Hi, I'm Doctor Natalie Dowrey, and today, I'm going to be talking to you about feline ageing, applying the science to your clinic. So before I get started, just my disclaimer slide. I am currently employed by Saint George's University working in Grenada as an assistant professor, but I am still an honorary researcher at the University of Liverpool with the Feline Healthy ageing Clinic.
My PhD work, postdoctoral work, and the clinic itself, is still all funded by, by Royal Cana. I have also done, various, sort of, speaking, providing educational material, consultancy work, which I've received financial remuneration for. And finally, photo credits throughout this presentation, are predominantly with the Feline Healthy ageing Clinic, and some of them are my personal photos.
So, what we're going to be, sort of covering today, is really just sort of starting by, defining and understanding the biology of ageing. And how that impacts, the development of, of age-related diseases, which tend to be what we're sort of most interested in clinical practise. And then we're going to, to sort of really look a little bit at the life stages, and, and what is a senior cat.
And then we'll cover the prevalence of age-related diseases and then we just sort of discussing about what tests we should be considering and maybe when we should be running them, when we think about our, our ageing population of cats. So, the ageing process itself, has been defined as, a universal, irreversible, continuous, intrinsic, deletitious process that manifests itself in the form of a gradual physiological decline with age, that causes an increase in mortality. But on a sort of more fundamental level, there are sort of three universal components that have really been sort of identified, to sort of explain ageing.
And this is across really all, all species. And so it's the sort of depletion of, of limited body. Reserves with grit and alteration and physiological processes and responses to stress, and to, to natural damage that occurs.
And there is also inherently sort of imperfect mechanisms of, of cellular maintenance and repair. And those sort of imperfect mechanisms mean that over time, there is a, a sort of an accumulation of damage. And all of these sort of ultimately contribute to a reduction in resilience, and, and essentially delay the animal's ability to recover from environmental stresses, but also put them at more at risk of, of then, sort of these pathophysiological processes that, that basically go on to, to sort of cause With some of the age-related diseases, that we recognise as clinicians.
So, it's sort of important that we do recognise that, that the pathophysiology of, of ageing is really complicated, and that the age-related diseases that we're seeing and diagnosing in practise are really much due to, to these complex processes. And we also have to recognise that they're, they're not happening overnight. So, you know, the diseases that we may be recognising and, and senior and mature, or super senior cats, are often the result of, the pathophysiological processes that really are starting to, to occur, during the sort of adult years or the mature years.
So, we recognise the diseases later in life, but the actual underlying processes that cause them are often occurring, several years, if not longer beforehand. So when we then start to think about healthy ageing, up until recently, there hasn't really been a, a universally sort of accepted definition of healthy ageing, in, in the companion animal field. So I was involved in a project and we published out our paper last year, on ageing as modifiable, Current perspectives on healthy ageing and companion dogs and cats.
And within that, that working group, we did come up with a proposed definition of healthy ageing. So ageing in which the individual maintains functional capabilities and develops resilience sufficient to meet their own physical, behavioural, social, and emotional needs throughout all of adult life stages while sustaining the human-animal bonds. So that was the sort of proposed definition that we came up on, on healthy ageing, to be really applied to, to our companion animals.
When we're then thinking about what we're trying to do in terms of us as veterinarians, and, and trying to promote healthy ageing, When we think about currently with cats, the average feline lifespan is about 14 years of age, a little bit over 14 years. But they do have the potential to live up to 30 years. Many of you in practise will have, will have seen cats well into their, at least their early 20s, if not their later 20s, and there have been a few sort of reported cases, where their, their potential lifespan is considerably longer.
And what we're trying to do isn't necessarily create patients that are immortal and live forever, but we're often trying to move that period of healthy life longer. You know, when we actually really talk to our clients, often it's not that they want their, their pet to live forever, but they don't want them to be suffering. They want them to still be happy and healthy and well.
And, and that's why in the proposed definition of healthy ageing, we also really included that human-animal bond side of things. People, people want us to be maintaining that relationship with their pet. And if their pet is, is, is experiencing healthy ageing, often, that, that, bond will be maintained.
And so, from the practicalities for us, in terms of extending that, that healthy lifespan, really, our goal as veterinarians is, is to try and do whatever we can to be able to delay the development of age-related diseases, but also once they occur, really to be slowing the progression of them. And being sort of trying to, to reduce the impact of these diseases may be having on, on the quality of life of the individual, but also, the impact that they may be having on the relationship with, with their owners as well. So, we have, hopefully, this is reasonably familiar to you guys.
We have the sort of life stages, as, as they are currently from, International Cat Care Veterinary Society, formerly the International Society of Feline Medicine. And these life stages, when they were first published quite a number of years ago, the super senior age range was actually defined as, as geriatric, but there has been a change in language and the term super senior is being used more. And we are generally referring and reserving the term geriatric, more towards our cats, that actually do develop age-related diseases.
So the ones that, are already suffering from a known age-related disease. And those Diseases don't necessarily just occur in the senior or super senior years. We are diagnosing some of these diseases earlier, sometimes in the later adult years and, and more commonly in the mature years as well.
And when we start to talk a little bit later on about frequency of visits and what sort of tests we should be doing with our geriatric cats, we really do have to tailor the testing very much to the individual disease and how, that particular patient is dealing with the individual disease. However, there has been some further work more recently, that aren't necessarily making us completely rethink the life stages, but just make us sort of start to think a little bit more, especially about the adult and the mature years. So the, there is a few things that we can be sort of discussing a little bit further in terms of our frequency of appointments around those.
The other thing we do also have to take To mind as well is, cats and visiting the veterinarian. Cats don't necessarily always like to visit the vets and owners don't necessarily always like to bring them to the vets. So, when we're sort of thinking about appointments and frequency of appointments, it's not just, us setting these up and telling people that they must come.
We often need to be thinking about some of the barriers to As to why owners aren't taking their cats to the vets. So there's some slightly older data now that was published from, a Big Bayer survey, it was published out in 2014. And that particular study found that, you know, 52% of, of cat owners hadn't taken the cat to the vet in the previous 12 months, and only 37% of them had attended a routine appointment in the same time.
Things perhaps a little bit better, with some more recent work from, Cats Protection, where 62% of them. Said they had taken the cat to the vet, every year. But we still have about 9% of cat owners in the UK that aren't registered with a veterinarian.
And so, often one of the barriers to, to healthcare, for our feline patients, especially, is just not attending the vets on a regular basis, not attending those more, sort of routine wellness appointments, which are really, really important if we want to, sort of achieve, a, a good healthy agent and us as veterinarians to be given appropriate advice at the appropriate time. We do need them to, to be coming to see us. We need them to be actually engaging in vet care in the first place.
So, just in coming to the vets, I think we have to take as a win. And then obviously, we can be starting to encourage them in terms of more appropriate frequency, based on their feline life stage, once we're getting them actually coming to see us on a regular basis. So the work that I was alluding to a little bit earlier, that was, initially some work that was published in 2022, from Salto where they were looking at, quite a large number of electronic medical records.
And this sort of heat map just starts to show that, in terms of some of the conditions that we see, there are some that are very much clustered, in younger age ranges. So unsurprisingly, some of the, the infectious diseases and the parasites, we probably see a bit More commonly in our, in our younger patients. And then some of the things that we may consider a little bit more sort of age-related diseases, especially things like nutri nuclear sclerosis or just geriatric pet, are unsurprisingly, clustered, towards our, our sort of super senior years.
So this, this work looked at quite a broad, range of diseases, but they were starting to get some clusters. And so as a result of that, they just approached a little bit. the life stages a little bit more differently.
So they had sort of the first cluster, which was very much, sort of young animals, and very much sort of focused more on that growth and development stage. Once they passed the sort of kittenhood years, And then we had a second cluster, which, sort of overlaps a little bit with the, later adulthood and the mature years as we sort of currently have them, have them defined. And they were calling that early midlife.
And then later midlife again is sort of, towards the end of the mature years and into the, into the senior. Years. And then senior years, they just moved back a little bit later, and super senior was sort of similar, but this was at least based on, on these diseases that they were seeing.
They were, were, were clustering, ages a little bit differently from the more sort of classic, sort of life stages that we may expect to see. Which is interesting, and it does also fit with some additional data that's been coming through through some other sources as well, including some of the work that we've been doing at, the Feline Healthy ageing Clinic. So this was a publication from my colleague, Christine Pie, looking at the long longitudinal data that we've been collecting, on body weight, body condition score, and muscle condition score, over, over the period of time that we've been following the cats.
So, we started enrolling the cats at the feline Healthy ageing Clinic between, aged between 7 and 10 years of age. And we started enrolling, way back in, 202016, and started seeing our first cases in early 2017. So, we've been following them for, for quite a long period of time.
And what this data has shown, so this is the body weight graphs, we're sort of seeing that, we, we start to get a decline in body weight, into, into the sort of, mature early senior years, and then we get a slightly deep sleeper decline, Once they're, they're more into the, the heading into the super senior years. But what we did see is a slight difference between male and, and female cats. So, in our male cats, they did tend to maintain their body weight, for a little bit longer before we started to get, get that decline.
With our female cats, we're starting to get the decline a little bit earlier overall. Unsurprisingly as well, we're also seeing a difference, between our healthy cats, our, our healthy ageing cats and our non-healthy ageing cats. And unsurprisingly, our non-healthy ageing cats are, are losing body weight, a lot faster, than our healthily ageing cats.
And this is just specifically looking at body weight. When we look more specifically at the muscle condition scoring that we were doing, we can see that actually we don't have that sex difference. So, it does really reflect, I haven't put the body condition score graphs up as well in this particular presentation.
But essentially what we're seeing with our male and female cats is we are getting a similar decline. And our lean body mass, which we're assessing by muscle condition scoring. So they're, they're all pretty good, up until about 8, and then we start to get a little bit of a decline, and then a more steeper decline as they get older.
Again, we're seeing that more overtly in our, in our cats that are not healthy. We get a far more rapid decline, in muscle condition scoring, but we're not seeing that sex difference and that reflects actually that probably in our male cats, we have a slight, increased risk of, of, obesity, and they are potentially Maintaining, this sort of adipocity, and that, that is what is keeping their body weight a little bit more maintained for a bit longer in our male cats compared to our female cats. So, I'll talk about this a little bit more later, but that's why it's really important to be assessing both body weight, body condition score, and muscle condition score as well.
And we were assessing lean body mass just by, using, the sort of body condition score, muscle, so, the muscle condition score, sort of, system that, has been validated. And, I've got some additional information on that later on as well. But our findings were actually reasonably similar, to, then an additional publication that came out.
And this was, some DEXA scan data, from a, a Hills feeding colony, that was published. And again, it's showing a relatively similar pattern. So if we look down the bottom, at the fat, proportion of the, of the DEXA scan, you can see that it kind of goes up.
And then it sort of stabilises for a period of time through the mature and early senior years, and then it starts to reduce. Obviously, overall mass overall goes up quite dramatically, up until, sort of 4 to 5 years of age, and then we have a sort of slow decline and then a more rapid decline. But they were again seeing a similar sort of starting reduction, in the lean muscle mass, over time as well from a, a sort of earlier stage, compared to, to the fat mass.
And so that DEXA scan data, we get this rapid increase up until about 2 years of age, and then we get a peak in lean mass at about 4.5 years of age, and then it starts to gradually decline until about 12.5 years of age and then a sharper decline after that.
And our muscle condition score data, which is slightly more subjective, than the DEXA scan data, even though the, the muscle condition scoring is, is validated and is shown to correlate well with DEXA scanning, it's obviously based on palpation and, and experience, so it is gonna be more subjective. But our pattern was very, very similar. And obviously, additionally, we had the additional information about health conditions and again, showing a, a, a more rapid decline with those.
So, it is interesting. I guess the point that I'm trying to sort of make with this when we tie it back to our life stages, is we really do need to probably start watching our cats closely from, from about 5 years of age. If we're, if we're really sort of assessing them, regularly.
We, we know they're probably going to be at about their sort of peak, peak condition, peak, peak health at probably sort of 4.5 to 5 years of age. So, it's really useful, that we start to really establish what is good for that individual.
What is the ideal, body weight and body condition for that particular individual at about that sort of 4.5 to 5 years of age. So very much during the, the adult time span.
And then it means that as changes occur, as they move more into their mature or senior years, we have a, a very good understanding about what that means for that individual in terms of assessing the changes. So yeah, mature and adult, are, are really still very important age ranges. When we're starting to think about healthy ageing, it's not just about our senior and our super senior cats.
We really need to, to have a good baseline understanding of what is good for that individual from, from sort of adult and mature years. So I'm going to talk next a little bit about disease prevalence. And the way I tend to think about disease prevalence is it gives us that kind of science behind what we should be testing for and, and when, really.
So first up, when we're sort of thinking about, age-related diseases in cats, obviously, chronic kidney disease is probably one of the biggest ones that we think about. So there are a few different prevalent studies out there. The first one, from Vet Compass, looked at, at sort of, the cat population overall, using electronic record data.
And they found overall in the UK about 1.2% of cats have chronic kidney disease, and the median age of diagnosis, is, 14.8 years, so just under 15 years.
We have some more, sort of smaller but more specific studies as well that again, are sort of pretty supportive of that. So, the 2009 study, from the RBC, Looked at a group of, of, cats that were diagnosed as healthy cats, geriatric cats is how they were describing at that point, but essentially it was cats over 9 years of age. And at the initial time of screening, they were considered non-azotemic, and then they followed them over a 12.
Month period. And just over 30% of them became azotemic in that over that one-year period. Again, within this, this particular cohort, the median age of diagnosis of chronic kidney disease, was 14.6 years.
Some later data from the RBC published out in, in 2016, had a similar study design. So again, looking at a, healthy cohort of, of senior cats, geriatric cats, or cats over, over nine years of age, and then following them over a twelve-month period. That particular study found a far lower level of azotemia, so only 11% of them became, diagnosed with chronic kidney disease during that period.
But the The cohort was actually younger at enrollment overall compared to the previous study from that group. And unsurprisingly, the median age of diagnosis was less, so it was 13.4 years.
So, sort of those studies and the, and the wider sort of group, whilst at the age of diagnosis, somewhere between, sort of 13 up to 15 years, most commonly. In terms of the risk factor of being diagnosed with chronic kidney disease, it does sort of start to increase. In our cats from about 8 to 10 years of age.
So, it needs to be on our radar, probably from the sort of mature years. And, and our data, from, from the Liverpool, again, is fitting with that. So, in our enrollment cohort, our cats aged between, 8 to 10, sorry, 7 to 10 years of age at the time they were enrolled in the study.
We found about 10% of them were, azotemic at that time point. Obviously, it's important. We do have to recognise to be able to diagnose chronic kidney disease.
We need both, blood samples showing the azotenia, but also a urine sample as well showing that the urine is not appropriately, concentrated. And we need to demonstrate chronicity. So we need, two separate occasions, at least a period of time apart to be able to demonstrate that, that azotemia and inappropriate concentration are, consistent with chronic kidney disease, that they are, they are, showing chronicity.
So, at that particular time point from our enrollment cohort where we had our data of, of 10%, some of them was just based on a single time point. So we, we couldn't say for sure they had chronic kidney disease, but we were suspicious of them. We've now got a, a publication currently in review that's looking at some of the, the longer, longitudinal data now, from, from the cohort.
So hopefully, at the time that you're listening to us, it will be, in publication. But as we followed, this group of cats over a period of time, between 4 and 7 years, depending on when they're enrolled into the cohort, we have confirmed a proportion of our cats at, at enrollment were actually, were, chronic kidney disease cases, and we've obviously diagnosed some further cases. In the cohort, over this time as well.
So overall, at least at this particular stage, our prevalence overall is about 11% for chronic kidney disease in our cohort. And our cohort is still relatively young, so at least at this particular time point, the median age of diagnosis, is 11.6 years.
Obviously, the cohort is, is still going. So we will hopefully have further longitudinal data, as, as, as cats sort of age out of the study, and, and potentially we might see a higher prevalence and we might start to get a slightly older, medium age of diagnosis in our cohort, but at least that's where we're sort of up to at this particular time point with chronic kidney disease. In terms of hyperthyroidism, again, depending on where the study has come from, we do see some variation, and prevalence of, of hyperthyroidism.
So, the Hong Kong study, in cats, 10 years and older, they found about just under 4% of them had, had hyperthyroidism. The Japanese study, just under 9% of them were diagnosed with hyperthyroidism. Unfortunately, the full papers in Japanese and that's only a bit of the abstract in English.
And so we don't necessarily know, how old the cats were that were included in that study. They're just called aged cats. So, I'm assuming they're probably over 8 or 9 or 10 years of age, but we can't say for sure from the Japanese study.
In the US, Mark Peterson, the sort of godfather of hyperthyroidism, his, his data is sort of indicating about 10% of all cats over 10 in the US, are going to become hyperthyroid. There's a study in Germany that's put it at about 11.4%.
And there was a study from Poland, specifically in Warsaw, that was putting their prevalences at just over 20%. So, there is quite a bit of variation. The, study, looking again, from the Vet Compass data, across, electronic records across all of, all of the UK, the apparent prevalence overall across all cats is about 2.4%, but in cats over 10 years of age, it increases up to 8.7%.
And then a more specific paper looking at annual incidence, from the RBC Group published out in 2011. They followed 104 cats over 9 years of age, and they found the annual incidence was about 7.4%.
So, about 7.4% of cats over nine become hyperthyroid over a, over a yearly time period. Again, when we start to look at when the risk starts to increase for hyperthyroidism, cats, at least at this particular time point, the data is sort of indicating 9 to 10 years of age.
In terms of our study, so at our enrollment cohort, where the cats were aged between, 7 to 10 years of age, we found about 3% of them were hyperthyroid at that time of enrollment. And then as soon as we're looking at our, our more longitudinal data, we found some new cases. Overall, and we found a sort of overall, apparent prevalence of about 8.6%, which again is similar from, for other studies in the UK, and our median age of diagnosis at this particular time point, is, is just over 11 years of age.
It's important when we think about hyperthyroidism and when we're starting to, to potentially work to try and catch some of these cases, perhaps a little bit earlier in the disease process before they're really overtly hyperthyroid. We will get ones, where the, the total T4 may be at the upper end of the reference range, but our, our clinical suspicion is still very high for hyperthyroidism. And this is where the additional testing free T4 and TSH, may be really helpful, with some of these cases that are, are sort of on the cusp of clinical hyperthyroidism, or they may have some concurrent disease going on that's just suppressing the thyroid a little bit.
This is where these additional tests can just sort of help tease out, some of these cases and, and help us achieve, an earlier diagnosis than maybe what we would have been able to, just relying on total T4 alone. Hypertension is probably one of the other big ones that we need to be thinking about, in our ageing cat population. So we have a few different studies around the prevalence of, of hyperthyroidism.
So one of the earliest studies from the RVC published in 2002, was specifically looking at the relationship between, hypertension, and chronic kidney disease, and they found just under 20% of CKD cats had systemic hypertension. A study from New Zealand published in 2014, found that about 16% of cats over 8 years of age had retinal lesions or ocular lesions consistent with hypertension, and about 50% of those cats also had concurrent, concurrent chronic kidney disease as well. We had some additional longitudinal data, from, the Royal Veterinary College, group as well, published out in 2015.
And that particular study found that systolic blood pressure significantly increased with age, with, healthy older cats being at lower risk of hypertension compared with cats that have been diagnosed with CKD, which isn't too surprising. And then we also had an additional study from the RVC, from, Doctor Payne, published out in 2017. This didn't specifically look at hypertension, but was looking at systolic blood pressure, and they did find that, age, demeanour, sex, mutostasis, and a history of being astray were all associated, with elevated blood pressure measurements.
And then finally, there was the mercury, blood, blood challenge, the Mercury Challenge, which was a big, sort of cohort study managed by SIA. And they found overall, 18.6% of cats, that had data submitted from their blood pressure readings were hypertensive, and 21.2% of them were severely hypertensive.
This one is a convenient sample. So it makes it a little bit trickier to interpret the prevalence. From that particular study, 21%, just over 2, 21.8% of them, had, concurrent chronic kidney disease.
And unsurprisingly, because we really do understand that relationship between hypertension and chronic kidney disease, you're more likely to also do blood pressure screening on your CKD. Cats. And similar, 12% of that particular cohort also had hyperthyroidism, and 3.1% of them had both.
And so, again, we probably had a little bit more weighting in this particular population of cats to cats that also had concurrent disease that put them at higher risk of hypertension. But again, what we do know is, is definitely the risk of hypertension starts to increase from about 10 years of age, and we see, our, our cats that have concurrent chronic kidney disease or concurrent hyperthyroidism are going to be at far greater risk of also them being diagnosed. Diagnosed with hypertension as well.
So, definitely, those are, those are the cases that we need to be regularly checking their blood pressure, but we also should be starting to routinely check it from sort of 10 years of age onwards in terms of the risk of disease development. What we saw with our, with our cohort in Liverpool, is about 5% of our cats at enrollment, had an elevated blood pressure, and about two of them, also had evidence of target or emogenazotemia. So we're obviously able to make a diagnosis in those cases of hypertension.
But again, we have to remember that to diagnose hypertension, we do have to show persistent elevation in the systolic blood pressure. So just a single elevated, time point is, is not enough, unless we also have evidence of, of target organ damage as well, which helps confirm our diagnosis. Again, with our longitudinal data, so a proportion of our cats that had elevated blood pressure at the time of, of, Of, enrollment.
Some of them were confirmed to be hypertensive, and subsequent to that, we have diagnosed, a proportion of cats with hypertension as well. So, our overall prevalence at this particular time point is just under 20%, 19.6%, and our median age of diagnosis.
This is 12 years. So this is the paper from the, from the paper that's just, going through review at the moment. We do have some further, systolic blood pressure, hypertension, work coming.
So hopefully, that will be published out towards the end of the year, but there's some really interesting findings from that. The other thing that I think is always really important that we talk about, when we're talking about age-related diseases in cats because it does have a, a significant impact, on their well-being and it's quite, I think, a significant cause of, morbidity, is osteoarthritis and degenerative joint disease. So there are two really big studies that get cited when we talk about OA prevalence, in cats.
The first one, assessed 100 cats aged from about 6 months of age up to 20 years of age, and it showed, 92% of them had at least one joint showing radiographic changes, consistent with degenerative joint disease. Essentially, for every year of age, the severity of the radiographic score increased by around 13%. The second study, a little bit different.
So, the first study was specifically looking at, radiographic changes associated with degenerative joint disease. The second study was looking more specifically at radiographic evidence of osteoarthritis. So, they were looking at slightly different characteristics, on the, On the, on the radiographs.
And this study was looking at a slightly different population of cats. So, again, it was 100 cats, but these were cats were aged over, 6 years of age. And it found that 61% of them had, evidence of OA, and 48% of them had more than one joint affected.
Again, increased age was associated with the presence of, of osteoarthritis. So, whilst these studies did use, slightly different methodology, both of them did find a really high prevalence of disease and severity, increased basically with age. It's also important to note that both of these studies showed that, yes, whilst, our older cats were probably, more severely affected, this wasn't a disease exclusive of older cats and, and radiographic changes consistent with, with joint disease were found in both the adult and the mature life stages as well.
And so it's important that we start to, to work towards recognising these conditions, potentially before they do start to, to have a clinical, impact, on the, on the individual cat's mobility. So, yeah, all ages are at risk, but, definitely severity of disease increases with age. Again, we, haven't been looking specifically for radiographic changes within, our cohort at the Feline Healthy ageing Clinic.
We've been very much sort of focused more on, on just performing an orthopaedic assessment, as part of our study. But within our enrollment cohort, we were finding 58% of the cats had, had abnormalities on their orthopaedic examination. And the cats that were, showing those were, were at the older end of the enrollment cohort.
So it was our cats closer in the 9 to 10 age bracket rather than the 77 to 8 age bracket. And again, obviously, an abnormality in an orthopaedic examination is not proof that, there is degenerative joint disease or if there is osteoarthritis. But it's important that we're recognising these, we're getting the cats comfortable with having the orthopaedic examination performed, and we can then start to track, you know, changes, in the severity of these signs over, over time.
Additionally, as, as part of the work that we did, with the Feline Healthy ageing Clinic, we were also doing some, pressure mats, gait analysis work as well, and we have published out some of our findings from that as well. So, unsurprisingly, getting cats to walk at a steady pace in a straight line is not the easiest. So our gait analysis, we had a far smaller cohort.
Of data. So he had 53 cats. But within that, that, particular study, we did find that the cats, with musculoskeletal disease were significantly heavier and had a greater body condition score than those that, that were considered the sort of healthy controls, for our gait analysis work.
Again, there's a little bit of a chicken and egg relationship. We do recognise this relationship between musculoskeletal disease and, and, greater, sort of obesity. And we can, we can say that potentially cats that are heavier are putting more force through their joint.
So the signs of, of musculoskeletal disease may be more obvious, because they're putting more weight on it, so, so it's more uncomfortable for them. But also, obesity is an inflammatory condition. And, you know, it's a painful condition.
Are our cats that are, that are painful and, and sore, more, more likely to not move around as much, and so, are they more likely to put on weight as well? So we, we, we haven't yet really got a good temporal association with this, but definitely our, our heavier cats are going to be at more risk of musculoskeletal disease, or the weight is making the musculoskeletal disease more overt and more clinically significant. In terms of our, our longitudinal data, our ongoing data, overall, we, we have found that, 82% of the cats in our cohort do have detectable changes on their musculoskeletal examination.
That make us concerned about musculoskeletal disease. Our medium age of, of, of us starting to recognise some of these changes is, is about 10 years of age. And we have also found that cats are, are more comfortable with having, the orthopaedic examination performed over time as well.
So That, again, to me, it should encourage us to start to think about including an orthopaedic examination, maybe in our cats, our adult cats, and definitely our mature cats, so that when we start to detect changes, we can be more confident that they probably do reflect actually a, a truly clinical significance, change. We've also found that cats with muscle wastage, were more likely to have a higher, osteoarthritis, sort of, orthopaedic examination, sort of finding changes as well. And again, that's probably a bit more supportive that what we are picking up on is, is actually of clinical significance.
And unsurprisingly, the score, so how uncomfortable they were on orthopaedic examination, did increase with age as well. And just some of the other things that have sort of popped up as well. So we have had a, a small number of cats diagnosed with, with diabetes.
Medium age, is, is, just over 12 years. We've had a few, unfortunately, that have been diagnosed with neoplasia. And again, age, average age is just under 12 years.
Unsurprisingly, a lot of our older cats also have heart murmurs. So getting up towards 60% of them have had a heart murmur detected at at least one appointment. And we know that from, from other, cardiology studies, the CAT scan study out of the RBC, showed again, a high prevalence of heart murmurs in cats that were, again, increasing as they got older.
And so unsurprisingly, our cohort has has found similar, average age of us detecting a, a heart murmur for the first time, just over 10 years of age. And we were seeing an awful lot of dental disease. And again, that's perhaps less age-related.
We're starting to diagnose dental disease, on, on an average, of, of, just over 8 years, just over 9 years of age. But we were also seeing a fair amount of dental disease and enrollment as well. But over, overall, nearly 85% of our cohort have been diagnosed with dental disease at at least one time point.
So, now that we've sort of talked about what the diseases are and what are common, I just want to get us thinking a little bit more about what, what some of the tests are that would be really useful for us to be making sure we're including, in our, in our, annual wellness checks. And the other thing I really just wanted to reiterate is we're not necessarily always talking about particularly expensive tests. So there's a lot of things that we can be incorporating into our, into our wellness checks, that are going to be really helpful with our ageing cats, that can just be incorporated into the cost of these appointments.
And so, the sort of first step of these is making sure that we are weighing the cats, and we're recording the weight on their medical record. But we're also not just looking at that in isolation. We're looking back through the medical record to see how the weight has changed since their last appointment, but definitely with our older cats, do look back and compare it to what their weight was when they were sort of in their prime, when they were, when they were sort of peak adulthood, and that hopefully is probably pretty close to what their ideal weight should be, and be comparing it to what their weight is now.
Similarly, it's also really important that we're assessing the body condition score, especially as they move through, their adult years into their mature years, into the early senior years, because that is where they're going to be at more risk of, of obesity. And then we also want to be assessing their muscle condition score, and tracking to see how their muscle condition is declining, especially as they're moving through into their, into their senior and super senior years. As well as that, take a nutritional history, find out what they're feeding and how much they're feeding.
All of these are available as resources, on the Wasava website. The Wasava Nutritional, Committee has some fantastic resources, including the muscle condition score and the body condition score posters and information. And they also have a form to help you take nutritional history as well.
So, I'd really encourage you guys to explore them and use those resources. They are fantastic. Why these things are really important is that, you know, we do get these declines.
So, I showed earlier, the, the muscle condition score, declining, with age in our cohort. But we also, see that it can give us a bit of an indication between healthy versus non-healthy. But we see this with some other things as well.
We have, just additionally, been including a, ultrasound measurement of appaxial muscle waste. So, obviously, whist, muscle condition scoring has been validated against, DEXA scanning. It is still a slightly subjective method and so there have been, some publications including ours, where we're starting to look to see if, if potentially, doing an ultrasound, apexxial muscle height may also be a helpful way of assessing muscle condition score.
And the reason why all of this is important is that we do get declines, in body weight, often before we diagnose disease. And so actually, an unexplained change in body weight to me is a really big prompt that we need to then discuss doing some additional tests with the owner. If the change in, in weight can't be explained, By a change in, in what they've been feeding them or a change in activity, then those are the ones that I would definitely be encouraging, blood testing to be done, because definitely with chronic kidney disease, we'll see, weight loss often before.
And in this particular study, potentially up to 2 years before, we, we diagnose the chronic kidney disease. Additionally, I just wanted to mention dental disease associated with, with weight as well. So, dental disease is seldom, severe enough for, for our patients to actually be, be losing weight, or, or not eating.
But both of these studies, have shown they were looking at slightly different things. But as part of these studies, what they were doing was measuring, Volume of food eaten and eating behaviour, both pre and post-dental intervention. And both of them have shown that once the cats have had their dental intervention, once the sore teeth have been taken out, once they're on appropriate postoperative pain relief, the amount of time that they spend eating increases and the volume of food that they eat increases.
So I do think that, the low-grade pain caused by, by dental disease, even the cases that don't look really bad, when we assess them, we know when we do dental X-rays, there's a lot more significant dental disease going on there under the gums, and potentially that pain associated with them is probably having an impact on, on the amount of food some of these cats are eating. So whilst it's not dramatically causing huge amounts of weight loss over a short space of time, it's probably contributing in a low-grade way to some of the weight loss that we see in some of our older cats because, you know, as we said from our paper, dental diseases is really, really common. In an ageing cat cohort, and, and we're diagnosing dental disease just based on a visual assessment, you know, we know we're going to be missing an awful lot of dental disease because this isn't a, an examination under a general anaesthetic.
This is just looking in their mouth as part of a physical examination. So, dental disease, I think, is potentially a really underrated cause, of weight loss in, in some of our feline patients. So our additional testing, the other thing that can be really, really useful, especially if we're thinking about some of the, the sort of more cost-effective things is, a urine sample and assessing for urine specific gravity.
So especially if, if we have clients where their, their cats are quite comfortable using litter trays, if they're happy to, to use one of the, sort of urine collection kits and bring in another sample. Along with their cats as part of their wellness visit. If that urine is nice and well concentrated, we probably don't have to be super worried, about chronic kidney disease or hyperthyroidism unless there are some other things going on that we're concerned about.
Obviously, if the urine is, is not well-concentrated, and we can't explain that solely through diet, you know, if they're being fed just a moist food, that urine is not going to be as well concentrated as cats that are also fed, a mixed diet or a predominantly, c-based diet. But again, urine can be really helpful, and just assessing whether or not we need to do additional blood tests or not, as well as being helpful if we have the blood test results and determining whether or not, we have, we have chronic kidney disease as well. And then the other thing that I would be really keen for you guys to be including routinely and, and pretty much all of your annual, annual wellness visits for cats of all ages is, is blood pressure monitoring.
If we can get the cats comfortable with having the procedure performed, then once they're moving into the age range where they're more at risk of, of actually developing hypertension, we can probably be less concerned about situational hypertension confiding our results because we've, we've gotten them comfortable with having their blood pressure measured on a regular basis. The other thing that I think is important for us to get comfortable with is performing retinal examinations. You know, we don't have to be the best ophthalmologists in the world, but if we can get really comfortable with looking at what normal is, for the back of a cat's eye, then when abnormal starts to creep up on us, we can, we can probably, be a lot more skilled at identifying it.
So as part of, of getting the cats comfortable with, with having their blood pressure measured, I think it's really good for us to get comfortable with also then routinely just looking in the back of the eye and assessing the retina. Also, don't forget to palpate for a goitre. So again, if you're just assessing for a goitre, if we start to palpate one, then that is a cat that I probably am going to want to maybe do a thyroid assessment on.
But if otherwise, I haven't had any weight loss, if I can't palpate a goitre, then I, I'm probably less concerned about assessing their thyroid at that point. I've already mentioned the appointment, importance of, of assessing for dental disease and the importance of, of getting them comfortable, and, and used to having an orthopaedic assessment performed. Alongside a, a physical, orthopaedic examination.
The other thing that can be really useful to start to include in is, is some of the screening tools for OA or DJD. So hopefully, the, the QR code here should take you through to the North Carolina State University, clinical metrology instrument page, and all of their, their validated clinical metrology instruments are there. So, the, the pain screening, the musculoskeletal pain.
Screening checklist. It's 6 simple questions that really we should just be including from adulthood onwards, into all of our feline wellness visits. And so long as, the owner is saying yes to everything, great.
If they start saying no to some of them, then that's a sign that we definitely do need to, to perform an orthopaedic examination if we're not doing that already. But at that point, we may also want to do, the full musculoskeletal pain index survey as well. That will give A, a little bit more additional information to help support your concern that this, this cat may have musculoskeletal pain secondary to osteoarthritis or degenerative joint disease.
But also the advantage of, of doing that, checklist is it, is also validated, to not just use as a tool to help with diagnosis, but also to use as a tool for response to treatment as well. So, I do really like to, to get a sort of baseline management of that as well when I start to see these cases. So when we think about the, the tests and the when, there's probably not a huge amount that we need to do additional with our our kittens and our juniors, apart from just making sure that they're growing, in the way we expect them to grow and obviously all of the vaccines and preventative healthcare things that we need to get them started out with.
But in terms of our adult cats, as they're as they're moving out of that growth phase, phase them into their adult phase. It's definitely really important that we determine what their ideal body weight is. And we're also making sure they maintain their ideal body weight as well, because as they move through, their later adult years and into their mature years, that is when they do start to be at more of an increased risk of, of, obesity.
Developing, and we want to make sure that, that we're keeping them at their nice ideal body weight. And then also making sure we know what that is, so that, as they move through more into their, senior years, and we start to be concerned more about weight loss, we can, can be comparing their current weight back to what it was when they were sort of in their prime at their ideal weight. Before I sort of talk a little bit more about, the sort of mature years and onwards, especially in the current climate, of veterinary medicine in, in the UK, I think it's really important that we talk about the perception of value.
And this was a really nice study that came out of, the States, but I think it's really useful, for us to just be thinking about how we frame These, some of these things that we're going to be wanting to be discussing with our client, and how they perceive the value of, of what we're saying. So, I think the first one is really important. Telling them doesn't work.
So telling them, your cat is now 10 and we need to see it twice a year, isn't necessarily going to, to have them, sign up and start coming back. In terms of how We're framing some of these discussions, definitely focusing on the caregiver relationship with the cat is going to be really important. And especially with cats that may not like to come into the vet clinic where it's actually really hard for the owner to get them into a carrier and get them into, into the vet clinic, even if they understand the importance of it.
Really be looking at what are Some of the things that we can advise on that may make it more successful, for that individual, you know, can, can we use home visit services? Is there some other things that we can do. So be thinking about the holistic picture, not just, you know, what is very, cookie-cutter for us as a, as a clinic, make sure you're, you're trying to individualise it as much as possible.
And definitely be tying our preventative healthcare discussions into the overall health and happiness of that pet as an individual. So, again, this is where probably the movement away, you know, calling these annual visits the vaccine appointment, especially where many of us now are following. Different protocols, which means that they actually don't necessarily need a vaccine every year.
But there is still that importance and value of these animals coming in to see us on a yearly basis and really be focusing on those things that we want to be assessing for that we can pick up earlier before it starts to cause pain or discomfort for the individual animals is often a really good way of doing it. Experience and Trump's qualifications. So, you know, if you can personalise it, you know, talk about, your experience, the other cases that you've seen, the value of some of these things, you know, probably starting the conversation out with, I listened to a webinar the other week from the Feline Healthy ageing Clinic, and they said X, Y, and Z, isn't necessarily going to be the way to, to frame this discussion.
So, we do want to make sure, that you're really personalising it to your own. Experience, but also personalising your recommendations to that, case as an individual, but also the owner's circumstances as well. So yes, ideally, you want to see them back in 6 months' time, but actually, if, if, you know, they've got family over during that time point, if there's something going on, can we, can we see them a little bit sooner?
Can we push it back a little bit later? Make sure you're making adjustments to make it work for the client because if we don't, they're just not going to come back. And then if there are, cost concerns, what was interesting that came out of the study is actually they prefer that to be just addressed head-on.
So if you're seeing a patient and you're picking up on some things that are going to make you want to advise that we do, do some additional blood tests, that we do some additional diagnostics, Be, be upfront about it. Say, look, you know, I found X, Y, and Z. Give them the justification as to why you're advising this.
Tell them, give them a quote, tell them what it's likely to be, and then work through it with them. If there are payment options available for your practise, fantastic. If there are things that they can sign up to, to be spreading the cost over with a sort of monthly payment scheme that might be suitable for some clients as well.
If, if they are very, very cost-limited, you know, give them the protocol of, of what you would ideally do under, under the circumstances, and then talk through with them which ones are the really, you know, we definitely need to know this, and which are the, this would be nice to know, but it probably won't actually impact my advice, so maybe we can hold off on that for now. So then tailor it down to them as an individual. And the way I often think about some of those things is, What, what is going to be my treatment advice based on the results of this?
Is that going to change? Yes, we always do like to know what we're dealing with, but is it actually gonna change my advice or actually is my advice still valuable, in terms of, of, the, the ongoing care of this patient, regardless of what the actual diagnosis is. So, that can be.
Helpful, but, definitely, in the current climate that we're in, we, we need to be making sure that we're, we're really, working with our clients so they they understand the value of, of what it is that we are advising. Ultimately, we're only advising these things to, to ensure that their, their, their cat is, is living hopefully a longer, healthier, happier life. So with our mature cats, so we've, we've had them through the adult years.
Ideally, we will be starting to do all of these things in the adult years as well, but we definitely want to start it with our mature cats. So from 7 years onwards. Definitely a, an annual wellness appointment with a veterinarian is, is fantastic.
But if the client is willing, then definitely, 6-monthly nurse checks are going to be really helpful with these cases as well. We want to be doing a good physical. Assessment of them, making sure we're tracking and monitoring weight, body condition score, muscle condition score.
We're having a good look at their, their teeth. We're getting them comfortable with having their blood pressure measured. And if possible, if we can get a urine sample, either the owner bringing one in or we're able to collect one during cyst with cystocentesis during the appointment, and just looking at the urine concentration, interpreting that with what they're being fed, will give us some, also some additional useful information as well.
Ideally, during this age range, we would, collect a minimum database, so a CBC, chemistry, urinalysis to really establish what is normal for that individual, and to look for changes over time. But, if, if it, if it's outside of our, our scope, In terms of what our client is, is able to afford and willing to engage with, or what the case is willing to engage with, then, you know, unless we've got weight loss or we can palpate a goitre, we don't necessarily need to do blood tests, every, every year on these patients. OK, and now we're covering our senior cats.
So sorry about that little hiccup there. Hopefully we'll be able to edit it out. So with our senior cats, we probably do want to start to see them a little bit more frequently.
So we're sort of saying at least every, at least once a year for our mature cats, potentially with our nurses every 6 months. As they move through to our senior cats, we definitely do want to be seeing them every 6 months. This could be a combination of, of, of nurse and vet visits depending on, on health.
Healthy the individual is. If they're one of our, our fantastic healthy ageing cats, and they're doing great, then a combination of vet and vet nurse visits will be fine. If they're ones that are already starting to become more of a geriatric and have, concurrent, comorbidities, then potentially, in those circumstances, they may be more appropriate to be vet visits every 6 months.
Again, we're going to be wanting to monitor the same things, but once they're in the senior years, there is a stronger argument because of the risk of diseases developing, that we probably should be doing our, our bloods, our CBC, biochemistry, on an annual basis, and obviously adding in a T4 if there's a goitre or if they've got an unexplained weight loss. Again, if you have got really cost-limited, Clients, then I wouldn't necessarily be routinely taking the blood samples. I would be doing them on the ones that, are starting to show unexplained changes.
So if there is unexplained weight loss, then those are the ones that I would, I would be then using that as a, as a reasoning behind why we probably do need to repeat some blood tests with them. Versus the ones that if everything is going really great, if they're stabilising well, maybe we only need to do baseline bloods, every, every year or two, rather than at every appointment. So you, you will just need to tailor it based on the individual and based on what you're finding.
But from my experience, there is a huge amount of value just monitoring changes in weight, body condition score, and muscle condition score, especially muscle condition score, because sometimes with these cats, the weight loss isn't particularly dramatic. It may only be 100 grammes to 200 grammes. But actually, what you're palpating is a significant decline in lean body mass.
And those are often your early hyperthyroid cats or your early kidney cats, that actually we get a change in lean muscle mass rather than a big change, particularly in body weight. In terms of our super senior cats, we're probably going to want to see these guys a little bit more frequently. So probably, every 3 months.
Again, if they're doing really well and, and a real healthy ages, then maybe we do only need to see them every 6 months. And definitely, if we, if we think every 3 months is indicated, these can probably be a mixture of, of vet visits and nurse visits, depending on the individual. Again, things are very much the same here.
But, again, we probably do want to be doing those blood tests on these guys on an annual basis. Again, if the client's cost-limited, those discussions can be had, but because If they're over 15, the, the risk factors for them developing some of these age-related diseases are greater, ideally, at least annual for the bloods is advisable. Obviously, a little bit more frequently if there's unexplained weight loss, or if we're starting to, to have a palpable goitre when we didn't have before.
So, our nurses, as I've sort of mentioned, can be exceedingly, exceedingly helpful, in terms of leading some of these clinics, depending on the combination that you can go into. But also alongside the veterinary visits, there's a huge amount of advice, our, our RBNs can, can help with. So when we think about the things that we're trying to do to ensure healthy around, the cases that we've diagnosed the disease.
Our nurses can really help, work with our clients, to, to make sure, the dietary interventions that we may be advising are working, because as we know with cats, they sometimes choose not to, to eat the diets that we're prescribing for them. And so our nurses can really work with them to help, tailor things maybe a little. A little bit more to the individual taste buds.
But also our nurses can really work with our clients to understand the environment that these cats are living with, and, and to really make, some good advice about, things that they can do to change the environment, maybe moving furniture around to help support, cats with osteoarthritis, or some additional husbandry changes, Location of water bowls, types of water bowls, how food is being given, and all of those sort of, more sort of holistic things, our veterinary nurses can be exceedingly helpful with. Obviously, as we may be diagnosing diseases and prescribing medication, again, our, our nurses can be working with our clients to, to give them the additional support that they may need to ensure that the cats are actually getting their medication. If we're working alongside our nurses, and, and making, these, these visits a combination of vet-led and nurse-led appointments, again, in our nurse clinics, our nurses, can still be exceedingly helpful in the early recognition of some of the comorbidities that might be going on.
So dentistry disease, musculoskeletal disease, hypertension. If they're also receiving urine samples to, to analyse, and they're seeing inappropriately concentrated urine, working with the vet team, they may be also really helpful for, for some of the earlier diagnosis of CKD and hyperthyroidism as well. So, depending on how your clinic's structured, there's a lot that you guys can do to be really working with your nurses, to hopefully achieve, some really successful wellness clinics.
As I mentioned earlier, our geriatric cats, these are the ones that we've diagnosed an age-related disease sort of regardless of their life stage, and really, the frequency of visits and the diagnostics do just very much need to be in line with the individual disease processes that may be occurring in these cats. And so, again, the frequency of visits needs to be tailored very much towards them as individuals. Finally, I just wanted to mention, quality of life and quality of life assessment tools, especially as these cats get older and they may have multiple comorbidities going on, we need to be really working with the client to make sure that we're looking at the cat in the round, not just at the, the individual diseases.
And this is where these sort of tools become really, really helpful. So the two questionnaire, is available through the Journal of Feline Medicine and Surgery. The full questionnaire is available.
And the supplementary material. And that's a really good validated generic health, related quality of life assessment tool for our cats. And some of you may have access to the vet metrica tool through your clinics, and that's the, validated, web-related quality of life instrument, which we use, at the, the Fairline Healthy ageing Clinic.
And it is a, a really useful tool, for, for, for monitoring changes over time. There also are some additional, quality of life tools associated with some of the age-related diseases, such as the chronic kidney disease one as well that you, you'll be able to, to find and have access to. But again, they're really useful, especially with some of these cats.
That's when they start to stop ageing healthily, and we really need to be making sure we're using a sort of independent validated tool that's going to help us assess how well that cat is coping, in the round with, with essentially some of these, these, comorbidities too. So, thank you all for listening. I hope you found, this particular webinar useful, and I've hopefully given you some thoughts and some tips, about some of the things that you can start to incorporate, in your, in your feline wellness clinics, not just your senior clinics, but also how you're structuring and running your clinics for your adult and mature cats as well.
