by Dr. Jeni Goedken, Hospice Veterinarian and owner of Fond Farewell.
If there were ever a time to ask pets how they feel, it would be during their final stage of life. Instead, their families must make difficult end-of-life decisions based on their intimate understanding of their senior pet’s needs.
What is quality of life (QOL) for senior pets?
QOL is a way to describe your pet’s wellbeing, as well as their daily needs and lifestyle to determine if extraordinary measures are sustainable and justified. For ailing senior pets, these needs may include:
• Nursing care
• Husbandry
• Physical assistance (e.g., being carried or transported with a sling)
• Feeding
Because each pet is an individual, lifestyle is more subjective and includes:
• Social interactions
• Responses to favorite things
• Awareness of or engagement with their surroundings
Despite your best attempts, most progressive conditions will eventually stop responding to treatment or require an unrealistic and unsustainable level of round-the-clock care.
Why is knowing when it’s time to say goodbye to my pet so difficult?
Concerned pet owners always ask how they will know when it’s time to say goodbye. Unfortunately, because we have unique emotional bonds with our pets, and end-of-life decisions are final, everyone’s answer is different. When facing euthanasia, pet owners may grapple with complex emotions, such as anticipatory grief, guilt, sorrow, or shame and criticism from friends and family who do not understand pet grief.
How can I objectively assess my pet’s quality of life?
The beautiful relationship that you’ve built with your pet can prevent you from seeing their circumstances clearly. For example, because of your desire to hold on to your pet, you may downplay their care needs (e.g., “It’s not that much work”) or overlook their struggle (e.g., “He falls a lot, but he can still make it outside”). To ensure the best possible care for your pets, you must put aside your love and affection and measure their QOL objectively.
Many excellent QOL scales are available, such as:
• HHHHHMM Quality of Life Scale
• JOURNEYS Quality of Life Scale
• The Ohio State University Quality of Life Scale
Because each assessment takes a slightly different approach—some more intuitive, and others more clinical—we encourage senior pet owners to try them all and select the one that best suits their needs.
What should I consider when evaluating my pet’s quality of life?
Each QOL scale covers the same key categories for measuring a pet’s needs and lifestyle. Such categories include:
• Pain and anxiety — Pets experience pain differently than people, and often instinctively hide their pain as self-protection. Senior pets may demonstrate pain in classic ways (e.g., vocalizing, limping), or through more subtle means, including personality changes, self-isolation, inactivity, appetite changes, and anxiety. In addition to traditional ache-like pains, senior pets may struggle to breathe normally, so considering all body systems is important when evaluating pain.
• Appetite and thirst — Your pet’s appetite and thirst reveal important information about how they feel. If they show little to no interest in food, or must be coaxed, persuaded, or need help to eat, their health may be declining. Dehydration can be temporarily corrected with at-home fluid therapy (i.e., subcutaneous fluids), but this process requires daily effort and may increase urination.
• Social interactions and awareness — Aging or ailing pets may lose interest in social interactions, and no longer seek affection. Cognitive dysfunction and some disease processes may affect their ability to recognize loved ones and familiar places, and cause disorientation and anxiety.
• Care needs — Senior pet health and care needs can change quickly, and your list of daily duties can mount. QOL assessments challenge owners to consider their pet’s independence and how much assistance they regularly require, including:
• Grooming and hygiene
• Feeding
• Elimination
• Mobility
• Medicating and performing treatments
Please remember that you are only human and do not have unlimited resources – whether it be time, money, or physical or emotional strength.
• Good versus bad days — When your pet’s bad days outnumber their good days, their QOL is compromised.
Quality of Death
As a hospice veterinarian, I prepare pet parents to shift from “Quality of Life” into a “Quality of Death” mindset. It is important to know that you will never be ready to say good-bye to your pet, so don’t wait to feel ready, because it will never happen. Even if you know euthanasia is the logical choice, your brain and your heart will likely be at odds with each other.
Once we have crossed the threshold between struggling and suffering, most pet parents have waited too long to provide the dignified and loving goodbye you both deserve. Sometimes, pets decline so rapidly that you have little time to plan, and in such unfortunate circumstances, an emergency euthanasia is the kindest option.
About the Author
Growing up in the Chicago suburbs as the daughter of a nurse and veterinarian, my desire to practice compassionate medicine was born at an early age. I entered clinical medicine upon graduation from the University of Illinois College of Veterinary Medicine in 2005. After a few years, I came to a humbling realization; It doesn’t matter how many tests I run, how much money clients spend, or how deeply those people adore their pets. I was going to lose every patient, and I couldn’t stop that train from coming.
That train came for me and my handsome orange tabby, Yoda, in 2009. As I held him in my arms at 2 am in the ER exam room, he had a seizure and fell onto the floor. Looking back, I realized that I had waited too long into his illness to give him a peaceful and dignified passing.
When my sweet cat Bogie started his decline years later, I thought of Yoda and summoned up the strength to learn from my past mistake. I made the decision to euthanize Bogie on a “good day” before he could start the painful downward spiral of catastrophic heart failure I knew was on the horizon. Bogie drifted away on my husband’s lap eating as many treats as he wanted while I showered him with love and gratitude. I made sure he was comfortable and at peace before his final breath, in the place where he belonged.
That changed the way I practiced and approached veterinary medicine forever. The experiences of Yoda and Bogie’s euthanasias and the memories of those nights I carry with me for the rest of my life are the reason why I am committed to guiding people through their beloved pets’ final moments.
