My senior patient presented with mobility issues, now what?

Although mobility means the ability to walk, it can represent so much more, especially to senior pets, because it is how they interact with the world, enact decisions, and take control of their lives. Because it requires integration of sensory, associate, and motor components of the central and peripheral nervous systems, plus the musculoskeletal system, it reflects a pet’s overall health as a final functional system. As pets age, their mobility will decline, and patterns of mobility loss reflect the decline of many body parts. So, how can veterinary teams assist their patients and clients whose pets are going through this, or are on the cusp of it?

During her lecture, "Paws in motion: Addressing mobility loss in senior dogs," at the 2025 Global Hill’s Symposium, Natasha Olby, Vet MB, PhD, MRCVS, DACVIM (Neurology), shares how veterinary teams can evaluate, diagnose, and treat senior pets that are losing mobility.

"What does it take to be mobile? Pretty much everything. So you need the whole nervous system, all of it. More about that later. Obviously, you need the mechanical parts. You need bones, you need joints, you need muscle. Muscle is an organ [that is] very, very important if we're going to have all those things work. We need blood flow. We need oxygen. I can put every organ of the body on here, you need them all to supply everything that is needed by the nervous system and by muscle, for example," Olby began her lecture, asking and explaining to attendees.

Patient evaluation

When a dog presents to the clinic for mobility loss, Olby stated that veterinary teams should first start by taking a detailed history of the patient’s general health and mobility. Teams can start by asking clients when the signs are at their worst, after rest for orthopedic disease, and what happens with exercise. If it improves, that can be a sign of an orthopedic issue, and if it stays the same or worsens, it can signify a neurologic disease. It can also help teams if they ask clients what their pet can no longer do, their pet's sleep quality, signs of pain, and elimination habits.

After the history is fully taken, veterinary teams will next need to perform a physical examination, making sure to do so before a gait evaluation. Olby explained that gait is often overlooked but can be a crucial part in the patient assessment, and she likes to perform it before a hands-on neurological and orthopedic exam. For the gait exam, dogs should walk on a nonslip surface because elderly canine patients tend to be more afraid of slick surfaces, which results in them either refusing to walk on them or walking in a very altered fashion. It can also help if teams bring the patient outside to walk on small slopes, shallow flights of steps if available, and curbs. Teams should view the patient from both sides and then the front and back, and can also take a short video to be viewed in slow motion prior to the exam.

Following the physical examination, carefully executed orthopedic and neurological exams should be next on the list. Performing these exams can confirm and clarify observations that were made during the gait evaluation. According to Olby, one of the most important tests is the assessment of postural reactions, hopping, and proprioceptive pacing. If there are any deficits in hopping or proprioceptive placing, there is a central nervous system problem.

However, Olby cautions that performing these tests requires appropriate weight support, particularly if the patient also has an orthopedic disease. She also noted that proprioceptive placing can be less reliable in chronic disease cases than hopping, but is still useful if present. The timing of initiation of the hop should also be carefully evaluated when supporting weight for the other 3 limbs, and can serve as an indicator of neurologic disease. Patients should also start to hop the second their weight masses midline.

Diagnosing and treating the patient

Following the assessment, veterinarians should begin to create a list of differentials for each problem and then categorize them in groups of diseases expected to improve greatly with treatment, those that can be treated to minimize or slow down the deterioration, and those with a grave prognosis. Deciding the course of action that is most appropriate also requires veterinary professionals to understand what the client will do about interventions and their ultimate goals. This helps ensure that whatever the diagnosis of the patient is, the client will treat it effectively.

When it comes to managing mobility loss, the key is to be ‘extremely holistic.' Olby explained it is crucial to identify comorbidities that can be addressed within specific therapy, like a urinary tract infection and endocrine disease, to document the presence of degenerative orthopedic and neurologic conditions. Then, it is important to determine how much pain is a driving factor in the mobility loss.

Environmental factors will always benefit patients with mobility loss, as well as with appropriate levels of exercise, appropriate nutrition, pain control, and rehabilitation. For environmental factors, veterinary teams can instruct clients to provide non-slip surfaces or use nonslip booties or nail and pad stickers. Clients can also add appropriate sling supports and change the exercise to a surface such as grass to give these senior pets the maximum sensory input and traction. Elderly canine patients are also more sensitive to cold and heat, so owners will need to plan walks accordingly. Plus, many may also lose vision and hesitate to cross boundaries between light and dark, so encouraging pet owners to be thoughtful with lighting can also help their patients.

Clients can also pursue other strategies for treatment, such as massages, appropriate bedding, and interventions provided by a rehabilitation expert.

There are also pharmacological strategies for pain control that veterinary teams and clients can discuss. For both orthopedic and neurological diseases, it is important that the veterinary team consider whether anti-inflammatory doses of prednisone will help the client. Olby provided the attendees with the example of chronic compressive spinal conditions, and spinal and brain neoplasia are likely to show some response to a low dose of prednisone, even if this is somewhat short-lived. In these occurrences, the use of an NSAID is contraindicated, and if this patient is only on an NSAID, a washout period is indicated.

“Typically, if osteoarthritis (OA) and compressive myelopathy coexist, a trial dosing regimen of 0.5 mg/kg prednisone twice a day for 3 to 5 days can be assessed. If there is a response, the dose is halved for 7 to 10 days and then tapered again to the minimum dose that will ameliorate the signs. If it is not helpful after 5 days, it can be tapered off and the response to an NSAID is assessed (or vice versa, depending on the relative severity of orthopedic and neurologic signs. A gabapentinoid is indicated if neuropathic pain could play a part in the signs, but elderly dogs can become sedate and ataxic, and a low dose should be trialed (for example, 3-5 mg/kg gabapentin once to twice a day) and then gradually increased to effect,” Olby stated in her proceedings for the lecture.

Using bedinvetmab for OA is indicated, but veterinarians should be cautious if they suspect a neurologic disease because the therapy was created and tested in canine patients with only orthopedic disease, making the consequences of using it with a neurologic disease present unclear at this current time.

Conclusion

Veterinary professionals face challenges in navigating the complexities of mobility loss in elderly patients. By performing thorough gait evaluations, utilizing environmental modifications, and ensuring effective pain control, you can make a meaningful difference. Take proactive steps to support senior pets and improve their quality of life—your guidance truly matters.

Reference

1. Olby N.Paws in motion: Addressing mobility loss in senior dogs.Presented at: Hill’s Global Symposium; October 27-28, 2025; Phoenix, AZ.