10.1WHY SCREEN GERIATRIC PATIENTS? 10.1 WHY SCREEN GERIATRIC PATIENTS?

Over one-third of cats and dogs presented to veterinary practices are aged 7 years or over (SAPTU, demographic data supplied by the Small Animal Practice Teaching Unit, University of Edinburgh, August 1991) and there is a great deal of interest in this group of animals because of:


(1) the effect of ageing on major body system function
(2) the likelihood of the occurrence of subclinical disease.


Early detection of problems and routine screening for the presence of subclinical diseases or reduced organ function are important clinical objectives in the management of older animals. Performance of a full physical examination and blood and urine tests at regular intervals is useful because it helps to:


(1) detect problems early to increase the chance of successful intervention to delay or prevent the onset and/or progression of disease
(2) provide base normals' for the individual against which future meacan be compared;
(3) demonstrates a caring attitude towards the patient and helps to move the practice away from providing a fire brigade service (only providing treatment at times of illness) to one of providing a comprehensive preventative medicine programme.


Health screening of older patients is important particularly before the administration of a general anaesthetic, the use of a therapeutic agent with narrow margins of safety, or the administration of drugs that require normal hepatic, renal or cardiac function. Modification of drug dosage may be necessary in patients with impaired organ function with or without evidence of subclinical disease.

An annual vaccination programme provides the opportunity to perform a full physical examination and would be an ideal time to recommend further screening tests although for some animals, particularly those that have a medical history of serious illness, checks should probably be more frequent - say every 6 months. Unfortunately with many owners their compliance with an annual vaccination programme deteriorates with time.

Some practices prefer to offer a geriatric screening programme sepafrom the usual routine vaccination/worming and flea control consultantions and this may have merit in that it allows the programme to be offered as a 'special' service. My personal experience of running a geriatric clinic is that some owners will gladly pay for screening tests whereas others will not.

Some practices claim that the best results may be obtained by offering the initial consultation free of charge as a 'lost-leader' with the costs of providing the service being borne by the follow-up work (e.g. dental work, or the implementation of a dietary programme) that is often generated as a direct result of the screening programme.

As a student I was taught to perform laboratory and other investigative tests only when they were indicated from the history and physical examination. However, my personal experience since graduation has been that serious conditions may be missed by selectively omitting tests from a screening profile, and I now prefer to perform a complete screen whenever possible (see Table 10.1). Fortunately technological advances have resulted in a significant decrease in the cost of laboratory testing, and sometimes it is actually cheaper to perform a full profile screen than to request a few specific tests. In my opinion it is good practice to include a wide range of tests in a routine screening programme.

Radiography is an important aid to diagnosis in geriatric animals (see Chapter 9) but the potential health hazards and the need to administer a general anaesthetic to most animals preclude it from being included in a routine geriatric screening programme unless it is indicated by the presence of a clinical problem. In the future survey ultrasonography may be useful in a geriatric screening programme.