What is quality of life for pets, and how do I assess it?
Pets can't tell us how they are feeling, so how do we quantify quality of life?
Hello there,
Whenever we turn to end of life discussions for pets, inevitably we should consider quality of life. What exactly does that mean, particularly as it relates to pets? If a pet is having normal body functions (eating, drinking, urinating, defecating, breathing, walking), is this a good quality of life?
Ideally, most pet caretakers would agree that freedom from pain or discomfort is also an important factor in quality of life. Our dogs and cats have evolved from wild creatures with strong survival instincts. Many pets may live with chronic pain but show few symptoms, which is an instinct from their undomesticated ancestors. Therefore, mere survival should not be enough to constitute a good quality of life. Chronic pain, however, can lead to subtle changes in behavior, such as sleeping more, or a decreased desire to play or interact with people. Noticing these changes can help us become attuned to shifts in quality of life.
As pets cannot communicate their experience through language, the burden of assessing quality of life falls to pet owners and veterinary professionals in perceiving subtle behavior changes. This can feel like a huge responsibility, and the weight of this can feel stressful.
As an internal medicine specialist, I discuss quality of life frequently with pet owners. Typically, animals with chronic illness will have some degree of difficulty with one or more of their normal body functions. However, if medications or therapy can improve that, generally that will result in an improvement in quality of life. Many chronic diseases may not be curable, but are treatable. The hope is that in addition to normal body functions and freedom from pain and discomfort, a good quality of life will also include activities and behaviors that the pet finds pleasure in. My Husky loved the beach, and happiness radiated from him when we were there. This type of a joy is a big part of a pet’s quality of life.
The difficult thing about quality of life is that we are trying to quantify something that is inherently non-quantifiable, and can be subjective. Luckily, during my career, as pets have become more like family members than just simply animal companions, many more tools have been developed to help us assess and discuss these delicate issues. I’ll start by discussing some of the things that I was taught in veterinary school and my training, and we’ll move on to some of the quantitative or scoring guides for assessing quality of life. My hope is that this discussion will be helpful for people struggling with these decisions; however, this information should be used in conjunction with the expertise and advice of your pet’s veterinarian.
FIVE FAVORITE THINGS:
One simple method to assess quality of life is for the pet owner to make a list of the top 5 favorite activities of their pet. When the pet is no longer doing or enjoying the majority of things on that list, then it is reasonable to assume they are not enjoying their time on this earth anymore.
The beauty of this assessment is the recognition that every pet, just like every human, is an individual and the range of likes and preferences of a pet can be just as infinite. For some pets, appetite may be a big part of quality of life, but it should not be the only guideline. Some pets will remain food motivated to their dying day (Labrador retrievers are famous for this), while others will have a very aloof lifelong relationship to food (I’m thinking of my notoriously picky Chihuahua). This is why it is a good idea to have at least 5 parameters, and it is helpful to get your family members or roommates (really anyone who has lived with and observed your pet closely) involved to make this list.
It is also important to make this list based on activities from when your pet was healthy and feeling well, compared to already debilitated and uncomfortable from a chronic illness.
My cat Wesley loved while I changed sheets on the bed to jump under the sheets and hide as I made the bed around him. It was a weird and quirky cat thing to do. But as he aged and his chronic gastrointestinal disease progressed, he did it less frequently, and then not at all. This, in addition to the other things on Wesley’s list (sleeping in a patch of sun, sitting on my lap, chasing a laser pointer, and watching the bird feeder outside my window) helped me realize when he was no longer comfortable enough or able to do the things he really enjoyed.
Although it sucked to say goodbye to him, using this method gave me some measure of peace of mind that I was doing it with his best interests at the forefront of my decision.
THE PENNY TEST:
During end of life for pets as well as people, some days are better than others. My grandmother had dementia at the end of her life, and she cycled on and off hospice care twice as her weight and appetite fluctuated. With a chronically ill or elderly pet, it is hard to know “when the right time” is when there can be small day to day variations. The biggest fear is that we may choose to end our pet’s life too soon, which feels like a huge burden of responsibility to have the power of that decision in our hands.
Sometimes the decision can come not because of one big traumatic change (such as a collapse or seizure episode), but small changes that are just worsening over time. Some days they might have more energy, and some days they may sleep all day. Some days they can finish all their food, and some days they walk away from the bowl without interest. They may urinate in their bed one day, but seem to have completely normal bathroom habits the next. It’s emotionally draining to try and track all these changes and feel comfortable that you are making the correct decision to euthanize.
Something that may help is to have two jars: one labeled for good days and one labeled for bad days. At the end of each day, you can assess how your pet did in terms of appetite, energy, comfort, bathroom habits, activity level and determine if it was a good or bad day for them. Put a penny in the correct jar. Over time, it will give a visual representation if your pet is still having more good than bad days, and still has a good quality of life.
QUANTITATIVE GUIDES:
These are guides that have scoring systems that allow you to have a numerical value associated with quality of life. They are really valuable for monitoring changes over time, since when we live with our pets, it can be easy to miss small day to day fluctuations. With pets that have chronic or terminal illness, I recommend using these guides to score their pet on a regular basis, which may be monthly, weekly or daily depending on the severity of disease.
Dr. Alice Villalobos, a veterinary oncologist, was a very early practitioner of hospice and palliative care for pets. Her guidelines are the basis of many current quantitative guides, and an article she wrote along with the scoring chart she created can be seen here:
In addition, the Ohio State University’s Veterinary Medical Center has an incredible non-profit program called Honoring The Bond. The information they are putting out is an incredibly useful resource. I very often use their quality of life assessment chart in my practice, and with my own pets in monitoring their quality of life. You can find this chart, in addition to information on making this difficult decision, here:
As with any other tool for quality of life, these quantitative guides are just that, a tool, which should be used in conjunction with your own observations and perceptions, in addition to the advice of your pet’s veterinarian. But they provide a good source of information about things to monitor for, as well as guidance for how to decide what decision may be right for you personally. I hope you have found this helpful.
Thanks for reading, and until next time,
-SG