Dr Liesel van der Merwe is a small animal medicine specialist. Send her your questions: This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

Dr Liesel van der Merwe

How often do we see patients with treatable conditions that owners do not recognize as problems – or choose not to treat because the patient is geriatric?

There are several conceptual frameworks used to understand aging. One characterizes aging as a normal and inevitable aspect of the life cycle and distinguishes normal aging from the symptoms of age-related diseases. This approach emphasizes healthy aging, maintaining optimal function and quality of life, defined in terms relative to the age of the individual.

Proponents of this framework recognize that aging is associated with a progressive loss of function and resilience and an increased risk of disease and death. However, they emphasize differentiating normal physical changes that occur with age from those that represent disease. In this approach, normal health is relative to age, and what may be seen as pathological or unacceptable in a young animal may be viewed as age-appropriate in an older dog or cat. Although a decline in activity level, a loss of lean body mass, or mild clinical laboratory abnormalities might be signs of disease in the young, these changes are considered normal in geriatric individuals and may not trigger diagnostic or treatment interventions.

Most veterinarians using this approach would not go so far as clients sometimes do in ignoring truly deleterious changes associated with age. Normal changes that adversely affect comfort and function are managed palliatively to preserve well-being as long as possible. Proponents recommend screening efforts and intervention when abnormalities cross the often-indistinct threshold between normal aging and disease. However, this view of aging does promote greater acceptance of the purportedly inevitable decline in function and resilience that comes with age, and it is predominantly reactive and palliative rather than preventative.

Another perspective is that aging itself is a disease, a constellation of biological processes and their clinical outcomes that should be diagnosed, treated, and, if possible, prevented like any other illness. Proponents of this view point out that treatment and prevention of individual age-associated diseases may not be as effective at extending life span or health span as directly targeting aging. If there is an identifiable set of common mechanisms behind age-associated diseases, wouldn’t we be more successful at preserving health by addressing these rather than accepting some as symptoms of normal aging and treating others as pathological?

The advantage of this view is that it encourages investigating and manipulating the fundamental mechanisms of aging to mitigate their effect on health and well-being. The disadvantage is that we seldom have sufficient knowledge or tools to do this effectively in a clinical setting. There is also a risk of pathologizing minor changes in geriatric patients that can lead to overdiagnosis and overtreatment.

I lean toward a pragmatic middle ground between these views, understanding aging as the single greatest modifiable risk factor for many superficially dissimilar age-related diseases. Aging is a ubiquitous process consisting of identifiable, evolutionarily conserved mechanisms that occur in all individuals. It is the root cause of many diseases, but it has a variable and often extended latency to clinical manifestations.

The greatest improvements in health and longevity will come from understanding and manipulating the core mechanisms of aging well before clinical disease develops. However, while we develop the necessary tools to accomplish this, we must strike a balance between palliating the impacts of aging on comfort and function and not subjecting our geriatric patients to excessive or unproven interventions.

The concept of healthy aging is clinically useful, but we should not overlook the importance of treating the root causes of age-associated physical decline and ultimately preventing many of the clinical problems we now view as either normal aging or as age-associated disease.

Traditional medical training emphasizes detection and treatment of extant disease more strongly than prevention. Even when we act prophylactically, we often focus our efforts narrowly on specific diseases, overlooking the underlying mechanistic connections between them.

As research evidence elucidating the mechanisms of aging grows, we must shift our practices away from a reactive and narrow focus on age-associated diseases and toward a broader emphasis on preventing the global biological processes that lead to age-related degeneration.

Although there is much work to do to develop clinical therapies directly targeting aging, there are interventions veterinarians can recommend now that can slow aging changes and mitigate their effect on health. The most significant of these is weight management. Another well-demonstrated method of slowing the damage done by aging is increased physical exercise.

The debates over whether aging should be called a disease are unlikely to be resolved any time soon. We can have the best of both perspectives, maximizing function and comfort in geriatric patients now and preparing for a future in which many of their ailments can be prevented.

Based on: Brennen McKenzie, VMD, MSc, MA; dvm360 March 2022, Volume 53, Issue 3