Last week, I talked about pain in our veterinary patients. I’m going to expand on that topic today by discussing how we evaluate “Quality of Life.”
Whenever we see a patient for an appointment (for any reason, well or sick), we perform a physical examination. We also ask for an extensive history about food intake, weight gain/loss, activity level, general attitude, and any concerns the owner may have. An assessment of a pet’s level of pain is also included in the examination and history.
Once we have all of our information organized, we have a good idea about whether a pet is healthy and doing well, or not. For the pets that are doing well, there’s not much that we need to do beyond routine preventive care with vaccination, parasite prevention, bloodwork and stool checks. However, many of our patients will have a problem that needs to be addressed. We spend time talking with the owner about what’s wrong and what can be done about it. We put a plan into action to help the pet, then re-evaluate at some point in the future to reassess the situation.
Some conditions can’t be cured, only managed. They become an ongoing part of our evaluations and plans. As patients age, we see problems begin to arise that are simply consequences of being older. Arthritis, loss of sight, lumps bumps and tumors, dental disease, mental decline… these are just a few of the chronic issues we deal with on a daily basis with our older pets.
It rapidly becomes very important to look at the big picture. We understand that older pets or certain illnesses are going to mean that a pet isn’t “100% healthy and problem-free.” Bearing that in mind, we ned a way to evaluate whether a patient is living a good life. We need to know if the treatment we’re providing is good enough that we aren’t being unfair to our pets by asking them to suffer. These are difficult subjective questions to talk over with owners. Each pet requires an assessment based on a smaller number of very specific guidelines which help us decide if a patient is doing well enough or needs more intervention.
One of the least specific questions we ask is, “Are there more good days or bad days?” This one’s tough for the veterinary team but great for owners. You know your pets better than anyone, so you’ll know if they’re having a bad day. You’ll recognize subtle changes in personality, activity level, enjoyment of toys/treats/activities, and sleeping patterns. Many older pets do have some days that are worse than others, and we have to be lenient about that. Things aren’t going to be perfect. That being said, a pet that’s having more bad days than good ones needs help to get back to more good days than bad.
Back in 1993, the United Kingdom’s Farm Animal Welfare Council developed a way to evaluate living conditions for farm animals. They’re quite easy to adapt to companion animals, too. They utilized a concept called “The Five Freedoms.”
1. Freedom from Hunger and Thirst
2. Freedom from Discomfort
3. Freedom from Pain, Injury, and Disease
4. Freedom from Fear and Distress
5. Freedom to Express Normal Behavior
These five criteria touch on the most basic parts of a life that we could consider ‘good.’ The most basic things — eating, for example — MUST be present for that animal’s life to be considered good. Without those, we’re doing any animal a disservice by continuing without changes to improve the animal’s status.
A veterinarian named Dr. Villalobos created a Quality of Life Scale that can be used to evaluate domestic pets. Each of the following criteria is evaluated on a 0-10 scale, with 0 being worst and 10 being best. It’s useful for both the veterinary team and the owner to fill this out for patients who need evaluation. We each have unique insights that, when combined, provide the most accurate assessment of quality.
HURT – Adequate pain control, including breathing ability, is first and foremost on the scale. Is the pet’s pain successfully managed? Is oxygen necessary?
HUNGER – Is the pet eating enough? Does hand feeding help? Does the patient require a feeding tube?
HYDRATION – Is the patient dehydrated? For patients not drinking enough, use subcutaneous fluids once or twice daily to supplement fluid intake.
HYGIENE – The patient should be brushed and cleaned, particularly after elmination. Avoid pressure sores and keep all wounds clean.
HAPPINESS – Does the pet express joy and interest? Is the pet responsive to things around him or her (family, toys, etc.)? Is the pet depressed, lonely, anxious, bored or afraid? Can the pet’s bed be close to the family activities and not be isolated?
MOBILITY – Can the patient get up without assistance? Does the pet need human or mechanical help (e.g. a cart)? Does the pet feel like going for a walk? Is the pet having seizures or stumbling? (Some caregivers feel euthanasia is preferable to amputation, yet an animal who has limited mobility but is still alert and responsive can have a good quality of life as long as caregivers are committed to helping the pet.)
MORE GOOD DAYS THAN BAD – When bad days outnumber good days, quality of life might be compromised. When a healthy human-animal bond is no longer possible, the caregiver must be made aware the end is near. The decision needs to be made if the pet is suffering. If death comes peacefully and painlessly, that is okay.
A score over 35 is considered an “acceptable” quality of life. Download a nice PDF of the assessment sheet here.
This is always a touchy area with owners. I believe the most owners know in their hearts when quality of life isn’t good enough. However, acknowledging that means that we have to accept the fact that a pet is in trouble and needs help, or will need to be put to sleep. If the condition that is causing life to be poor is easily addressed, the pet gains tremendous benefit and can have quality go way up. Sometimes, though, the harsh reality is that there will be a limit to what can be done. We have to be fair, we have to be selfless, and we have to be realistic. Letting go is insanely difficult, a fact that -any- pet owner understands. From my side of the table, I have seen clients make poor decisions about quality of life that they ultimately regret. I don’t say this to be judgmental or to preach. Seeing the truth is difficult at best, not to mention emotionally painful in many ways.
The Quality of Life assessments, when started -early- and used often, can help us identify small problems before we’re trying to push a boulder up a hill. All too often, I see pets that have had declining quality of life that the owner overlooked until it’s so bad that the pet is in horrible shape. In some cases, the owners elect to euthanize. In others, they ask, “What can we do to save him?” That second question is guaranteed to bring about an extremely difficult answer. Whether it’s the high financial cost to try to get a pet with lots of problems back on its feet, or a disease we simply can’t do anything about at that point, the pet is the one who has suffered its way to that point in time.
We can do so much better than that. Every single one of the quality criteria in that list can be worked on and improved. “Pawspice” care can be a wonderful way to ease pets through their golden years, but only if we have the courage and dedication to acknowledge that it’s needed.