# Vet education recap: Resources for canine geriatric medicine

by Brennen McKenzie, MA, MSc, VMD

One key step in solving a problem is recognizing it as a problem. Despite being the most important single risk factor for most of the life-limiting diseases in senior dogs, aging is still too often seen as an inevitable and immutable fact of life.

In a recent webinar on the VetGirl continuing education platform, called [Aging in the Dog: Foundations of Canine Geriatric Medicine](https://vetgirlontherun.com/webinars/march-16-2023-aging-in-the-dog-foundations-of-canine-geriatric-medicine/), I challenged this view of aging. As an alternative, I encouraged vets and veterinary technicians to think of aging as a modifiable risk factor for disease — just another aspect of canine biology that we can study, understand, and eventually learn to change to extend lifespan and healthspan in dogs.

The course introduces students to the fundamental principles of canine aging: how and why dogs age; when a dog should be considered geriatric; and what interventions are available now to extend lifespan and healthspan in companion dogs as well as what tools might be available in the future. The course also presents a systematic approach to assessing and managing common age-associated diseases and clinical problems.

In building this course, I created a resource list for veterinarians. This list includes foundational material on aging in general, clinical assessment tools to help vets identify aging-related problems in their patients, and clinical practice guidelines to make our treatment plans more systematic and evidence-based.

I always like to make such materials available as widely as possible to support all veterinary professionals and dog owners in their efforts to give their patients and pets the healthiest happiest life possible. This is not an exhaustive list, but it contains a lot of the core concepts and information needed to begin approaching aging in our dogs as a solvable problem. Enjoy!

## Resources for veterinarians

### 1. Aging science publications

- Azkona G, García-Belenguer S, Chacón G, Rosado B, León M, Palacio J. Prevalence and risk factors of behavioural changes associated with age-related cognitive impairment in geriatric dogs. J Small Anim Pract. 2009;50(2):87-91. DOI: [10.1111/j.1748-5827.2008.00718.x](https://doi.org/10.1111/j.1748-5827.2008.00718.x)

- Belshaw Z, Dean R, Asher L. Slower, shorter, sadder: A qualitative study exploring how dog walks change when the canine participant develops osteoarthritis. BMC Vet Res. 2020;16(1):1-8. DOI: [10.1186/s12917-020-02293-8](https://doi.org/10.1186/s12917-020-02293-8)

- Bray EE, Raichlen DA, Forsyth KK, Promislow DEL, Alexander GE, MacLean EL; Dog Aging Project Consortium. Associations between physical activity and cognitive dysfunction in older companion dogs: results from the Dog Aging Project. Geroscience. 2023;45(2):645-661. DOI: [10.1007/s11357-022-00655-8](https://doi.org/10.1007/s11357-022-00655-8)

- Britton K, Galioto R, Tremont G, Chapman K, Hogue O, Carlson MD, Spitznagel MB. Caregiving for a Companion Animal Compared to a Family Member: Burden and Positive Experiences in Caregivers. Front Vet Sci. 2018;5:325. DOI: [10.3389/fvets.2018.00325](https://doi.org/10.3389%2Ffvets.2018.00325)

- Christiansen SB, Kristensen AT, Sandøe P, Lassen J. Looking after chronically ill dogs: Impacts on the caregiver’s life. Anthrozoos. 2013;26(4):519-533. DOI: [10.2752/175303713X13795775536174](https://doi.org/10.2752/175303713X13795775536174)

- Cole A. Grow Old along with me: the Meaning of Dogs in Seniors’ Lives. Int J Community Well-Being. 2019;2(3-4):235-252. DOI: [10.1007/s42413-019-00034-w](https://doi.org/10.1007/s42413-019-00034-w)

- Fefer G, Khan MZ, Panek WK, et al. Relationship between hearing, cognitive function, and quality of life in aging companion dogs. J Vet Intern Med. 2022;36(5):1708-1718. DOI: [10.1111/jvim.16510](https://doi.org/10.1111/jvim.16510)

- Gardner M, McVety D. Treatment and Care of the Geriatric Veterinary Patient. John Wiley & Sons. Hoboken. 2017. DOI: [10.1002/9781119187240](https://onlinelibrary.wiley.com/doi/book/10.1002/9781119187240)

- Hoffman JM, Creevy KE, Franks A, O’Neill DG, Promislow DEL. The companion dog as a model for human aging and mortality. Aging Cell. 2018;17(3). DOI: [10.1111/acel.12737](https://doi.org/10.1111/acel.12737)

- Kealy RD, Lawler DF, Ballam JM, et al. Effects of diet restriction on life span and age-related changes in dogs. J Am Vet Med Assoc. 2002;220(9):1315-1320. DOI: [10.2460/javma.2002.220.1315](https://doi.org/10.2460/javma.2002.220.1315)

- Knobel DL, Arega S, Reininghaus B, Simpson GJG, Gessner BD, Stryhn H, Conan A. Rabies vaccine is associated with decreased all-cause mortality in dogs. Vaccine. 2017 5;35(31):3844-3849. DOI: [10.1016/j.vaccine.2017.05.095](https://doi.org/10.1016/j.vaccine.2017.05.095)

- Landsberg G, Araujo JA. Behavior problems in geriatric pets. Vet Clin North Am – Small Anim Pract. 2005;35(3):675-698. DOI: [10.1016/j.cvsm.2004.12.008](https://doi.org/10.1016/j.cvsm.2004.12.008)

- Landsberg GM, Nichol J, Araujo JA. Cognitive Dysfunction Syndrome. A Disease of Canine and Feline Brain Aging. Vet Clin North Am – Small Anim Pract. 2012;42(4):749-768. DOI: [10.1016/j.cvsm.2012.04.003](https://doi.org/10.1016/j.cvsm.2012.04.003)

- Larsen JA, Farcas A. Nutrition of aging dogs. Vet Clin North Am – Small Anim Pract. 2014;44(4):741-759. DOI: [10.1016/j.cvsm.2014.03.003](https://doi.org/10.1016/j.cvsm.2014.03.003)

- Lawler DF, Larson BT, Ballam JM, et al. Diet restriction and ageing in the dog: major observations over two decades. Br J Nutr. 2008;99(4):793-805. DOI: [10.1017/S0007114507871686](https://doi.org/10.1017/s0007114507871686)

- López-Otín C, Blasco MA, Partridge L, Serrano M, Kroemer G. Hallmarks of aging: An expanding universe. Cell. 2023;186(2):243-278. DOI: [10.1016/j.cell.2022.11.001](https://doi.org/10.1016/j.cell.2022.11.001)

- McKenzie BA, Chen FL. Assessment and Management of Declining Physical Function in Aging Dogs. Top Companion Anim Med. 2022 Oct 21;51:100732. DOI: [10.1016/j.tcam.2022.100732](https://doi.org/10.1016/j.tcam.2022.100732)

- McKenzie, BA. Lacroix-Fralish, ML. Chen, F. The phenotype of aging in the dog: How aging impacts the health and wellbeing of dogs and their caregivers. J Amer Vet Med Assoc. 2022;260(9):963-970. DOI: [10.2460/javma.22.02.0088](https://doi.org/10.2460/javma.22.02.0088)

- McKenzie, BA. Comparative Veterinary Geroscience: Mechanism of molecular, cellular, and tissue aging in humans, laboratory animal models, and companion dogs and cats. Amer J Vet Res. 2022;83(6). DOI: [10.2460/ajvr.22.02.0027](https://doi.org/10.2460/ajvr.22.02.0027)

- McKenzie, BA. Chen, FL. Gruen, ME. Olby, NJ. Canine Geriatric Syndrome: A Framework for Advancing Research in Veterinary Geroscience. Front Vet Sci. 2022;21(9):853743. DOI: [10.3389/fvets.2022.853743](https://doi.org/10.3389/fvets.2022.853743)

- Mark A. Oyama, Lindsey Citron, Justine Shults, Dorothy Cimino Brown, James A. Serpell & John T. Farrar (2017) Measuring Quality of Life in Owners of Companion Dogs: Development and Validation of a Dog Owner-specific Quality of Life Questionnaire, Anthrozoös, 30:1, 61-75. DOI: [10.1080/08927936.2016.1228774](https://doi.org/10.1080/08927936.2016.1228774)

- Park R, Royal K. A national survey of companion animal owners’ self-reported methods of coping following euthanasia. Vet Sci. 2020;7(7). DOI: [10.3390/vetsci7030089](https://doi.org/10.3390/vetsci7030089)

- Salt C, Morris PJ, Wilson D, Lund EM, German AJ. Association between life span and body condition in neutered client-owned dogs. J Vet Intern Med. 2019;33(1):89-99. DOI: [10.1111/jvim.15367](https://doi.org/10.1111/jvim.15367)

- Salvin HE, McGreevy PD, Sachdev PS, Valenzuela MJ. Growing old gracefully-Behavioral changes associated with “successful aging” in the dog, Canis familiaris. J Vet Behav Clin Appl Res. 2011;6(6):313-320. DOI: [10.1016/j.jveb.2011.04.004](https://doi.org/10.1016/j.jveb.2011.04.004)

- Sándor S, Kubinyi E. Genetic Pathways of Aging and Their Relevance in the Dog as a Natural Model of Human Aging. Front Genet. 2019;10. DOI: [10.3389/fgene.2019.00948](https://doi.org/10.3389/fgene.2019.00948)

- Shaevitz MH, Tullius JA, Callahan RT, Fulkerson CM, Spitznagel MB. Early caregiver burden in owners of pets with suspected cancer: Owner psychosocial outcomes, communication behavior, and treatment factors. J Vet Intern Med. 2020;34(6):2636-2644. DOI: [10.1111/jvim.15905](https://doi.org/10.1111%2Fjvim.15905)

- Spitznagel MB, Jacobson DM, Cox MD, Carlson MD. Caregiver burden in owners of a sick companion animal: a cross-sectional observational study. Vet Rec. 2017;181(12):321. DOI: [10.1136/vr.104295](https://doi.org/10.1136/vr.104295)

- Szabó D, Gee NR, Miklósi Á. Natural or pathologic? Discrepancies in the study of behavioral and cognitive signs in aging family dogs. J Vet Behav. 2016;11:86-98. DOI: [10.1016/j.jveb.2015.08.003](https://doi.org/10.1016/j.jveb.2015.08.003)

- Thompson MJ, von Holdt B, Horvath S, Pellegrini M. An epigenetic aging clock for dogs and wolves. Aging (Albany NY). 2017;9(3):1055-1068. DOI: [10.18632/aging.101211](https://doi.org/10.18632/aging.101211)

- Tran L, Crane MF, Phillips JK. The distinct role of performing euthanasia on depression and suicide in veterinarians. J Occup Health Psychol. 2014;19(2):123-132. DOI: [10.1037/a0035837](https://doi.org/10.1037/a0035837)

- Urfer SR, Wang M, Yang M, Lund EM, Lefebvre SL. Risk Factors Associated with Lifespan in Pet Dogs Evaluated in Primary Care Veterinary Hospitals. J Am Anim Hosp Assoc. 2019;55(3):130-137. DOI: [10.5326/JAAHA-MS-6763](https://doi.org/10.5326/jaaha-ms-6763)

- Urfer SR, Kaeberlein M, Promislow DEL, et al. Lifespan of companion dogs seen in three independent primary care veterinary clinics in the United States. Canine Med Genet. 2020;7(7). DOI: [10.1186/s40575-020-00086-8](https://doi.org/10.1186/s40575-020-00086-8)

### 2. Rational diagnostic testing

- McKenzie, BA. Rational use of diagnostic and screening tests. J Sm Anim Pract. 2021;62(11):1016-2. DOI: [10.1111/jsap.13393](https://doi.org/10.1111/jsap.13393)

- McKenzie, BA. Overdiagnosis. J Amer Vet Med Assoc. 2016;249(8):884-889. DOI: [10.2460/javma.249.8.884](https://doi.org/10.2460/javma.249.8.884)

- McKenzie, BA. Veterinary clinical decision-making: cognitive biases, external constraints, and strategies for improvement. J Amer Vet Med Assoc. 2014;244(3):271-276. DOI: [10.2460/javma.244.3.271](https://doi.org/10.2460/javma.244.3.271)

### 3. Assessment tools

- Banzato T, Franzo G, Di Maggio R, et al. A Frailty Index based on clinical data to quantify mortality risk in dogs. Sci Rep. 2019;9(1):16749. DOI: [10.1038/s41598-019-52585-9](https://doi.org/10.1038/s41598-019-52585-9)

- Belshaw Z, Asher L, Harvey ND, Dean RS. Quality of life assessment in domestic dogs: An evidence-based rapid review. Vet J. 2015;206(2):203-212. DOI: [10.1016/j.tvjl.2015.07.016](https://doi.org/10.1016/j.tvjl.2015.07.016)

- Brown DC. The Canine Orthopedic Index. Step 1: Devising the items. Vet Surg. 2014 Mar;43(3):232-40. DOI: [10.1111/j.1532-950X.2014.12142.x](https://doi.org/10.1111/j.1532-950x.2014.12142.x)

- Brown DC. The Canine Orthopedic Index. Step 2: Psychometric testing. Vet Surg. 2014 Mar;43(3):241-6. DOI: [10.1111/j.1532-950X.2014.12141.x](https://doi.org/10.1111/j.1532-950x.2014.12141.x)

- Brown DC. The Canine Orthopedic Index. Step 3: Responsiveness testing. Vet Surg. 2014 Mar;43(3):247-54. DOI: [10.1111/j.1532-950X.2014.12162.x](https://doi.org/10.1111/j.1532-950x.2014.12162.x)

- Cachon, T. et al. (2018) ‘Face validity of a proposed tool for staging canine osteoarthritis: Canine OsteoArthritis Staging Tool (COAST)’, Vet J. 235, pp. 1-8. DOI: [10.1016/j.tvjl.2018.02.017](https://doi.org/10.1016/j.tvjl.2018.02.017)

- Chen FL, Ullal TV, Graves Jl, Ratcliff ER, Naka A, McKenzie BA, Carttar TA, Super KM, Austriaco J, Weber SY, LaCroix-Fralish ML, Vaughn J. Evaluating instruments for assessing healthspan: a multi-center cross-sectional study on health-related quality of life (HRQL) and frailty in the companion dog. Geroscience. 2023 Feb 13. DOI: [10.1007/s11357-023-00744-2](https://doi.org/10.1007/s11357-023-00744-2).

- Freeman LM, Michel KE, Zanghi BM, Vester Boler BM, Fages J. Evaluation of the use of muscle condition score and ultrasonographic measurements for assessment of muscle mass in dogs. Am J Vet Res. 2019;80(6):595-600. DOI: [10.2460/ajvr.80.6.595](https://doi.org/10.2460/ajvr.80.6.595)

- Freeman LM, Rush JE, Farabaugh AE, Must A. Development and evaluation of a questionnaire for assessing health-related quality of life in dogs with cardiac disease. J Am Vet Med Assoc. 2005 Jun 1;226(11):1864-8. DOI: [10.2460/javma.2005.226.1864](https://doi.org/10.2460/javma.2005.226.1864)

- Fulmer AE, Laven LJ, Hill KE. Quality of Life Measurement in Dogs and Cats: A Scoping Review of Generic Tools. Animals (Basel). 2022;12(3):400. DOI: [10.3390/ani12030400](https://doi.org/10.3390/ani12030400)

- Hielm-Björkman AK, Rita H, Tulamo RM. Psychometric testing of the Helsinki chronic pain index by completion of a questionnaire in Finnish by owners of dogs with chronic signs of pain caused by osteoarthritis. Am J Vet Res. 2009;70(6):727-34. DOI: [10.2460/ajvr.70.6.727](https://doi.org/10.2460/ajvr.70.6.727)

- Hua J, Hoummady S, Muller C, et al. Assessment of frailty in aged dogs. Am J Vet Res. 2016;77(12).

- Hutchinson D, Sutherland-Smith J, Watson AL, Freeman LM. Assessment of methods of evaluating sarcopenia in old dogs. Am J Vet Res. 2012;73(11):1794-1800. DOI: [10.2460/ajvr.77.12.1357](https://doi.org/10.2460/ajvr.77.12.1357)

- Lemaréchal R, Hoummady S, Barthélémy I. Canine Model of Human Frailty: Adaptation of a Frailty Phenotype in Older Dogs. J Gerontol. 2023;Series A: glad006. DOI: [10.1093/gerona/glad006](https://doi.org/10.1093/gerona/glad006)

- Madari A, et al. (2015) ‘Assessment of severity and progression of canine cognitive dysfunction syndrome using the CAnine DEmentia Scale (CADES)’, Applied Animal Behaviour Science. Elsevier, 171, pp. 138-145. DOI: [10.1016/j.applanim.2015.08.034](https://doi.org/10.1016/j.applanim.2015.08.034)

- Salvin HE, McGreevy PD, Sachdev PS, Valenzuela MJ. The canine cognitive dysfunction rating scale (CCDR): A data-driven and ecologically relevant assessment tool. Vet J. 2011;188(3):331-336. DOI: [10.1016/j.tvjl.2010.05.014](https://doi.org/10.1016/j.tvjl.2010.05.014)

- Schmutz A, Spofford N, Burghardt W, De Meyer G. Development and initial validation of a dog quality of life instrument. Sci Rep. 2022;12(1):12225. DOI: [10.1038/s41598-022-16315-y](https://doi.org/10.1038/s41598-022-16315-y)

- Walton, M. B. et al. (2013) ‘Evaluation of Construct and Criterion Validity for the “Liverpool Osteoarthritis in Dogs” (LOAD) Clinical Metrology Instrument and Comparison to Two Other Instruments’, PLOS ONE. Public Library of Science, 8(3), p. e58125. DOI: [10.1371/journal.pone.0058125](https://doi.org/10.1371%2Fjournal.pone.0058125)

- Wojciechowska JI, Hewson CJ. Quality-of-life assessment in pet dogs. J Am Vet Med Assoc. 2005;226(5):722-728. DOI: [10.2460/javma.2005.226.722](https://doi.org/10.2460/javma.2005.226.722)

### 4. Clinical practice guidelines

- [AAHA Guidelines](https://www.aaha.org/aaha-guidelines/what-are-aaha-guidelines/), including:
  - [Senior Care](https://www.aaha.org/globalassets/02-guidelines/2023-aaha-senior-care-guidelines-for-dogs-and-cats/resources/2023-aaha-senior-care-guidelines-for-dogs-and-cats.pdf)
  - [Canine Life Stages](https://www.aaha.org/globalassets/02-guidelines/canine-life-stage-2019/2019-aaha-canine-life-stage-guidelines-final.pdf)
  - [Pain Management](https://www.aaha.org/globalassets/02-guidelines/2022-pain-management/resources/2022-aaha-pain-management-guidelines-for-dog-and-cats_updated_060622.pdf)
  - [Oncology](https://www.aaha.org/globalassets/02-guidelines/oncology/2016_aaha_oncology_guidelines_for_dogs_and_cats.pdf)
  - [End-of-Life Care](https://www.aaha.org/globalassets/02-guidelines/end-of-life-care/2016_aaha_iaahpc_eolc_guidelines.pdf)

- ACVIM Consensus Statements, including:
  - [MMVD](https://onlinelibrary.wiley.com/doi/10.1111/jvim.15488)
  - [Chronic Hepatitis](https://onlinelibrary.wiley.com/doi/10.1111/jvim.15467)
  - [Pulmonary Hypertension](https://onlinelibrary.wiley.com/doi/10.1111/jvim.15725)
  - [Rational Use of Gastroprotectants](https://onlinelibrary.wiley.com/doi/10.1111/jvim.15337)
  - [Seizure Management](https://onlinelibrary.wiley.com/doi/full/10.1111/jvim.13841)

- International Renal Interest Society (IRIS) [Guideline for Chronic Kidney Disease](http://www.iris-kidney.com/guidelines/staging.html)
- International Society for Companion Animal Infectious Disease [(ISCAID) Guidelines](https://www.iscaid.org/guidelines), including:
  - [UTI](https://www.sciencedirect.com/science/article/pii/S109002331830460X?via%3Dihub)
  - [Respiratory Infections](https://onlinelibrary.wiley.com/doi/10.1111/jvim.14627)