S e n i o r P e t N u t r i t i o n an d

Management
a, b,c
Julie A. Churchill, DVM, PhD *, Laura Eirmann, DVM

KEYWORDS
 Senior  Geriatric  Aging  Nutrition  Nutritional assessment

KEY POINTS
 Aging is a continuum with individual variation regarding the onset and degree of age-
related physiologic and pathologic changes. This individual variation prevents a one-
size-fits-all approach to senior nutrition.
 Physiologic changes associated with aging include changes in energy requirements, body
composition, and certain nutrient requirements. In addition, senior pets are at risk of path-
ologic changes, risk of frailty and comorbidities that may require thoughtful nutrition
planning.
 Every pet requires a nutritional assessment and specific recommendations. Frequent re-
assessment of the senior population is critical to ensure the nutrition plan continues to
meet the needs of the elder pet who is at risk for various age-related health issues.
 There is no established Association of American Feed Control Officials nutrient profile for a
senior life stage, so the nutrient composition of products marketed for senior pets varies
widely.
 As end of life approaches, recognize the importance of feeding as part of the bond with the
pet. Consider shifting the focus from eating the so-called right food to nurturing with foods
to provide compassionate care.

INTRODUCTION

Senior pets represent approximately one-third of the pet population.1 The point at
which an individual progresses from the mature adult to senior life stage is variable.
For this reason, age groupings are arbitrary demarcations that can help veterinary
health care teams (VHCTs) focus attention on physiologic changes that occur at
different stages. For cats, the American Association of Feline Practitioners (AAFP)–
American Animal Hospital Association (AAHA) Feline Life Stage Guidelines group
cats 11 to 14 years of age as seniors and cats more than 15 years of age as geriatric.2
Dogs’ life expectancies vary widely depending on breed and body size, and aging

a
Veterinary Clinical Science Department, University of Minnesota College of Veterinary
Medicine, 1352 Boyd Avenue, St Paul, MN 55108, USA; b Oradell Animal Hospital, 580 Winters
Avenue, Oradell, NJ 07652, USA; c Nestle Purina PetCare, St Louis, MO, USA
* Corresponding author.
E-mail address: [email protected]

Vet Clin Small Anim 51 (2021) 635–651

https://doi.org/10.1016/j.cvsm.2021.01.004 vetsmall.theclinics.com
0195-5616/21/Published by Elsevier Inc.
636 Churchill & Eirmann

changes are also variable. Rather than characterize the senior life stage by specific
age ranges, the 2019 AAHA Canine Life Stage Guidelines define the senior life stage
as the last 25% of estimated lifespan through end of life.3 Physiologic
changes associated with aging may include loss of senses (hearing or vision), reduced
energy requirements and lean body mass, as well as a decline in various organ func-
tions.4,5 Physiologic changes associated with aging may make a pet less tolerant of
nutritional deficiencies or excesses.6 Senior pets are more vulnerable or at risk for
age-related health problems. Nutritional management can influence many of these
chronic diseases. A vital component of preventive medical care should include a se-
nior screen or health risk assessment for early detection of health problems and ad-
justments to care and prevent or slow the onset of age-related diseases. Every
senior health screen should include a thorough nutritional assessment followed by
an individualized nutritional recommendation.

NUTRITIONAL ASSESSMENT

Before recommending any diet changes, a nutritional evaluation should be performed.

The goal of the nutritional assessment is to obtain the necessary information to pro-
vide a specific detailed nutrition recommendation. Nutritional assessment is
an iterative process that includes evaluating the patient, all foods, and the feeding
management (www.ACVN.org). Signalment, dietary and medical histories, and com-
plete physical examination with appropriate diagnostic testing for the senior pet
comprise the nutritional assessment. The AAHA and World Small Animal Veterinary
Association (WSAVA) recommend a nutritional assessment and dietary recommenda-
tion every time a pet presents for veterinary consultation.7,8 An accurate diet history is
invaluable when assessing the nutritional health of the patient and is vital to formu-
lating an individualized diet plan. Understanding the nutritional changes that occur
with aging and identifying any changes in the individual patient can help the clinician
better match the appropriate food with the patient’s unique needs (Table 1). The pa-
tient, the food, and the pet owner’s feeding practices are interrelated and require reas-
sessment. Health and nutritional status are not static, especially in senior pets, but are
a dynamic process worthy of continued reevaluation and treatment modifications to
match the changing needs of the pet.

Patient Assessment
An initial assessment of the patient uses information collected as part of a health
assessment: a complete medical and diet history, a thorough physical examination,
and appropriate laboratory work (eg, complete blood count, serum biochemical pro-
file, urinalysis, and thyroid function [feline]). Patient factors, including body weight and
body condition score (BCS), are essential because food recommendations and
feeding amounts are based on body condition and optimal body weight. Body weight
and BCS should be recorded at each visit in a manner that allows the VHCT to observe
trends. Several body scoring systems have been developed and evaluated in dogs
and cats.9–13
Adopting a universal 9-point BCS, which has been more extensively validated than
other BCS systems,9,10,14–16 is preferable and is also the system that has been recom-
mended by the WSAVA Global Nutrition Panel.17 The 9-point BCS offers several ad-
vantages compared with other BCS and zoometric measures of adiposity,12,13 most
notably speed and simplicity to ensure consistent use in veterinary practices. A univer-
sal BCS would better enable VHCTs to interpret veterinary medical research, more
consistently and accurately assess their patients’ body conditions, and clearly
 Senior Pet Nutrition and Management 637

Table 1
Considerations to address nutritional/metabolic alterations of healthy aging pets

Key Nutrient/Metabolic
Change Feline and Canine Rationale
Energy Increase or decrease Senior cats have a gradual
decrease in MER through
middle age (w11 y) and
thereafter more
commonly have an
increase in MER
associated with loss of
body weight.
Senior dogs commonly
have decreased MER, but
geriatric dogs are also
more likely to be
underweight
Water No alteration or Increase Reduced total body water,
decreased sense of thirst,
mobility conditions
limiting access to water,
and subclinical increases
in water losses (urinary)
increase risk of
dehydration. Ensure easy
access to water, offer
higher-moisture foods, or
add water/liquid to dogs’
food
Consider nutrient-enriched
water supplement for
cats
Protein Increase (unless evidence of Twenty percent of geriatric
medical condition cats have decreased
reducing protein protein digestion
tolerance) Protein requirements of
healthy senior cats and
dogs increase with age
because of compromised
protein synthesis
Fat Increase or decrease An estimated 35% of
geriatric cats have
decreased fat digestion
and may benefit from
nutrient-dense highly
digestible growth
formula
Dogs have no change in fat
digestion with aging,
and dietary fat intake
should be adjusted to
manage nutrient density
of the diet and healthy
BCS of the dog

(continued on next page)

638 Churchill & Eirmann

Table 1
(continued )
Key Nutrient/Metabolic
Change Feline and Canine Rationale
Long-chain omega-3 No alteration or increase Have shown promise in
polyunsaturated fatty dogs with osteoarthritis,
acids renal disease (VCNA
Parker) heart disease
(Freeman79) and some
forms of cancer (VCNA
Saker)
Antioxidants and medium- No alteration or increase Valarie V. Tynes and Gary
chain triglycerides Landsberg’s article,
“Nutritional
Management of Behavior
and Brain Disorders in
Dogs and Cats,” in this
issue

Abbreviations: BCS, body condition score; MER, maintenance energy requirement.

communicate with colleagues and clients. Using the 9-point system, each unit in-
crease in the BCS greater than ideal is approximately equivalent to 10% to 15%
more than ideal body weight.18
A muscle condition score (MCS) system, as recommended by the WSAVA, is also
an essential component of the patient assessment. The MCS uses palpation of the
skeletal musculature over the spine, skull, scapula, and pelvis, and is independent
of body fat and BCS. An MCS has been developed and evaluated in both cats and
dogs.19,20 Senior dogs and cats experience sarcopenia, a loss of lean body mass
(LBM) with age, unrelated to disease.4,21 Sarcopenia is commonly accompanied by
an increase in body fat, which may result in stable body weight. This loss of LBM
may go unrecognized if the clinician relies on body weight trends and ignores
MCS.22,23 Evaluation of MCS in senior pets is an important first step in identifying
age-related sarcopenia or cachexia (loss of muscle mass secondary to an underlying
catabolic disease). Loss of LBM is important to recognize because it is associated
with increased morbidity and mortality.21,24
The nutritional screening process (Table 2) can quickly identify patients with nutri-
tional risks. Healthy seniors without identified risks, who are eating an appropriate
nutritionally balanced diet, have a healthy body weight, healthy body and muscle con-
ditions (BCS, MCS), and are free of significant physical or laboratory abnormalities
need no further evaluation at this time, but a recommendation for the client is impor-
tant. A pet-specific nutrition assessment and recommendation for healthy seniors can
be done quickly. Nutritional recommendations should include the specific name of
foods that match the pet’s current nutritional needs, the amount and frequency for
feeding, and a monitoring plan. In many of these healthy patients, the feeding recom-
mendation involves little or no change, but it should include a verification and valida-
tion for the owner that the current food and feeding plan meets the pet’s needs, and a
documentation of the current feeding plan in the medical record. At a minimum, the
monitoring should include body weight and BCS by the owner each month in order
to detect changes early.
If nutritional risk factors or age-related problems are identified, an extended evalu-
ation and management plan is indicated. This in-depth evaluation should address
 Senior Pet Nutrition and Management 639

Table 2
Initial screen: assessing for nutritional risk factors

Check When Any Risk Factors Present in the Patient

Require
Extended
Evaluation
Nutritional Screen for Risk Factors if (U)
History of:
Treats/snacks/human foods >10% intake
Inadequate information/inappropriate feeding/food
Consuming unconventional diets
Previous/ongoing medical problems
Gastrointestinal signs
Physical Examination:
Any abnormal BCS (s5 out of 9)
Any abnormal MCS
Unintentional weight loss or gain
New medical condition
Poor skin hair coat
Dental disease

Adapted from the 2010 AAHA Nutritional Assessment Guidelines for Dogs and Cats. ª American
Animal Hospital Association, 2010.

changes that may indicate the onset of common age-related diseases that may be
influenced by nutritional management (Box 1).

Diet Assessment
A comprehensive diet history is a critical component of the nutritional assessment of
senior pets. To facilitate obtaining a comprehensive diet history, a form can be pro-
vided to the owner before the appointment (http://acvn.org/wp-content/uploads/
2020/04/ACVN-Diet-History-Form-2020-FINAL_fillable.pdf). This form allows the
caregivers an opportunity to look at pet food labels at home, measure the amount
they are feeding, and perhaps keep a food diary before the visit. The diet history
should identify all snacks, treats, and nutritional supplements by type and amount.
The drug/supplement history should include questions about the use of food to admin-
ister medication, because it may comprise a significant portion of the pet’s caloric
intake. Diet history information combined with the patient assessment provides infor-
mation about the patient’s daily caloric requirements and specific nutrient intake. This
nutrient intake should be compared with the patient’s individual needs. For example,
an overweight pet with a robust appetite should not be fed a calorie-dense product.
Reducing the amount of a high-calorie product to limit calorie intake could lead
to deficiencies of other essential nutrients25,26 and increase hunger or undesirable
food-seeking behaviors. Such pets would benefit from a diet specifically formulated
to contain lower calories and a higher nutrient/calorie ratio.

Feeding management assessment

Feeding practices and preferences influence pets’ intake. Multipet households
may present competition, limiting the senior pet’s access to food. A senior pet
with mobility issues may have difficulty or pain associated with accessing food.
640 Churchill & Eirmann

Box 1
Extended screening: assessing senior dogs for nutritionally relevant age-related factors

Extended evaluation: age-related diseases to evaluate in senior dogs

Abnormal body and muscle condition: change in weight and muscle mass?
Diet: is the pet eating appropriate amounts of balanced diet?
 Assess appetite and intake
 Assess ability to eat: prehension, mastication swallowing for those underweight and/or poor
intake
 Perform oral examination: include periodontal, tonsils, or any oral abnormalities
 Assess sensory input: smell, vision, palatability of food; consider palatability enhancer if
necessary
Mobility and access to food and water
 Is the pet able to walk, access food provided? Able to stand to eat and drink?
 Other pets or physical limitations impairing access?
 Mobility and exercise: is the pet’s MCS normal (3 out of 3)?
 Presence of osteoarthritis, lameness, pain? Play a role in maintenance of comfort, fitness, and
healthy BCS
 Activity minimizes sarcopenia
 Exercise and activity provide mental stimulation and environmental enrichment
Cognitive function
 Disorientation/confusion: becomes lost or confused, fails to recognize familiar people?
 Changed interactions with family members? Isolates or seeks attention less often?
 Change in sleep/activity cycles? Wander or pace, sleep more in day, less at night?
 Loss of house training (nonmedical reasons)
Change in clinical status to suggest disease onset
 Changes in energy, demeanor, and well-being
 Changes in urination or stool quality, frequency, or quantity

An extended evaluation is performed if more than 1 risk factor is identified in the nutritional
screening process. This evaluation should include eating (both appetite and intake), oral exam-
ination, aspects of activity and mobility, sleep, cognitive function, and behavior.

Dental disease, common in senior pets, may limit intake because of pain
or difficulty prehending. Age-related decline in sensory perception or cognition
may require a different feeding strategy, such as warming food or hand feeding.
Determine whether food is accurately measured, how much/how often food is
offered, and how much is eaten. Ask whether there have been recent changes
to the feeding plan and why, as well how the pet adapted to those changes. Senior
pets becoming picky may be the first clue the owners notice of an underlying med-
ical condition.

Reassessment and Modification of Treatment Plan

Nutritional assessment of geriatric pets is an ongoing process. Dogs and cats expe-
rience a variable and wide variety of metabolic changes as they age. It is important
to communicate and engage pet owners to create the expectation of continued reas-
sessment and treatment modifications that accommodate the specific changes
observed in each individual pet, rather than adopting a general senior protocol. A vigi-
lant monitoring plan allows early detection of problems if they arise and a better op-
portunity to intervene or modify the pet’s individualized nutritional plan to improve
its health. Partner with clients to help ensure success and maintain adherence to
the feeding and monitoring goals.
 Senior Pet Nutrition and Management 641

EFFECTS OF AGING ON NUTRITIONAL NEEDS

Energy
Aging can result in both structural and functional changes of the gastrointestinal tract.
However, clinically relevant differences in nutrient absorption between young adult
and geriatric dogs have not been reported.27,28 In contrast, approximately one-third
of cats greater than 12 years of age have decreased fat digestibility and approximately
20% of cats greater than 14 years of age have reduced protein digestibility.22 Mainte-
nance energy requirement (MER) is defined as the energy required to keep an animal
at a state of energy equilibrium such that caloric intake matches energy expedition
resulting in stable body weight. MER varies depending on factors such as breed, ac-
tivity level, health, neuter status, and age. As dogs age, MER decreases w25%, with
the greatest decline at middle age,29 although some studies report an even greater
decline in MER with age.30 In cats, MER seems to decrease by approximately 3%
per year for the first 11 years of life, but, after w12 years of age, MER tends to in-
crease, and weight loss and decreases in LBM are common.31–33
Because of the wide range of individual energy requirements across the senior pet
population, each senior needs frequent monitoring to adjust energy intake to match
that individual’s needs. Aging pets may be less active than young adults, which contrib-
utes to reduced MER. If no adjustments are made to energy intake to account for the
reduced caloric requirement, the senior pet may gain unhealthy weight. A less
calorie-dense diet with a higher nutrient to calorie ratio would be beneficial to promote
ideal weight while delivering sufficient intake of essential nutrients. Results from a life-
long study performed in dogs revealed lower disease incidence, later onset of disease,
and increased life span in calorically restricted animals. Dogs fed to maintain a lean
body condition lived an average of 13.0 years compared with 11.2 years in the heavier
control group.34 Thus, maintaining energy balance to maintain optimal body condition
should be one of the most important health goals for senior pets. In 1 study following a
colony of aging cats, body weight decreased starting about 2.5 years before end of life,
before clinical evidence of underlying disease.22 For this reason, clinicians should take
note of subtle declines in body weight and recommend appropriate diagnostics with the
goal of earlier diagnosis of an underlying medical condition. Evaluating changes in body
weight and body condition in conjunction with food intake also allows veterinarians to
investigate possible underlying disorders. Weight loss despite increased food intake
in a senior cat increases the index of suspicion for diseases such as hyperthyroidism.
Weight gain with stable caloric intake may occur in a senior dog with decreased mobility
because of osteoarthritis (OA) or certain endocrinopathies, such as hypothyroidism.
Unhealthy weight gain exacerbates several age-related conditions, including OA, so
caloric intake must be adjusted. Maintaining energy balance to maintain optimal
body condition should be one of the most important health goals for senior pets.

Water
The prevalence of dehydration in elderly humans is 20% to 30%. It is mainly secondary
to reduced thirst sensation and reduced ability to concentrate urine. Hypohydration or
chronic mild hydration in human elders is associated with frailty, morbidity, and mor-
tality.35 Mild dehydration has also been associated with impaired cognition, mood,
and pain sensation in humans.36–38 Although optimal water recommendations
for senior dogs and cats remain unknown, it is prudent to closely monitor water intake
in this population. Older pets with decreased mobility may need management modi-
fications, including an increased number of water bowls in multiple locations to facil-
itate access to clean fresh water at all times. Water intake should be monitored or
642 Churchill & Eirmann

ensured when older dogs are exercising or exposed to hot environments. Senior pets
may also be at risk of dehydration if they have subclinical renal insufficiency. When a
senior pet has a good appetite but water intake is suspect, changing to a moist food,
adding water to the food as the pet tolerates it, or considering a nutrient-enriched wa-
ter supplement to improve hydration should be considered.
Protein
Protein requirements increase with age because of increased protein turnover and
reduced protein synthesis.39,40 Healthy senior pets do not benefit from protein restric-
tion41 and may be harmed by limiting dietary protein.42,43 Insufficient or marginal pro-
tein intake contributes to sarcopenia. Thus, protein restriction of seniors could be
more detrimental than protein deficiency in younger animals.44 Although nutrition
alone does not prevent loss of LBM, providing adequate dietary protein is an essential
component to limit this loss. As a general guideline for estimating adult daily protein
needs, provide at minimum 2.55 g protein per kilogram body weight (or w 1 g protein
per pound body weight) for dogs,8,20,21 and w5 g protein per kilogram body weight
(w2 g per pound body weight) for cats.45–48 There is growing support that, like healthy
senior people, senior pets may require approximately 50% more dietary protein than
adults.49 This level of protein intake should minimize risk of protein deficiency, help
minimize loss of LBM, and should only be restricted when medically indicated.
Because of the wide variation in energy needs as pets age, protein intake should be
assessed in the context of the individual’s energy needs. For example, older dogs
generally require fewer calories, or less food, than younger dogs, whereas senior
cats may or may not need calorie adjustments to maintain healthy body weight. In gen-
eral, diets for older dogs should contain not only lower calories but a higher percent-
age of protein or a higher protein/calorie ratio in order to meet the dog’s age-related
nutritional needs. Based on the diet history, ensure that the pet is meeting daily protein
needs. Regular reassessment of MCS to monitor LBM is important in managing the
nutritional health of seniors.

WHAT IS A SENIOR PET FOOD?

Pet owners perceive that most pets, including senior dogs, are healthy and do not
require a therapeutic food,50 but they are still left with hundreds of pet foods options.
Advice and information recommending the best food is available almost anywhere,
from trainers to pet food retailers, from magazines, Internet sources, and social media.
In a survey of pet owners’ opinions about nutritional requirements of senior dogs, most
responded that senior dogs have different nutritional needs than adults, with seniors
needing fewer calories and less fat, sodium, protein, and carbohydrates.51 However,
the Association of American Feed Control Officials (AAFCO) has established nutrition
guidelines for growth, reproduction, and adult maintenance, but there is no estab-
lished nutrient profile to meet the geriatric life stage needs.52 The nutrient and caloric
content of products marketed for both senior dogs and cats is widely variable.51,53
There is a wide discrepancy between perceived needs of senior pets and actual
diet composition of products marketed for senior pets. This discrepancy makes it
even more critical for the VHCT to play an active role in providing credible nutritional
advice, especially for senior dogs and cats that have unique nutritional concerns.

NUTRITIONAL INTERVENTION OF SELECTED AGE-RELATED DISEASES

Although the most common age-related conditions in pets are best managed with a
multimodal approach combining nutritional strategies, exercise or environmental
 Senior Pet Nutrition and Management 643

enrichment, and medical management, the following discussion focuses on nutritional

management. This issue of VCNA has several chapters devoted to the nutritional man-
agement of specific disease conditions. Therefore, this article highlights nutritional
concerns of generally healthy senior pets. The following discussion focuses on comor-
bid conditions that occur commonly in aging pets and are often overlooked or dis-
missed as simply aging changes, when nutritional intervention for these conditions
can play an important role in optimizing health.

ABNORMAL BODY WEIGHT

Overweight/Obese
Hyperadiposity, the most prevalent form of malnutrition, contributes to many of the
diseases linked to obesity.54–56 However, pets that are overweight often go unrecog-
nized or may not have this health concern addressed. The canine lifespan study34
showed the benefits of maintaining a lean body condition and many negative health
consequences with as little as 25% weight gain above healthy ideal BCS (4.5–5 out
of 9). For information regarding maintaining or achieving healthy body weight, see
Megan Shepherd’s article, “Canine and Feline Obesity Management,” in this issue.
In contrast with dogs, evidence suggests cats with BCS up to 6 out of 9 may be asso-
ciated with longevity.57

Underweight
Cats greater than 12 years old more commonly experience weight loss with advancing
age and have a greater likelihood of being underweight than young adult cats.58,59
Identifying weight loss or underweight senior cats is important because underweight
cats are more likely to have a greater morbidity and mortality.57 Weight loss has
been shown to precede diagnoses of disease in cats,60,61 and early detection may
provide an opportunity for early diagnosis and nutritional or medical intervention. To
address unintentional weight loss, either increase the amount of the current food or
transition to a more calorie-dense diet.

DEGENERATIVE JOINT DISEASE

OA is common in senior cats62 and is the most prevalent joint disorder in dogs,
affecting as many 1 in 5 dogs, with OA increasing in incidence and severity with
advancing age.63 Being overweight or obese is recognized as a primary risk factor.64
Poor mobility and decreased activity are each components of a frailty score in dogs.
Increased frailty is associated with shorter time to death.65 Nutritional strategies for
improving geriatric health span and minimizing OA include weight and muscle man-
agement, and provision of omega-3 fatty acids.

Weight and Muscle Management

Correction of hyperadiposity can improve clinical signs of lameness in arthritic dogs.66
Scientific data are limited regarding cats with OA; however it is assumed, as in other
species, that obesity management is important in reducing inflammatory mediators
and pain associated with OA. Strategies to maintain healthy body weight, BCS, and
LBM and prevent sarcopenia should be prioritized for senior pets. This management
can be achieved by selecting a complete and balanced diet that supplies protein and
other nutrients while providing the number of calories to prevent excess body fat gain.
The nutritional goal is to delay onset and prevent progression of OA, maintain LBM,
and delay frailty.
644 Churchill & Eirmann

Long-Chain Omega-3 Polyunsaturated Fatty Acids

Intake of omega-3 polyunsaturated fatty acids (n-3-PUFAs) shows the greatest evi-
dence for synovial antiinflammatory effects in dogs67–69 and cats62,70 compared
with other nutraceuticals. The n-3-PUFAs eicosapentaenoic acid (EPA) and docosa-
hexaenoic acid (DHA) compete with arachidonic acid in cell membranes to yield fewer
inflammatory leukotrienes, prostaglandins, and thromboxanes, which reduce the pain
of OA. Marine oils (EPA>DHA)71 are more effective compared with shorter-chain plant-
source n-3 oils. Studies have shown the beneficial effects of supplementing n-3-
PUFAs in dogs with lameness secondary to OA.68,69,72 There is currently no standard
accepted dose of omega-3 fatty acids for dogs or cats. In dogs, a general recommen-
ded range of doses for OA is a combination of EPA and DHA of 230 to 310 mg/kg of
metabolic body weight, whereas doses of 90 to 110 mg/kg body weight were also
effective.68,69,73 In cats with OA, a diet containing 188 mg of omega-3 fatty acids/
100 kcal or a similar amount of added supplement alone improved owners’ perception
of their cats’ activity.62,70 Veterinary diets formulated to help pets with OA have
enriched concentrations of n-3-PUFA with EPA and DHA. The therapeutic joint diets
also include some combination of proteoglycan precursors (glucosamine and chon-
droitin sulfate) and antioxidants. Consumption of therapeutic diets may allow reduc-
tion in nonsteroidal antiinflammatory drug use. Note that these diets are better
suited for pets that are not significantly overweight, because the therapeutic joint diets
are not intended for weight reduction, and limiting food to achieve weight loss may not
only lead to nutrient deficiencies but may also not deliver the therapeutic level of sup-
plements. For this reason, a new generation of combination therapeutic diets formu-
lated as combination weight loss and mobility supplements are entering the market.

COGNITIVE DYSFUNCTION

As many as 20% to 68% of middle-aged to elderly dogs are thought to experience

cognitive dysfunction or behavioral changes, which can manifest in varying degrees
of mental decline74 (see Table 2). Nutraceuticals may have potential use both in pre-
vention and treatment but are best when combined with environmental enrich-
ment.75–77 Antioxidants and medium-chain triglycerides have shown promise in
helping dogs with cognitive dysfunction, as addressed in the Valarie V. Tynes and
Gary Landsberg’s article, “Nutritional Management of Behavior and Brain Disorders
in Dogs and Cats,” in this issue.

SUPPLEMENTS VERSUS ENRICHED DIETS

One caveat for the use of nutraceutical supplementation is that they have not been
adequately assessed for efficacy, optimal doses, or nutrient interactions. When
considering whether to select a diet containing the supplement or to prescribe a sup-
plement, consider the nutrient composition of the base diet. Ensure that the base diet
meets the macronutrient needs of the patient and determine whether it will provide an
adequate dose of the intended supplement when fed to meet the energy needs of the
individual pet. If not, it is prudent to select a more appropriate diet and give the
intended dose of supplement (Box 2 Provides an example of supplement dosing).

THE CONUNDRUM OF COMORBIDITIES

Making a nutritional recommendation seems straightforward when the senior pet is

healthy or has only a single problem. Challenges arise when patients present with mul-
tiple seemingly competing or conflicting comorbidities, such as overweight patients
 Senior Pet Nutrition and Management 645

Box 2
Examples of supplement dosing with enriched food versus supplement administration

Two senior 10-kg mixed-breed dogs with OA

Both dogs are at their healthy weight with a body condition of 5 out of 9
A hypothetical joint supplement (Y) has been recommended for both dogs at a standard dose
of 50 mg/kg body weight
The daily dose for each dog: 10 kg  50 mg/kg 5 500 mg of supplement Y per day
One pet food company just released a new therapeutic food formula BegoneOA. This
therapeutic dog food has a caloric density of 370 kcal/cup, which contains 75 mg supplement Y/
100 kcal.
Is it better to give each dog the Y supplement or feed a food with the Y supplement
incorporated into the formulation?
Dog A: current daily intake of 1.5 cups/d of an adult maintenance food (380 kcal/cup) for a
total of 770 kcal/d to maintain his healthy weight
The BegoneOA food fed at 770 kcal would provide:
75 mg/100 kcal  7.7[100 kcal] 5 577.5 mg of supplement Y
The food would provide an appropriate daily supplement dose for dog A.
Dog B: current daily intake is 1.5 cups/d of a healthy weight product (300 kcal/cup) for a total
of 450 kcal/d
The BegoneOA food fed at 450 kcal would provide:
75 mg/100 kcal  4.5[100 kcal] 5 337.5 mg of supplement Y
The food would not provide the 500-mg recommended daily supplement dose for dog B.
The dog should continue eating his current food and receive 500 mg of supplement Y per
day or change to the therapeutic food and supplement an additional 163 mg of
supplement Y per day to achieve the recommended dose.

with renal disease or cancer and pancreatitis. Except for obesity and OA, there is little
research in how to manage multiple problems. However, in the absence of evidence,
patients must eat. A general approach to prioritizing comorbidities is described in
Box 3. Table 3 lists typical ranges of nutrient modification to consider when managing
multiple medical conditions. For example, an overweight senior cat or dog with early
kidney disease may benefit from a modestly high-protein, lower-phosphorus diet.41
Once a diet plan is implemented, the patient is monitored to see whether the desired
effect is achieved with a repeated nutritional assessment and modifications to the plan
as necessary in an iterative process.

END-OF-LIFE CONSIDERATIONS

Nutrition and nurturing are intimately linked, and food is a primary way of caring for
pets. When the pet approaches end of life and is facing advanced stages of a progres-
sive life-limiting illness or disability, realigning nutrition goals is usually indicated. Nutri-
tion is a component of the integrated end-of-life treatment plan outlined in the 2016
AAHA/International Association for Animal Hospice and Palliative Care (IAAHPC)
End-of-Life Care Guidelines.78 Provide empathetic nonjudgmental communication
regarding nutrition with the goal of maximizing patient comfort and minimizing
suffering while supporting the caregiver. The veterinarian should assess and monitor
the patient’s hydration status, food intake, and feeding behaviors. Address underlying
causes of hyporexia or dysrexia such as nausea or discomfort when possible. Help set
expectations with the caregiver that will reduce stress for both the patient and family
during this critical time. Consider giving the pet and caregiver permission to skip a
meal or resume favorite foods that might have been discouraged in the past because
646 Churchill & Eirmann

Box 3
Nutritional prioritization process for comorbidities
There is little evidence for best practices for managing senior pets with multiple conditions or
comorbidities, but patients must eat to support their needs and support their quality of life.
One approach is to perform a nutritional triage or prioritization, considering the following el-
ements of the patient’s status:
 Consider nutrients of concern or nutritional evidence to:
 Try to meet needs for species and senior life stage
 Consider medical condition’s onset: is it acute or chronic?
 Prioritize conditions affecting clinical signs and the patient’s quality of life, and the degree or
severity.
 Prioritize medical problems next based on the prognosis and/or progressive nature of each.
 Build a key nutrient profile wish list
- Nutrient profile for management of each disease

- Consider contraindications or intolerance

 Find a balance or prioritize management of diseases

 Check Table 3 to consider key nutrient ranges desired to manage the patient’s individual
needs
 Select a therapeutic diet or seek board-certified veterinary nutritionist assistance for
homemade formulation
 Make a nutritional recommendation
 Exact product name, form, and flavor
 Specific amount to feed
 Frequency to feed
 Monitoring or follow-up plan

Table 3
Informationb for assessing products with nutrient modifications

AAFCOa
Nutrient Modification Minimum Low Moderate High
Protein: Dog (g/100 kcal) 4.5 <5 6–7 >9
Protein: Cat (g/100 kcal) 6.5 <7 7–8 >10
Fat: Dog (g/100 kcal) 1.4 <2 (ultralow) 2.5–3.5 (low) >5
Fat: Cat (g/100 kcal) 2.3 <3 4–4.5 >5
Phosphorus: Dog (mg/100 kcal) 100 <100 <150 >200
Phosphorus: Cat (mg/100 kcal) 125 <125 (ultralow) <160 (low) >200
Sodium: Dog (mg/100 kcal) 20 <70 (ultralow) <100 (low) >250
Sodium: Cat (mg/100 kcal) 50 <70 (ultralow) <100 (low) >250
Combined EPA and DHA: NA NA w10–15 >15 (wide
Dog (mg/100 kcal) variation)
Combined EPA and DHA: NA NA — 15 (wide
Cat (mg/100 kcal) variation)

Typical nutrient ranges and AAFCO minimum levels for adult canine and feline maintenance to use
as reference when selecting products with nutrient modifications to either enrich or restrict a
particular nutrient.
a
AAFCO 2020 Official Publication adult maintenance minimums.
b
There are no currently established values for low, moderate, and high nutrient ranges. The spe-
cific ranges provided in this table are based on the authors’ opinions and clinical experience with
commercially available foods.
 Senior Pet Nutrition and Management 647

of the underlying medical condition. Veterinary professionals are aware that

decreased water and food intake are often part of the normal end-of-life process.
However, caregivers may be under the impression that they just have not found the
right food the pet will eat. This false assumption can be highly stressful to both the
pet and the caregiver. Discourage force-feeding, which may lead to food aversion
and is stressful to both the pet and caregiver. Instead, reframe realistic expectations
of food intake and encourage coaxing and reassurance to both the pet and caregiver.

SUMMARY

Senior pets are increasingly becoming a sizable proportion of patients seen in primary
care. Therefore, an iterative, proactive approach to making nutrition assessments and
patient-specific recommendations to support optimal health and body condition con-
tributes to their health spans. More frequent health and nutritional screens beginning
when pets are middle aged improve disease surveillance and early detection, allowing
medical and nutritional intervention.

DISCLOSURE

Funding sources: none.

Conflicts of interest: J.A. Churchill: none. L. Eirmann: Veterinary Communications
Manager, Nestle Purina Petcare.

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