When to say goodbye to your older cat

Knowing when to say goodbye to your beloved pet is a very difficult and very personal decision to make. Despite all the advances in modern veterinary medicine, time will catch us all and our pets will eventually pass away too. Ensuring they have a dignified passing to prevent suffering, is a difficult but important part of being a responsible pet owner. While some pets will pass quickly and peacefully at home, based on my experience as a veterinarian these are the minority. Some pets that are not euthanised can experience immense suffering and pain at the end of their lifetime, which is why we offer them a dignified and humane passing free of the suffering associated with some natural deaths. Knowing when to make this decision can be difficult and there is no specific formula because each pet and each situation is unique.

    I have put together a guide to help consider the quality of life your pet is experiencing based on you and your pet’s situation by thinking about the following questions. They are to provide guidance in helping you make the right decision for you and your pet.

Pain
    Assessing how much pain your cat is in can be very difficult. Most cats do not show obvious signs of pain until they are suffering significantly so it is important to keep an eye out for more subtle signs. You may notice that they:
- Can’t jump up onto furniture anymore
- Can no longer groom themselves properly (especially around their back end)
- Seem to not want to get up unless they have to
- Appear stiff when they first get up after a long sleep
- Spend more time hiding
- Toilet just outside the litter tray (because it hurts to climb over the edge)
- Seem more irritable and do not like to be stroked in certain spots or
- They just want to be left alone.

These can all be signs of pain.

    You may also notice that your cat is no longer eating well despite being interested in food. If you notice that they come up to the food and sniff at it, but then will only lick the gravy or do not eat any hard biscuits they may have significant oral pain from dental disease or mouth ulcers.

    If you feel that your pet may be in pain it is best to see your veterinarian to determine if they truly are in pain, what the cause is and what can be done to help your pet.

It is also important to ask two questions about the pain:
Can it be controlled with medication or a medical procedure?
Is it a temporary state or will it keep getting worse over time?

    If the pain cannot be controlled through medication or a procedure, this will be reducing your pet’s quality of life. If you notice that with medication your pet improves a lot then it is important to continue to monitor their pain levels in case their condition deteriorates. Don’t forget that there are many different types of pain relief medication available for your pet so you may need to trial a few different combinations to get the right regime for your pet. Your veterinarian can help you with this so it is important to let them know if it is not working well. Cats process medications differently to humans so never give your cat any human pain relief unless expressly told it is safe by your veterinarian. Many human pain relief medications are fatal if given to cats.

    It is also important to consider if the pain your pet feels is likely to be short term (eg they have dental disease which your veterinarian will fix with a dental procedure) or if it is likely to continue to get worse over time (eg severe osteoarthritis). If it is a condition that will worsen over time it is even more important to ensure that their pain is well controlled as they are going to have an overall decline from now on.

Eating
    Your cat’s eating habits can give you some clues as to when they are unwell. As discussed above if they seem interested in food but then don’t eat much or will only lick up the gravy from wet food they may have oral pain from dental disease or mouth ulcers. But there can be other clues to indicate that something else may be wrong too.
    
    Cats will often go off their food if they are feeling unwell. If you notice that your cat isn’t as interested in food as they used to be or that they are off their food altogether you should follow up on this to see if there is a medical reason. Problems commonly associated with inappetence in cats include cat flu, renal disease, pancreatitis, cancers, parasite burden, high fever, sepsis and anaemia just to name a few. There are also many other causes, but this demonstrates why even a trained professional such as your veterinarian may wish to perform further diagnostics such as blood testing or an ultrasound as many medical conditions may initially present in a similar fashion. This will allow them to work up a differential diagnoses list so they can start treating your pet as required.

    Some conditions will be treatable and your veterinarian will have your cat feeling well again with the right treatment. Other conditions may not respond as well to treatment or they may be progressively degenerative. If your pet has a condition that cannot be cured or controlled, it is important to assess their quality of life and consider their level of comfort regularly.

    Finally, some cats may seem ravenously hungry all the time. This may be a sign of a medical condition, especially in older cats where the incidence of hyperthyroidism is higher. These cats are often hungry all the time but continue to lose weight. If you feel that your cat may be eating excessively and seems ravenously hungry you should see your veterinarian who can do a blood test to check if this may be the case. Hyperthyroidism has multiple treatment options which can be discussed with your veterinarian.

Toileting
    Cats’ toileting habits can be difficult to assess if your cat toilets outside, but sometimes it can be more obvious. Common problems include constipation, inappropriate urination (eg urinating on bathmats, clothing etc) and faecal incontinence.

    Constipation in older cats can be a straightforward one-off episode, or it can also be a sign  of something more chronic going on. They may have a condition known as megacolon or they may have severe arthritic changes in their spinal column which is impairing nerve function to the colon and rectum preventing them from passing or controlling motions. In severe cases, the nerve function can be impaired to such a degree that your cat may experience faecal incontinence. As the underlying cause is progressive in nature, if your cat is diagnosed with these conditions it is important to monitor their quality of life. Cats that are unable to pass faeces properly feel unwell and may begin to vomit which is very serious. If this is a progressive and recurrent condition, it may be kinder to consider having them euthanised rather than pass away from complications associated with severe constipation.

    Inappropriate urination may be related to stress, or there may be a medical reason such as a UTI or crystalluria which both require treatment. Your veterinarian will be able to help with these. If your cat is still urinating inappropriately even with treatment and behaviour modification, it can interfere with your cat ownership experience and start to strain your bond with your cat.

    Faecal incontinence can also be problematic, especially in older cats or cats that have suffered nerve damage (eg cats with pelvic fractures). It is unpleasant and if your cat cannot control their bowel motions they often get faecal matter stuck around their back end. This can burn the skin and can cause infections as well as cause problems with flies. In pets with faecal incontinence or faecal matter around their back end it is important to determine if clipping or constantly grooming them is something that you are willing to do and also consider the long term progression of the underlying condition causing it.

Zest for life
    This is a little harder to put into words. Sometimes as pets age, their quality of life declines and they just lose their zest for life. They seem to be disinterested in their environment and they don’t seem happy anymore. It is very different from just being old and tired, as it is something that you notice that seems to be a permanent change in their attitude. This is usually something that an attentive owner will pick up on that can be a sign that your pet is no longer enjoying life. If you aren’t sure, it may help to discuss this with family, people familiar with your pet or your veterinarian.

Your ability to provide assistance
    Is it feasible for you to meet your pets requirements both now and in the near future? For example if you are at home 24 hours a day, 7 days a week you may be able to assist your pet more if they need ongoing assistance (eg uncontrolled epilepsy or diabetes, hygiene care for faecal incontinence etc). If you work full time or travel away a lot there may not be anyone home to help them if they get into trouble. Also if your pet has a degenerative condition and you are planning a lengthy trip away it can be a lot to ask of a carer to monitor your pet’s quality of life and make the call to put them to sleep if required. If you do feel that their increasing needs for assistance cannot be met it can be kinder to have them euthanised while they still have a reasonable quality of life rather than waiting for them to get into trouble or passing on the responsibility to a carer in your absence.

Who is this decision about?
    It is also good to ask yourself if you are making your decision for them or for yourself? We all know that we will miss them dearly once they have passed but we need to put this feeling aside and try to make the decision based on our pet’s needs and their quality of life. As a veterinarian one comment I hear from time to time is owners who question whether they kept their pet alive for too long because they were too afraid to let them go. Once the time is right for your pet it is important to remind yourself that you are doing this for them, and find comfort in knowing that as a responsible pet owner you are giving them the gift of not having to suffer at the end of their life.

Assessing Quality of Life
    If you aren’t sure, your veterinarian is there to help you. Veterinarians are well trained to assess a pet’s quality of life and they will ask you a series of questions about your pet’s home life while also performing an examination of your pet so that they can ascertain how their quality of life is going. It is best to be confident in your decision before electing to have your beloved pet euthanised and having a professional provide their insight can be helpful in feeling confident that you are making the right choice for your pet to prevent them from suffering at the end of their life.

    In summary it is a very personal and individual decision to make so, as the pet’s owner, it is up to you to decide when is the right time. It is often a very difficult decision to make but it is an important one to prevent unnecessary suffering at the end of your pet’s life. Hopefully this article has helped you think about a few aspects of your pet’s life and has made the decision-making process that little bit easier during such a difficult time.