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Care of the Geriatric Horse
Care of the Geriatric Horse
Scott M. Austin, DVM, MS
Clinical Assistant Professor
Define Geriatric!
• Greater than 16 years old
• In an owner survey, average age considered “old” was 22 years.
Geriatric HorsesGeriatric Horses
• 15% of horse population
• Shift to companion animals
• Improved health care– Dewormers
– Nutrition
– Dental care
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The Aging HorseThe Aging Horse
• Gradual, irreversible changes
• 70% of geriatric horses have some age-associated problem that requires special care
Owner Survey of Geriatric Problems
• Muscle loss
• Weight loss
• Change in hair shedding
• Problems eating
• Lameness
• Hoof problems
• Reduced exercise capacity
• Sagging skin
• Slack lower lip
• Hollow appearance of face
• Muscle degeneration
• Sagging of topline
Weakening of Collagen
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The Aging HorseThe Aging Horse
• Graying of face
• Cataracts
• Decline of immune system
• Exercise tolerance– Reduced aerobic exercise capacity
– Decreased muscle mass
– Reduced heat tolerance
CataractsCataracts
• Blue -gray lens
• Ground glass appearance
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Management of Geriatric Horses
• Recognition of problems– Aging change vs. medical problem
• Adjust routine preventative care
• Preservation of performance
• Quality of life– Rarely can cure
– Manage problems
COMMON MEDICAL PROBLEMS
• Body weight
• Dental Abnormalities
• Gastrointestinal problems
• Musculoskeletal problems
• Respiratory disease
• Endocrine abnormalities and neoplasia
BCS: 6 = moderately fleshy
BCS: 4 = moderately thin
BCS: 5 = Ideal
Body condition in older horsesShould remain in this range
Changes in body shape withAge may make scoring harder
Body Condition
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From Tribute Nutrition
From Tribute Nutrition
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OBESITYOBESITY
Overfeeding
• Expectations
• Feeding grain
• Lush pastures
• Feeding too much forage
• Lack of winter weight loss
• Sedentary lifestyle
Consequences of Obesity
• Exercise intolerance
• Strain on musculoskeletal system
• Fat cells are metabolically active– Increased activity of steroids
– Increase inflammation
– Increase clotting
– Constrict vessels
– Insulin resistance
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Equine Metabolic Syndrome
• Obesity
• Insulin resistance
• Normal dexamethasone suppression test
• Active or subclinical laminitis
Weight Loss is a greater problem in older horses
• Under-feeding
• Protein-calorie malnutrition
• Dental problems
• Loss of appetite
• Increased nutrient requirements
• Nutrient loss
• Management or social dynamics within the herd
BCS: 3 = thin
Encysted Small StrongylesEncysted Small Strongyles
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Feeding the Geriatric HorseFeeding the Geriatric Horse
• Palatability
• Easy to chew
• Improved digestibility
• Maintain normal intestinal flora
• Decrease competition at feeding time
• Dental health
Do Not Forget Water Intake
• Water intake in geriatric horses may be decreased– Decreased thirst perception– Oral pain due to underlying dental disease
• Consequences– Low grade dehydration– Reduced exercise tolerance– Renal dysfunction– Impaction colic or choke
• Water accessible– Heated source?
Dental Health of Older HorsesDental Health of Older Horses
• Teeth erupt continuously
• Check twice yearly
• Bad teeth contribute to disease– Weight loss
– Choke
– Colic
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Signs of Dental Disease
• Dysphagia
• Dribbling or dropping feed
• Quidding
• Packing feed in mouth or teeth
• Pain when chewing
• Halitosis, mal-odor
Enamel PointsEnamel Points
• Upper jaw wider
• Upper teeth - outside edge
• Lower teeth - inner edge
Wave MouthWave Mouth
• Accentuated undulating pattern
• Some teeth too long
• Others ground to gum line
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Step MouthStep Mouth
• An abrupt change in the height of one tooth
• Opposing tooth missing or malpositioned
Shear MouthShear Mouth
• Accentuation of normal oblique occlusal surface
• Ground to gum level on inside edge of uppers and outside edge of lowers
• Limits side to side motion of the jaw
Treatment of Abnormal WearTreatment of Abnormal Wear
• Cut off overly long molars or hooks
• Rasp off points with dental rasp
• Powerfloat or Dremel
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Parrot MouthParrot Mouth
• Overbite, Inferior brachygnathism
• May cause hook formation
• Hooks– First upper
– Last lower
– May be painful
• Rx - Cut off hooks and rasp teeth
Parrot MouthParrot Mouth
Sow MouthSow Mouth
• Under bite, Monkey mouth, inferior prognathism
• Uncommon
• Hooks– Last upper
– First lower
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Abnormal Incisor WearAbnormal Incisor Wear
Tooth AbscessTooth Abscess
• Unilateral nasal discharge
• Swelling
• Draining tracts
Periodontal DiseasePeriodontal Disease
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ChokeChoke
ChokeChoke
ColicColic
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EnterolithsEnteroliths
Musculoskeletal Problems
• A major reason for veterinary evaluation and for reduced athletic capacity in geriatric horses
• Predisposing causes– Cumulative wear-and-tear
– Athletic history
– Cartilage degeneration
– Concurrent disease (PPID)
Musculoskeletal Problems
• Common conditions– Osteoarthritis– Laminitis– Hoof-related problems– Tendon injury
• Common clinical signs– Lameness– Stiffness– Reduced range of motion– Difficulty standing
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High RingboneHigh Ringbone
SpavinSpavin
Arthritic MareArthritic Mare
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Flexion TestsFlexion Tests
Annular Ligament ConstrictionAnnular Ligament Constriction
Suspensory DegenerationSuspensory Degeneration
• Dropped fetlock
• Straight hocks
• Lameness
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ArthritisArthritis
• Proper foot care
• Extra bedding
• Control of weight
• Controlled exercise
• Feed supplements
• Injectable products
Feed SupplementsFeed Supplements
• Chondroitin sulfate
• Glucosamine
• MSM
Injectable ProductsInjectable Products
• Sodium hyaluronate
• Polysulfated glycosaminoglycans
• Glucosamine
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Decline of the Immune SystemDecline of the Immune System
• Increased susceptibility to disease
• Increase in occurrence of allergic diseases– Culicoides hypersensitivity
– Recurrent airway disease
Culicoides HypersensitivityCulicoides Hypersensitivity
Culicoides HypersensitivityCulicoides Hypersensitivity
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• C.O.P.D.
• Heaves
• Broken Wind
• Emphysema
• Chronic Bronchiolitis
• Equine Asthma
Recurrent Airway ObstructionRecurrent Airway Obstruction
Causes of Recurrent Airway ObstructionCauses of Recurrent Airway Obstruction
• Small airway disease
• Allergic hypersensitivity – Molds
– Dust
– Straw
– Hay
• Viral
• Genetic?
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Risk Factors of RAORisk Factors of RAO
• Middle aged to older• Stabled, seasonal• Exposure to dust and
molds• Previous viral respiratory
disease• Intermittent, progressing
to continuous
CLINICAL SIGNS OF RAOCLINICAL SIGNS OF RAO
• Exercise intolerance– Increased expiratory effort
– Biphasic respiratory effort
– Dyspnea
• Coughing associated with feeding and exercise
• Heave line
Heave Line
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CLINICAL SIGNSCLINICAL SIGNS
• Wheezes and crackles
• +/- mucoid nasal discharge
• No fever
DIAGNOSIS OF RAODIAGNOSIS OF RAO
ENDOSCOPY
DIAGNOSIS OF RAODIAGNOSIS OF RAO
ENDOSCOPY
COPD Normal
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RAO THERAPYRAO THERAPY
THREE GOALS
• Optimize environment
• Clear airways (mucus and debris)
• Decrease inflammatory response
Therapeutic efforts are nearly
always unsuccessful unless to horse’s environment is altered and exposure to
offending allergens is eliminated.
Therapeutic efforts are nearly
always unsuccessful unless to horse’s environment is altered and exposure to
offending allergens is eliminated.
MANAGEMENTMANAGEMENT
• Turn horse out to pasture
• Improve stable ventilation
• Change bedding
• Adjust diet
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Medical TreatmentMedical Treatment
• Broncodilators
• Oral corticosteroids
• Expectorants
• Antihistamines
• Inhalation therapy
Drug TherapyDrug Therapy
INHALATION THERAPYINHALATION THERAPY
• Direct delivery to site of problem
• Minimizes side-effects
• Aero Mask or metered-dose inhalers– Anticholinergic Agents
– ß2 Adrenergic Agonists
– Mast Cell Stabilizers
– Corticosteroids
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Flexineb
Cardiovascular• Heart murmurs
– Aortic
– Mitral
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Management of the Geriatric Horse
• Diet• Pain management• Preventative care
– Teeth– Farrier– Vaccination– Deworming
• Quality of life– Physical activity & exercise– Environmental and medical management– Seasonal changes in management
Pierre, age 33
Questions ?????
