Don’t wait for the bad days: Rethinking quality-of-life assessment for senior pets

November is Senior Pet Month, which offers veterinary teams an opportunity to evaluate how they care for aging patients and identify areas for improvement. One area worth reconsidering is not necessarily which tools are being used but when they are introduced.

Quality-of-life (QOL) scales are familiar tools in veterinary medicine, but they are often introduced at a difficult point in a pet’s journey. A senior pet has developed progressive disease. The family has noticed more bad days. Treatment options are becoming limited. Eventually, someone asks the question many veterinary professionals have heard countless times: “How will I know when it’s time?”

A QOL scale can bring structure and objectivity to an emotionally overwhelming decision. But what if the first QOL assessment happened months—or even years—earlier? Rather than reserving QOL tools primarily for hospice and end-of-life decision-making, veterinary teams can introduce them while senior pets are still doing well. Doing so creates an individualized baseline, helps families recognize meaningful changes earlier, and makes planning for future care a natural extension of senior medicine rather than a conversation initiated during a crisis.

Establish the baseline while “good” is still easy to recognize

QOL is inherently individual. The 2023 American Animal Hospital Association (AAHA) Senior Care Guidelines emphasize that senior care cannot follow a one-size-fits-all approach and should consider the individual patient’s health, function, environment, and family.¹ The same principle applies to QOL assessment.

For one dog, a good day might include a morning walk, waiting at the kitchen counter for something to fall, and greeting family members at the door. For another, it may mean sleeping comfortably most of the day and still becoming animated when the leash appears. A cat’s meaningful activities might include grooming, jumping onto a favorite chair, seeking affection, or watching birds from the same window every afternoon. These details can seem inconsequential while a pet is healthy, but they become important reference points as that pet ages.

During a senior visit, veterinary teams can begin asking questions such as the following:

• What does a really good day look like for this pet?
• What are 3 to 5 things the pet loves to do?
• What changes has the family noticed over the past 6 months?

The answers establish something that can be surprisingly difficult to reconstruct later: what “good” looked like before chronic disease, pain, cognitive decline, or progressive frailty changed the picture.

Look for trends, not just a single score

There is no shortage of tools available to help assess different aspects of a pet’s health and QOL. The commonly used HHHHHMM scale, for example, considers hurt, hunger, hydration, hygiene, happiness, mobility, and whether the pet is experiencing more good days than bad.² Other validated owner-reported instruments assess areas such as pain and mobility, including the Canine Brief Pain Inventory and the Liverpool Osteoarthritis in Dogs questionnaire.³

The value of these tools, however, is not simply the number produced at the bottom of the page. A single QOL score is a snapshot, whereas repeated assessments can create a meaningful timeline. This distinction is especially important because caregivers see their pets every day. QOL changes can be difficult to recognize when their onset is gradual.

A dog does not wake up one morning suddenly unable to take the same walk he enjoyed a year ago. The walk may gradually become shorter over time; he may stop going upstairs, hesitate before jumping into the car, or sleep through the greeting he once never missed. Any one of these changes may be easy to rationalize as “just getting older.” Viewed longitudinally, however, they may reveal a meaningful decline in mobility, comfort, cognition, or engagement. And regular QOL assessment gives the veterinary team and family a common language for recognizing those trends.

Use a decline in QOL as a reason to intervene

One of the risks of introducing QOL assessment primarily at the end of life is that clients may understandably associate the tool with euthanasia. That association can make families reluctant to engage in QOL discussions because they fear what a declining score means. Veterinary teams have an opportunity to reframe that conversation.

A change in QOL does not automatically indicate that a pet is dying—it indicates that something has changed. A dog that no longer wants to walk may have inadequately controlled osteoarthritis pain. A cat that stops jumping onto the bed may benefit from pain assessment, environmental modifications, or both. Changes in sleep, interaction, housetraining, or anxiety may warrant evaluation for cognitive dysfunction. Decreased appetite or grooming may reveal an underlying medical problem that has not yet been diagnosed.

The 2023 AAHA Senior Care Guidelines specifically emphasize that senior care is not limited to sick pets and includes proactive attention to pain, cognition, nutrition, behavior, mobility, and the pet’s environment.¹ This is where longitudinal QOL assessment becomes clinically useful: not simply as a tool for identifying when QOL has become unacceptable but as an opportunity to identify where the veterinary team may still be able to improve it.

Let QOL conversations lead naturally into planning

As a senior pet’s needs increase, QOL conversations can gradually become more specific. Early planning does not require asking a family to decide today what they will do months or years from now. It may begin with identifying which activities are most important to their pet and what changes should prompt a veterinary visit.

Changes should prompt a veterinary visit. With progressive disease, the discussion can evolve:

• Which clinical signs should prompt a call?
• What constitutes an emergency?
• If the pet deteriorates overnight, where should the family go?
• Would hospitalization align with the family’s goals?
• At what point might the focus of care shift from disease-directed treatment toward comfort?

Helping families prepare by thinking through answers to these questions can substantially reduce stress, panic, or uncertainty during a crisis.

Eventually, planning may include preferences surrounding hospice care, location of euthanasia, and aftercare, all of which should be documented in the medical record. These conversations are easier when they are not happening for the first time during an emergency. They also allow families to consider decisions when they have the emotional space to process information, ask questions, and discuss with other family members. When a crisis does occur, the family may still experience fear, uncertainty, and grief, but they are not being asked to consider every possible end-of-life decision for the first time.

Start the conversation sooner

QOL tools will always have an important place in hospice and end-of-life care. They help families organize observations that can otherwise feel subjective and overwhelming, and they can provide useful structure for conversations about euthanasia. But that does not have to be where their usefulness begins.

Senior Pet Month offers an opportunity for veterinary teams to introduce QOL assessment differently: not as a tool that signals the end is approaching but as another way to proactively care for an aging pet. Establish what a good day looks like while good days are plentiful.

Revisit that picture over time. Pay attention when something meaningful begins to change, and use those changes to guide intervention and planning.

Then, someday, if a family does ask, “How will I know when it’s time?” the conversation does not have to start there. The veterinary team and family will already have been asking an equally important question all along: “How is this pet doing today?”

References

1. Dhaliwal R, Boynton E, Carrera-Justiz S, et al. 2023 AAHA senior care guidelines for dogs and cats. J Am Anim Hosp Assoc. 2023;59(1):1-21. doi:10.5326/JAAHA-MS-7343
2. Villalobos AE. Quality-of-life assessment techniques for veterinarians. Vet Clin North Am Small Anim Pract. 2011;41(3):519-529. doi:10.1016/j.cvsm.2011.03.013
3. Walton MB, Cowderoy E, Lascelles BD, Innes JF. Evaluation of construct and criterion validity for the “Liverpool Osteoarthritis in Dogs” (LOAD) clinical metrology instrument and comparison to two other instruments. PLoS One. 2013;8(3):e58125. doi:10.1371/journal.pone.0058125