in consults, isn't a fan of maybe being in theatre, I was one of those nurses, spending a whole day in theatre, monitoring anaesthetic was not my bag at all.

I would much rather be in the clinic, facing the owners, chatting to the owners all day. So I would generally be on the clinics. So if you've got nurses that like to do that position, like to do that role, let them run, go for it and let them run with it.

But making sure you've got a nice relationship between the vets and nurses is also really important. So, if you've got nurses that are happy to do these clinics, they are happy to get the bloods with your nurse assistant, spend time with the owner, blood pressure, gather all the information and feed it back to a vet, and cha chat about it together, work through the case together, and either the vet or nurse can then report back to the owner. It makes these work really well.

It keeps that time for the vets for their veterinary consults, for their surgery. And the nurses can crack on and do every part of these ageing cat clinics. And vets as well need to be referring these cats to the nurses.

If the vet sees a cat for a booster and it's 9, then let them know that there's ageing cat clinics going on, say, Oh, would you like to see our nurse for an ageing cat clinic? Start that relationship going between that nurse and that owner, and get them in there. And also use, again, use the whole team.

So your receptionists as well are really important to making these clinics work. If they're booking cats in and they recognise that the cat's a little bit older, or they're chatting to an owner in the waiting room and they've got all the, they're all the cat with them, just make sure the receptionists are making these owners aware that these ageing cat clinics are happening. Hand them out a leaflet, just chat to them in general about it, chat to them if they've noticed any changes in their older cat, and if the cat, the owner's like, Oh yeah, actually, they don't seem to want to move around the bed as much.

There's your opportunity for your receptionist to get in there and let them know that there's these ageing cat clinics going on. Also, an owner education is a big thing about making these cat clinics work well and making these owners want to keep coming back and see you. It's going to improve the feline welfare in general, if these owners are more aware of things they can do to make their cats healthier and live longer.

By educating these owners, you're helping form that bond. And if you've got a nice bond with your owner, they're gonna want to keep coming back. They're gonna want to keep seeing you.

And obviously this is going to increase the revenue, which is what our business managers like as well. So. It's really, really useful to educate these owners, and there's little things that we can tell them.

Again, this is another webinar that could go on for ages about environmental modification. So just a brief rundown. But, get the owners to provide steps for their cats up to their favourite places, make sure that they can still reach the window sill or their favourite sleeping spot.

These are really, really great, these scratch posts. They're fantastic. But you can also get some from Amazon that are kind of just like general steps up to their favourite places.

Providing horizontal scratch posts as well, rather than vertical scratch posts, and asking them to provide more water sources or raising their food and water sources as well. So just some little snippets of owner education that you can do that makes the owners look after the cats a bit better, put that trust in you as well. You can also edge and educate owners during client evenings as well.

So they don't have to be physical ones. We actually did a virtual client evening in August, where we did a little talk on environmental modifications and what to look out for in our older cats. And, you know, we had a really good turnout.

So, owners love that kind of thing. But if you can do it in the practise, definitely do it. Get your reps to come and provide you some cheese and wine or something like that, and get the owners in the building and talk to them and educate them.

You've got your general handouts as well, especially if you're diagnosing a cat with a problem in the clinic, give them a handout. They're gonna want to read as well at home when they kind of chuck in the information that you've given them. It's really useful for them for them to have it on paper as well.

And social media is great. It's absolutely brilliant for educating owners and just making them aware of what's going on in the clinic. You can let them know that there's offers going on, you know, you might be doing your CAT clinic for a bit cheaper than you normally would do with your, senior bloods and all that kind of thing.

So, advertising offers is really great on Facebook. Getting people engaged, doing photo competitions and stuff like that. It just makes owners aware that you're there, and gets them engaging, and then on your posts are gonna become more viewable to them.

And again, educational posts, so letting them know about certain things to look out for or photos showing them what they can do for these cats. And then the other thing I wanted to kind of touch on briefly is telemedicine. So obviously during COVID, everything changed and everything changed for us as well.

We had to stop seeing the cats in the clinic cause we weren't emergency. We were general routine stuff. So I decided to have a go at doing some Zoom consults.

With our appointments and they actually worked surprisingly well. So you could introduce these into your clinic, there's a photo of me there with one of the cat looking at me very confused, . So you could introduce these for the 3 monthly checks, rather than the owner coming in with the cat, just having a chat with them, having a look at the cat on the video or just a general phone call works as well.

If you've got cats that are due their 6 monthly check, but they're really anxious and really stressed, and the last checkup, you weren't too concerned about anything, you could just do a drop in Zoom consult with them for a 6 monthly check. You can provide them the questionnaire, beforehand just to make them think of things that they might see that they want to talk to you about. Get them to weigh the cat at home as well if they've got scales, so they can do this by either putting the cat in a carrier, weighing them in the carrier, then weighing the carrier, or standing on the scales themselves, weighing with the cat and then on their own without the cat, to talk to the two numbers.

And I definitely found owners more were more open to talk to me about behavioural stuff during a Zoom consult. I don't know if it's because they feel more comfortable because they're in their home environment. They don't feel like they're in a clinic.

The cats aren't stressed, so they're not stressed. They're remembering to talk to you about more stuff. But they were really open.

So, I think they could be really useful. We did a little questionnaire afterwards as well to our owners, just a little bit of a survey to see how they thought it went. And if it is something that might be useful in the future, and 73% of owners found the virtual consultation beneficial, which I was quite surprised at actually.

So that was a nice number, the the owners that found it beneficial. And some of the feedback we got was my cat felt much less stressed. And that they would be very helpful for seeing a vet for advice and guidance that doesn't involve directly examining the pet.

The ease and convenience of attending is a great benefit and puts less stress on the pets as they wouldn't need to be transported. So, it's something to think about for not just our ageing cat clinics, but maybe things like our parasite treatment checkups and stuff like that. So yeah, a little bit of a bizarre thing to finish on with there, but definitely think about telemedicine as well in your ageing cat clinics.

So that's pretty much everything I wanted to talk through you with regards to the ageing cat clinic. So I've touched on age-related diseases, the prevalence, what we really need to be looking out for in these consults. You know, hopefully know what to include in your consults, how often to do these, and what to include in your own questionnaires, and how to make them successful as well.

So I hope you're ready to get back into the clinic and start writing up, get the team together, having a little bit of a meeting with everyone and see how these CAT clinics can work. If you're doing them already, fantastic. If all of this is everything that you're doing, then wonderful.

There might be some bits that you just want to include in your CAT clinics that you weren't already doing. But also, I am more than happy to go through things in more detail as well, if you want to. My email is there for you.

If you've got any questions, you want to start setting them up and you don't know where to begin, and you just want to talk some things through. I'm happy to have a chat with you on Zoom or something like that. We're also on Facebook and Instagram as well.

There's lots of tips and things on there to include in your cat clinics. So, yeah, that's pretty much me. Thank you so much for listening.