Frailty Syndrome in Geriatric Dogs
By Susan E. Davis, PT
Pet owners often ask, “What is the most important thing I can do to help my dog’s overall health?”I always say, “It is most important to help your pet achieve and maintain a healthy weight.” You may assume this refers to pets that are overweight, and therefore at risk for arthritis, loss of mobility and metabolic disease. While obesity is a common problem for older dogs, it is important for pet owners to also understand frailty in dogs.
With advances in veterinary medicine, our pets are living longer and may develop issues in their geriatric years that include changes in appetite, dental disease, fluctuation in hormones, reduced blood flow to the brain, and slower nerve and balance reactions. The pet becomes frail and compromised when these changes cause lowered body weight, decreased muscle mass (called “atrophy”), thin skin, bone loss, weakness and limited endurance. Similar changes can occur after extensive surgery or prolonged illness in an older dog. The term Frailty Syndrome is often used to describe this combination of signs and symptoms.
Examination & Treatment
A veterinarian can advise the pet owner about nutrition (percentages of fats, amounts of protein and supplements), dental care, pain management and assessment of cognition for the elderly frail dog. An animal-trained physical therapist can evaluate and treat the dog’s function, mobility, coordination, balance and strength.
Here is a list of items a physical therapist should look for during the evaluation, along with tips to help manage and even reverse aspects of Frailty Syndrome.
The evaluation will include an examination of posture and weight distribution, which includes watching the dog rise and sit or stand from a lying position, balance testing, sensation to touch and pinch, proprioception (the dog’s sense of his or her body position in space), feeling for areas of pain, swelling, tenderness, measuring limb circumference to assess muscle mass, checking the joints for range of motion, gait analysis, checking reflexes and strength.
Tell your physical therapist about your home environment (one level, stairs, other pets, type of flooring), changes in behavior you may have noticed (dog paces around the house, seems lost, has a hard time standing still, is falling), how much time your dog sleeps and rests during a 24-hour period, any changes in bowel/bladder function, changes in water and food consumption, how your dog uses food/water bowls (if the dog is able to stand up or has to sit down to eat and drink).
Types of physical therapy interventions may include modalities to decrease pain such as Cold Laser, TENS or PEMF. Other physical therapy treatments include range of motion exercises (within pain free range), low force strengthening, light functional exercises (to conserve energy), weight shifting in standing (forward and back, diagonally, side to side), paw placement on different surfaces and heights to stimulate balance and awareness of body position. Therapists will adapt all exercises to allow for slower speed, zero or very low resistance, fewer reps and longer rest period between exercises. This allows muscle tissue adequate recovery time to avoid painful lactic acid build-up, which is harder for a frail pet to metabolize and eliminate. If the pet has a difficult time standing then the therapist will use physio-rolls, balls, carts or clinic standers (see Eddie’s Wheels for Pets) to assist with weight bearing. Water is also used to assist with standing and walking, via the underwater treadmill, a tub or a pool. Pools can also be used for swimming, with the frail dog wearing a flotation vest, to improve circulation and cardiovascular health.
4. Your Home:
Follow all preventative measures given by your vet to maintain good dental care of mouth and teeth, maintain proper length of nails and health of paws and pads. Follow your vet’s advice on nutrition and ensure your dog gets plenty of water and has easy access to food (even if you have to bring it to them). Hydration and food intake are often decreased when there is limited mobility in a frail dog.
If the dog has difficulty walking, don’t pass on giving them the opportunity to stand up during the day and evening. Frequent standing can make a significant difference in cardiovascular health and endurance even if the dog is very frail. You can start with only 20 to 30 seconds of standing and increase gradually to 1 to 2 minutes every few hours (ex: 5 times per day). If a dog needs assistance to stand then use a sling, harness, or place them over a stack of cushions. Use toys and treats to keep the dog moving and active. Engage them in moving their head or limbs by tickling the belly or rubbing lightly across their back or under the chin. Help the nervous system by providing sensory stimulation through petting, light massaging, brushing their coat, rubbing their ears and paws.
If your dogs can walk then short but frequent walks are best. A few 6 to 10 minute walks are more beneficial than one 30 minute walk for a frail pet. As the dog gains strength, try low impact functional exercises such as “sit to stand” for 6 to 10 reps. If dog has difficulty with this then place a cushion or step under the rump for a boost. For balance and coordination do leash-guided walking around cones of chairs in a wide circular pattern, on carpet, grass or other non-slippery surface. Challenge balance safely by having dog stand on an inflated mattress, a couch cushion, foam pad. For safety, help them gain traction on the floor with the following: Dr. Buzby’s Toe Grips, carpet runners, non-skid booties or socks such as those made by Sticky Pawz or Woodruff Wear, placing non-skid pads on steps, or use of ramps with sides.
5. Precautions and Contraindications:
Deep tissue massage, stretching, heavy resistance, over-challenging your pet to the point of fatigue. Avoid slippery surfaces such as tile or wood floors, walking the dog up and down hills or steep stairs, activities that include jumping or running.
Frailty can be reversed, even partially, through home care and physical therapy. In the most severe cases, physical therapy can help maintain the status and prevent it from becoming worse. In either situation, it is important to ensure safety and maximize your dog’s quality of life. Despite limited mobility and decline in former levels of function, happiness and high spirits can be achieved by meeting their needs at this new level. Accept your dog as they are, and show joy while providing their care. If your dog feels special and loved, they will be content in fulfilling their main life purpose: to be your faithful companion.