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This chapter includes a brief discussion of how noise is converted and interpreted into sound, causes of hearing loss, monitoring and testing geriatric pets for signs of hearing loss, and a discussion on the management techniques that can enhance the quality of life for a geriatric pet with hearing loss. Age‐related hearing loss is the most common cause of deafness in pets. As it develops, many pet owners mistakenly interpret their pet's partial hearing loss as a behavioral issue, similar to what some would consider “selective hearing”. Advanced diagnostics to evaluate auditory function in dogs is possible. The Brainstem Auditory Evoked Response (BAER) has been used in veterinary patients. When deafness in a pet has been diagnosed, there are a few issues that should be considered. Veterinarians can discuss these issues and management techniques with their clients during a focused visit.

When a family takes in a pet, the last thing they want to think about is when they have to say goodbye. But as the pet ages and shows signs of fragility, it will creep into their minds. People measured their experience of suffering moment by moment, by requesting the patients to rate their pain (via an electronic device) every 60 seconds. The duration of pain was largely ignored. Instead, the results were best predicted by what Kahneman termed the “Peak‐End rule”: an average of the pain experienced at just two moments ‐ the single worst moment of the procedure and the very end, meaning that the pain at the end was remembered just as much as the moment of maximum pain. This chapter discusses a geriatric pet, namely Serissa. She has diabetes for seven years, bad hips and cataracts.

Environmental enrichment typically involves the identification and subsequent addition to the zoo environment of a specific stimulus or characteristic that the occupant(s) needs but which was not previously present. Before examining enrichment for pets, it may be helpful to better understand enrichment by offering examples of enrichment at zoos. Numerous studies of zoo animals demonstrate that living in unenriched and uninteresting environments is unhealthy, potentially leading to various abnormal behaviors and can play a role in weight gain and general ill health. While there is certainly a correlation between zoo animals and companion animals, few clients live with anteaters or cheetahs. More relevant is how enrichment may be used to enhance lifespan and quality of life of the pets, particularly senior pets. Adding a second pet will help to provide a new spark, and older pet begins to play like a young one.

A decrease in a pet's sense of smell may be partial or complete and can lead to a decreased appetite, malnutrition or weight loss, as smell and taste are both involved with “tasting” food. The most common condition seen in geriatric pets involving the nose and smelling is neoplasia. Owners may first see nasal discharge, epistaxis, noisy breathing, or even changes in the physical appearance of their pet's face. The most commonly observed form of cancer in the nasal cavity in geriatric dogs is nasal adenocarcinoma, while the most common form of nasal planum tumor is the mast cell tumor. Diagnosis is made through x‐rays or computed tomography, biopsy, and histopathology of the affected nasal tissue. If an underlying issues is present (tumor, infection, inflammation, other), addressing and ameliorating the problem would be the only way to improve the pet's decreased olfactory ability.

This chapter focuses on cognitive dysfunction and sleep disturbances that are common in geriatric pets. It addresses the causes of cognitive dysfunction, the best diagnostic approaches, and the numerous treatment options that are available to increase and prolong the quality of life of the geriatric patient and their caretakers. In order to better diagnose and treat cognitive dysfunction, it is important to discuss the current understanding of the pathophysiology of the disease process. Immunotherapy is an emerging area of study in the battle against cognitive dysfunction syndrome, Alzheimer's disease, and associated cognitive decline. Ambient temperature is comfortable for the pet's needs, and in some cases a heated bed should be used to support healthy sleep patterns by soothing a pet's muscles and joints. For CDS patients that are still having a difficult time falling asleep, it is necessary to give anxiolytic drugs and/or benzodiazepines to provide necessary rest to both the patient and their caretakers.

Understanding the vulnerability in the older pets allows veterinarians to support the family as the primary care‐giving unit and offers them the education and tools to successfully care for their geriatric pet. The US elderly population is expected to dramatically rise over the coming decades (the same can be said for the elderly pet population); thus, increasing the need for more focus by physicians on geriatrics. This chapter looks into the history of human geriatrics to get an understanding of how it came to fruition, what a geriatrician does, and if there are parallels veterinarians can make in veterinary medicine. It mainly concerns with the pets that are fragile and need extra consideration. Fragility is a syndrome where one has increased vulnerability and decreased physical function; thus, increasing the probability for adverse outcomes.

The scope of geriatric nephrology includes normal age‐related renal changes, the clinical consequences of such changes, and the renal diseases that can occur as a result of these changes. To understand the renal‐related disease processes that can occur in a geriatric pet, one must first understand the general physiology behind the aging kidney, and information must be procured from both human and veterinary resources. Human studies reveal that arterioles in the renal vasculature show subendothelial deposition of hyaline and collagen fibers that produce intimal thickening. This chapter outlines a summary of the common diseases that geriatric patients may experience. Early detection and appropriate intervention is key in maintaining the health of the kidney in the geriatric pet; thus, serial evaluation of a patient's chemistry profile, complete blood cell count, urinalysis, and blood pressure are recommended for assessing and monitoring the health of the kidney.

This chapter discusses the neurologic conditions that most commonly associated with older dogs and cats. For further classification, the disorders are listed under the corresponding section of the nervous system. As a pet ages, the nervous system undergoes natural changes over time. Sensory systems of geriatric pets become less acute, notably hearing, vision, smell, taste, and balance. Neoplasia of the central nervous system can occur in dogs of any age. Meningioma is the most common primary brain tumor diagnosed in dogs and cats. Neuropathic pain is best described as a complex, chronic pain that develops following direct injury to the peripheral or central nervous system. Analgesics that may be useful for neurologic pain include non‐steroidal anti‐inflammatory drugs (NSAIDS), opioids, and N‐methyl‐D‐aspartate receptor antagonists (NMDA), such as amantadine. Common complementary and alternative medicine modalities in the treatment of neurologic disease are acupuncture, chiropractic, therapeutic ultrasound and laser, and physical therapy, including massage, stretching, and swimming.

This chapter reviews general body temperature regulation, specific changes that occur as pets age and how these changes affect body temperature regulation, and outlines management efforts to help protect geriatric pets from hypo‐ or hyperthermia. It also reviews some management efforts that can be used to provide radiant heat or to help insulate a pet. Nearly all major organ systems are adversely affected by excessive and prolonged hypothermia and hyperthermia. The effects of hyperthermia are most severe when they lead to heat stroke. It can be expected that prolonged hyperthermia can lead to dehydration from respiratory fluid loss, especially with panting in dogs. Preventing hypothermia is easier and more efficient than treating it once it occurs. Simple management efforts and awareness can go a long way in keeping the geriatric pets more comfortable. Maintaining a normal temperature can help maintain tissue/organ perfusion and oxygenation, and potentially limit side effects to medications.

Background To systematically examine the clinical utility of tau-PET and Braak-staging as prognostic markers of future cognitive decline in older adults with and without cognitive impairment. Methods In this longitudinal study, we included 396 cognitively normal to dementia subjects with 18 F-Florbetapir/ 18 F-Florbetaben-amyloid-PET, 18 F-Flortaucipir-tau-PET and ~ 2-year cognitive follow-up. Annual change rates in global cognition (i.e., MMSE, ADAS13) and episodic memory were calculated via linear-mixed models. We determined global amyloid-PET (Centiloid) plus global and Braak-stage-specific tau-PET SUVRs, which were stratified as positive( + )/negative( − ) at pre-established cut-offs, classifying subjects as Braak 0 /Braak I+ /Braak I–IV+ /Braak I–VI+ /Braak atypical+ . In bootstrapped linear regression, we assessed the predictive accuracy of global tau-PET SUVRs vs. Centiloid on subsequent cognitive decline. To test for independent tau vs. amyloid effects, analyses were further controlled for the contrary PET-tracer. Using ANCOVAs, we tested whether more advanced Braak-stage predicted accelerated future cognitive decline. All models were controlled for age, sex, education, diagnosis, and baseline cognition. Lastly, we determined Braak-stage-specific conversion risk to mild cognitive impairment (MCI) or dementia. Results Baseline global tau-PET SUVRs explained more variance (partial R 2 ) in future cognitive decline than Centiloid across all cognitive tests (Cohen’s d  ~ 2, all tests p  < 0.001) and diagnostic groups. Associations between tau-PET and cognitive decline remained consistent when controlling for Centiloid, while associations between amyloid-PET and cognitive decline were non-significant when controlling for tau-PET. More advanced Braak-stage was associated with gradually worsening future cognitive decline, independent of Centiloid or diagnostic group ( p  < 0.001), and elevated conversion risk to MCI/dementia. Conclusion Tau-PET and Braak-staging are highly predictive markers of future cognitive decline and may be promising single-modality estimates for prognostication of patient-specific progression risk in clinical settings.