AAFP–AAHA: Feline Life Stage Guidelines

How Frequent?

The panel supports the recommendations of the American Association of Feline Practitioners (AAFP) and American Animal Hospital Association (AAHA) that a minimum of annual wellness examinations and consultations for all cats is justifiable. More frequent examinations may be recommended for seniors and geriatrics, and cats with medical and behavioral conditions.

Semi-annual wellness exams are often recommended for all feline life stages by veterinarians and veterinary organizations. Their reasoning includes the fact that changes in health status may occur in a short period of time; that ill cats often show no signs of disease; and that earlier detection of ill health, body weight changes, dental disease, and so on, allows for earlier intervention. In addition, semi-annual exams allow for more frequent communication with the owner regarding behavioral and attitudinal changes, and education about preventive health care. Further research is needed to identify the optimal examination schedule to maximize the health and longevity of the cat.

The panel members concluded that preventive veterinary care can improve quality of life, detect illness earlier and, therefore, reduce the long term expenses associated with a cat’s health care. They believe that cat owners are willing to seek more veterinary care when it improves quality of life and detects illnesses earlier, thereby reducing the long term expenses associated with their cat’s health care. Improved client communication and education of the benefits of regular veterinary care are essential to achieve that goal (Fig. 1).

The reasons pet owners have cited for not seeking care were that they did not know it was necessary, the veterinarian did not recommend it, and the need or benefit was not well explained.⁷ Other obstacles include the cat’s stress or fear associated with veterinary visits and the practical difficulties of transporting cats to receive veterinary care. Suggestions for overcoming such barriers are provided on page 77.

History-taking

It is not the intent of the panel to reiterate the basics of the veterinary visit, but instead to offer a checklist to assist the veterinarian (see Table 1). Where relevant, aspects of feline behavior, nutrition, and various disease prevention and detection strategies are expanded on in the text.

History-taking includes the use of open-ended questioning (eg, ‘How has [cat’s name] been doing since the last visit?’).⁸ This approach is often combined with a template or checklist, such as given in Table 1, to ensure important aspects are not overlooked.

Physical Examination

When performing the physical exam, particular attention should be paid to:

• Observing the cat from a distance to assess breathing patterns, gait, stance, strength, coordination and vision.

• Changes in parameters from prior exams (body weight, body condition score [BCS], vital signs).

• Other specifics as noted in the discussion/action items in Table 1.

The Minimum Database

Although specific data documenting benefits are not available, the panel concluded that regular wellness examinations and collection of the minimum database (MDB; Table 2) can be valuable, allowing early detection of disease or trends in clinical or laboratory parameters that may be of concern. Additionally, it provides a baseline for interpretation of data recorded at subsequent visits.

Specific recommendations about age and frequency of laboratory testing depend on many factors.^5,18,24 One consideration in determining this frequency is that the incidence of many diseases increases as cats age. Guidelines for management of mature, senior and geriatric cats may be found in the AAFP Senior Guidelines.⁵ Retroviral testing is discussed in detail in the AAFP Retrovirus Testing Guidelines.²² Measurement of blood pressure is discussed in detail in the ACVIM guidelines.²⁵ Although limited incidence studies have been performed to identify the age of onset of hyperthyroidism in cats, the panel recommends that veterinarians strongly consider T4 testing in the apparently healthy mature cat. More robust incidence data is needed to develop firmer recommendations.

Diet Basics

Energy and nutrient needs vary with life stage, sterilization status and activity, and so general feeding recommendations provide only a starting point. Individual intakes must then be adjusted to maintain the desired weight and body condition score (Fig. 2).

Satisfactory diets for cats contain all the required nutrients in proper balance, are palatable and digestible, and are free of spoilage and contaminants. The specific source of nutrients in feline diets is irrelevant when these criteria are satisfied.²⁶ Both canned and dry food have been found to support health during all life stages.²⁷ The presence of a label guarantee that the food was tested using feeding trials provides the current best initial evidence that a diet is satisfactory.

The panel examined published peer-reviewed evidence-based studies in healthy, client-owned cats for any significant health effect of: feeding canned versus dry food (including contribution to dental health); providing a variety of foods versus a consistent diet; feeding high protein, low carbohydrate versus lower calorie and high fiber diets; feeding raw diets; providing dietary supplements, or access to grass or plants. Based on the available data, specific recommendations in favor of any of these practices cannot be made.

Despite the concern surrounding the effects of carbohydrate in dry foods, current evidence suggests that housing and activity (which may be a marker of welfare)²⁸ are more significant predictors of health.^29–32 Evidence does not support the carbohydrate content of foods as being harmful or an independent risk factor for diseases such as obesity or diabetes.^29,33

With regard to home-made foods, the veterinarian should discuss and share evidence about nutritional balance, risks associated with preparation and feeding of foods raw, and advantages of using food formulated for cats, referring clients to additional resources if required (Table 3).

Feeding Regimens

A variety of feeding styles can maintain good health in client-owned cats, including free choice or provision of meals. In addition to monitoring intake, considerations include:

• Providing water via bowls, dripping faucets and/or fountains, to promote adequate intake. When increased water intake is desirable, feeding of canned foods may help achieve this.

• Locating food in a quiet area, especially for nervous or fearful cats (eg, away from other animals or household items that may make noises intermittently).³⁴

• Offering dry foods in foraging devices (eg, food balls or puzzles),³⁵ and in multiple small meals in several widely dispersed bowls to slow intake and increase mental and physical activity.

Weight Management

Obesity may occur at any age, but is most commonly encountered in middle age.^32,36 The risk of obesity may be reduced by environmental enrichment, increasing opportunities for activity, and individualizing food intake. The energy density of cat foods varies widely, based on the moisture and fat content of the diet. This information should be helpful in determining a guideline of how much to feed.

Tips and items for discussion with clients include:

• Slowly (<10% increments and decrements) adjust calorie intake to life stage and conditions (eg, sterilization, indoor housing).

• Provide environmental enrichment to increase activity.³⁵

• Switch to a diet with lower energy density (reduced fat, increased air, fiber and/or moisture).

• Change the feeding strategy.

• Switch to meal feeding, with portion control.

• Introduce foraging devices (see above).

• Introduce barriers to food access (eg, baby gates, elevated feeding stations).

All Ages

• Provide plentiful resources – hiding spots, elevated resting spots, food, water, scratching posts and litter boxes –throughout the home, particularly for cats kept indoors and in multi-cat households (Fig. 3).

• Controversy exists over whether cats should be kept indoors-only or in an indoor/outdoor environment (see box on page 82). These debates reflect geographical and cultural differences, as well as individual owner preferences.^30,37–41 They underline the importance of providing an appropriate and stimulating environment for the cat.³⁵

Kitten

• Play: Kittens have a high play drive; inter-cat social play peaks at about 12 weeks of age,⁴⁵ then object play becomes prevalent. Toys offer an outlet for normal predatory sequences as part of play, and help prevent play biting.

• Litter boxes: Litter box set-up and cleaning is critical for box usage. Although individual preferences can vary, most cats prefer clumping litter⁴⁶ and a clean box in an accessible but not busy location. Initially, kittens can be simultaneously offered a variety of litter box options to permit them to express personal preference through usage. Some cats may find scented litters aversive.⁴⁷

• Socialization/handling: Kittens should be gradually and positively acclimated as early as possible to any stimuli or handling techniques that owners plan them to encounter during their lifetime (eg, children, dogs, nail trims, tooth and coat brushing, car transport). This can be accomplished with food or other appropriate rewards, avoiding interactive punishment as it may elicit defensive aggression.

Junior

• Inter-cat relations: The reduction in social play combined with the dispersal effect (when free-living offspring leave the family unit at about 1–2 years of age) means that inter-cat aggression may develop at this stage of life.

• Litter boxes and elimination: Litter box rejection can stem from a variety of causes including litter type, box cleaning, box style, and box size. Cats have shown a tendency to prefer larger boxes.^48,49

• Urine marking: Most intact cats and about 10% of sterilized cats mark their territory with urine.⁵⁰ The onset of this behavior can coincide with sexual maturity.

Adult and Mature

• Play: Declining play activity increases susceptibility to weight gain. In one study, three 10–15 min exercise sessions per day caused a loss of approximately 1% of body weight in 1 month with no food intake restrictions.⁵¹

Senior and Geriatric

• Senior and geriatric cats exhibiting behavioral changes (eg, vocalization, changes in litter box usage) should always be evaluated for an underlying medical problem.⁵

Kittens

• Because prenatal infection does not occur in kittens, roundworm treatment given every 2 weeks can start at 3 weeks of age. Kittens may begin receiving a monthly general endoparasite preventive at 8–9 weeks of age.²⁰

All Life Stages

• Feces testing allows monitoring of compliance with preventive medication as well as diagnosis of some endoparasites not treated by broad-spectrum preventives.

• Heartworm presents a risk at all life stages in endemic areas.⁵² Some points of note are listed in the box on page 82; additional details may be found on the websites of the CAPC and American Heartworm Society (see Table 3).