Quality of Life at the End of Life for Your Cat

By Tammy Hunter, DVM; Robin Downing, DVM, CVPP, CCRP, DAAPM

Each and every pet has certain needs that should be recognized and respected. Quality of life is a way to refer to and discuss the day-to-day life and lifestyle of a cat reaching the end of its life. If we can successfully meet an ailing or chronically ill cat's basic needs, then we can feel confident that our efforts in preserving life are justified.

What are some of the conditions that might cause a cat’s quality of life to deteriorate?

Most senior pets develop one or more medical conditions that tend to worsen over time. Examples of chronic medical conditions common in the older cat include:

  • Blindness. Generally occurs gradually from changes in the lens of the eye.
  • Cancer. The risk of all types of cancers increases with age.
  • Chronic renal disease. This degenerative kidney disease leads to the decreased ability of the kidneys to filter biological waste from the blood.
  • Deafness. Generally occurs gradually over time as the eardrum becomes less flexible.
  • Osteoarthritis. Painful inflammation and deterioration of the joints.
  • Overweight/obesity. More than half of senior cats are overweight or obese, reducing their quality of life.

Cats can provide special challenges as they age because they are already very adept at disguising illnesses. The signs associated with chronic degenerative conditions can be quite subtle, even for owners who are tuned in to their cat's needs and routine behaviors.

Is there a way to objectively measure my cat’s quality of life?

Dr. Alice Villalobos, a veterinary oncologist, has developed a quality-of-life scale for cats so that owners can act on behalf of their beloved animal family members as a pet's end of life approaches. The quality-of-life scale provides guidelines that help owners and veterinarians work together to maintain a healthy human-animal bond. The scale provides a tool with which to measure the success of a palliative care or hospice plan for a cat with life-limiting disease and to fine-tune that care/plan.

Dr. Villalobos' quality-of-life scale looks at seven different categories and scores each parameter from 1 to 10, with 10 being the best. A score above 5 in each category, or an overall score greater than 35, suggests that the cat's quality of life is acceptable and that it is reasonable to continue end-of-life care and support.

The categories to be measured can be remembered as ‘HHHHHMM’. This list of letters stands for Hurt, Hunger, Hydration, Hygiene, Happiness, Mobility, and More good days than bad.

What does each category mean for a cat approaching the end of its life?

Hurt. Adequate pain control, including the ability to breathe properly, is an absolute necessity. Most pet owners do not know that being able to breathe is ranked as an important pain management strategy. Cats hide their pain extremely well. They will become very still if breathing is a problem. Pain control may include oral or injectable medication.

Hunger. If a cat cannot eat properly or willingly, first try hand-feeding. If this is not successful, it may be appropriate to consider a feeding tube for blended or liquid diets, particularly if oral medication must be given.

Hydration. Fluid under the skin is generally an easy and well-tolerated way to supplement what an ailing cat is drinking. This is not a heroic measure but can really help an older cat feel better.

Hygiene. Can the cat be brushed, combed, and kept clean? Is the coat matted? Cats are very sensitive about keeping themselves clean. If they have an oral tumor or back pain, they may not be able to groom and may need help. Waterless shampoo works well to keep the coat clean and a regular 'lion cut' can keep the coat short and easy to manage.

Happiness. Is the cat experiencing joy or mental stimulation? Cats communicate with their eyes, as well as by purring. Is the ailing cat still interacting with family members and with the environment? Placing comfortable beds near family activities helps a cat remain engaged in life.

Mobility. If the cat can no longer move around on its own, it may be time to consider a mobility device. Cats are surprisingly accepting of two- and four-wheel carts as long as any pain is well managed. Mobility and hygiene go together when a cat is bedridden. Your veterinarian is an important resource when working through mobility issues.

More good days than bad. When there are too many bad days in a row, or if the cat seems to be turned off to life, quality of life is compromised. Bad days may mean nausea, vomiting, diarrhea, seizures, frustration, unrelenting pain/discomfort, or inability to breathe.

How will I know it’s the right time to consider euthanasia?

A healthy human-animal bond requires a two-way exchange, and when that exchange is gone, the time for humane euthanasia has arrived. It is important to plan for the end of life before that time arrives, and the quality-of-life scale can be an integral part of that planning. You can help your cat maintain a good day-to-day life experience by using this scale to regularly measure the parameters that evaluate how well your cat's basic needs are being met. The scale can also help you clarify the decision for euthanasia, hopefully relieving anxiety and regret about your beloved cat's end of life.

Can my veterinarian help me decide when to let go?

Veterinarians are often asked to help cat owners with the difficult decisions around euthanasia. Your veterinarian is there to help with these very difficult decisions.

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