Too old for treatment? Aging pets and medical decision-making
Posted Sep 26 2008 3:18pm
This is a tough one. And it’s a biggie. How old an animal happens to be makes a huge difference for how the pet’s medical condition is interpreted and assessed as well as for how diagnostic and treatment resources are allocated. But is that fair?
Owners, veterinarians, family, friends and society at large are all responsible for how we see our aging pets. Creaky, rickety older guys are part of all our history. We know that older animals start acting sluggish and slow and that they’re more likely to suffer disease. But does that mean they don’t deserve to be treated for these simply because it’s what we expect?
Take a three year-old cat with a urinary obstruction versus an otherwise healthy ten year old in the same predicament: Owners and veterinarians alike are more likely to treat the former case with more optimism and positive-minded aggressiveness. And there are two reasons for that:
1-Older animals are more likely to suffer from more complex underlying factors such as tumors and already compromised kidneys. And…
2-Young ones are perceived to have “their lifetimes ahead of them.”
To these points I’ll offer two corresponding rebuttals:
1-We can’t possibly make assumptions about underlying health concerns (in either case) until we take a closer look. Both animals deserve the same level of care until the basics can be assessed and decisions can be made about choosing to proceed. And yet our human biases always manage to rear their ugly heads, even if we think they don’t.
2- Don’t none of us know how long we have.
This latter one is the more insidious issue. I like to call it the “lifetime factor.” Pets under five get the biggest boost from this bias while ones over ten get the most flak from it.
Our human perception of their “time left on Earth” pervades all discussions in these older pets, as if whether we treat them to relieve their pain or discomfort should have everything to do with whether they have ten, five, two years or one month left to live.
Sure, it’s a factor in which treatment options we choose. But this factor is often exaggerated out of proportion to reality based on how we as humans perceive the importance of animals relative to their ages.
Here are some examples from this past week’s work:
Hips on the fritz
I have two canine patients with severe, end-stage hip dysplasia. One is a nine year-old Rottweiler. The other is a twelve year-old Golden retriever. Both need hip replacements. Both sets of owners have the same concern: “Is it worth it considering how old he/she is?”
Well, when did you expect a hip replacement would be most necessary? For most dogs, salvage procedures like hip replacements come due after much wear and tear. It’s only the minority of extremely afflicted pets that require earlier intervention. And yet, come ten years of age, many pet owners are thinking sunset years = no cost-effectiveness for a $3,500 procedure (per hip).
But if not now, what’s to happen with those hips? Two or three more years of creaking around (in an otherwise healthy dog)?
Them: “But what if she gets cancer next year?”
Me: “And what if a bus hits her tomorrow?”
The hyperthyroid cat
Here’s another common one I confront: The hyperthyroid cat who happens to be ten…or fifteen…or seventeen-plus.
Owners often decline the gold standard I-131 treatment (a one dose treatment of intravenous radioactive material) for these emaciated cats with vigorous, speedy-metabolism appetites. Sometimes it’s a money issue—but more often it’s age concerns that seal the deal. “But she’s so old!”
Whatever the case, it helps to do the math: An average of $50 a month for the rest of your cat’s life with frequent bloodwork and daily medication and continued disease or…a $1,200-$1,500 one-time cure?
Even if she only lives a year, isn’t a one-time, complete cure worth it?
Apparently not if she’s fifteen. That seems to be the magic age for most of my clients. Though that’s the most popular age for hyperthyroid diagnoses (hyperthyroidism happens almost exclusively to geriatric cats), most draw the line at treating a fifteen year-old with an expensive approach.
Now, I understand that there’s a lot more going on than just an animal’s age—especially when you consider what it costs to treat these conditions in the “best” way possible. But it’s age that often becomes the excuse. As in, “I don’t want to put her through it at her age.”
And I’m of the opinion that this assessment's not fair. Not in cases like the ones I’ve presented. Not in the case of most cancer treatments and dental therapies, either.
Our responsibility to our animals does not decline with advancing age any more than it does for our aged parents and grandparents. Now, if we’re talking about unnecessarily prolonging suffering through feeding tubes and painful, invasive measures…I’m right there with you.
But when age is used as a rationale for declining treatments that could make the difference between comfort or cures and pain or disease…I don't buy it.