section epub:type=”chapter” id=”c0008″ role=”doc-chapter”> Ilona Rodan and Andrew Sparkes Cats are popular companion animals and are often considered to be family members. However, cats still receive less veterinary care than dogs. Most cat owners are concerned about their cats’ behavior and well-being – and if veterinarians do not have the opportunity to provide reliable information, they will often search elsewhere, and cat welfare may be compromised. This chapter discusses the benefits of feline preventive health care, the barriers we face today, the opportunities for improvement, and the components of a comprehensive preventive health care program tailored for each life stage. Cat; feline; preventive health care; human-animal bond; feline-friendly handling; Cat-Friendly Practice; vaccination; life stage; pet health insurance; medical history; environmental needs; neutering; nutrition; minimum database; genetic testing; dental care; parasite control; microchip Cats are popular companion animal in many countries, and are considered to be family members by most owners (Fig. 8.1).1–3 Despite their popularity and the affection held for them, cats still receive far less veterinary care than dogs, and preventive care is especially lacking.4,5 This chapter discusses the benefits of feline preventive health care, the barriers we face today, the opportunities for improvement, and the components of a comprehensive preventive health care program tailored for the life stage. As veterinarians, we have a crucial responsibility to address the welfare of our patients, helping them to cope with the lifestyle that we provide for them while still allowing them to perform normal species-specific behaviors.6 Feline preventive care should thus include consideration of the physical, emotional, and mental health of the cat.6 Although veterinary education has historically largely focused on physical health, caring for emotional and mental health is now an important component in veterinary continuing education, journals, and books such as this. Clients are concerned about their cats’ behavior and well-being – and if we do not provide information, they will often search elsewhere, and cat welfare may be compromised. Cats are especially in need of preventive health care because they hide signs of pain and illness – a protective mechanism derived from predator avoidance and survival as a solitary hunter in the wild. Cat owners are willing to seek more veterinary care when they understand its importance. For example, most owners would be willing to take their cat for more frequent veterinary visits if they knew that it could help prevent problems and reduce more expensive treatment later on, and if the care would help their cat live longer.4,7,8 Thus to achieve optimum feline health care, veterinarians must engage with clients so they understand the benefits of preventive care. An essential part of that engagement is listening and responding to owner concerns. An important component of preventive care is client education about how to prevent undesirable or problem behaviors, and the potential negative ramifications of these, including punishment, breakdown of the human–animal bond, relinquishment, and euthanasia of pet cats. The three key elements of a comprehensive preventive health care program are: By engaging in proactive preventive health care that incorporates these three key elements, owners and cats receive many benefits including: Millions of cats in the United States alone do not receive adequate veterinary care. One of the biggest hurdles is that cat owners are often unaware of the medical needs of their cat and the importance of preventive health care.8 Troubling statistics indicate that dogs are taken to the veterinarian more than twice as often as cats; and 50% or more of cats may not receive an annual examination.5,7,8 Even in households with both cats and dogs, the cats received less veterinary care than the dogs,8 with adult cats especially lacking in preventive health care. Unfortunately, adult cats have many diseases that are often overlooked, such as obesity, dental disease, and lower urinary tract disease. Adult cats are also more likely to be surrendered because of problem behaviors,9 and a lack of care impacts welfare, morbidity, and longevity. The reasons for the relative lack of veterinary care for cats are many and varied, but important factors include the following: Despite the problems recognized, there are huge opportunities to improve feline preventive health care, increase the number of feline patients, and increase the frequency of feline veterinary visits. Many of these opportunities have been identified in large, published studies.5,7,8 The open-access American Association of Feline Practitioners (AAFP)/American Animal Hospital Association (AAHA) Feline Life Stage Guidelines3 provide evidence-based recommendations to help veterinary teams and clients understand each component of feline preventive health care and the associated benefits. Additionally, important resources aimed at both owners and veterinarians to help improve engagement with preventive health care are available. Guidelines have also been developed to help with behavioral issues, vaccinations, and common conditions of older cats such as chronic kidney disease, diabetes mellitus, hypertension, and hyperthyroidism ( A veterinarian’s communication skills, interactions with cats, and ability to engage with the owner about the cat’s needs drives the client’s perceptions of the value of services and the quality of the care. Studies have found that clear and thorough communication with the veterinary client could ultimately increase adherence by as much as 40%.8 For example, when the veterinarian recommended and clearly explained the service and benefits to the owner, preventive dental care increased 64%.8 Communication skills can be improved to enhance interactions with clients – learning resources are available at major veterinary conferences, through webinars, and in books and journals. It is also important to ensure that all members of the veterinary team have excellent communication skills, not just the veterinarian, and ensure adequate time is allowed for consultations.12 How veterinary teams interact with feline patients and having a “feline-friendly” hospital environment can have a positive impact on the frequency of examinations and the number of feline patients. Most clients do not know how to evaluate the quality of veterinary care, but they do know how veterinary team members handle cats – clients don’t care how much we know until they know how much we care for them and their cats. Information on “feline-friendly” handling is found in Chapter 1: Understanding the Cat and Feline-Friendly Handling, and the hospital environment in Chapter 2: The Cat-Friendly Practice. These vital aspects of clinical practice help overcome resistance to feline visits. Whether the practice is an exclusive feline, companion animal, or mixed animal hospital, steps must be taken to make feline veterinary visits more pleasant. Providing a separate waiting room or a separated waiting area for cats or placing them directly in an examination room to avoid stressors in the reception area (smells, sights, sounds) are some examples of how the hospital environment can be more feline-friendly. If one person in a companion animal or mixed animal hospital has empathy with cats and cat owners, that person can be dedicated to work with feline appointments as much as possible. Transporting the cat to and from the veterinary clinic is a major hurdle for most owners and providing good information to ease this difficulty is an important part of being feline-friendly and should be offered when the appointment is scheduled. When seeing a family dog or cat, veterinary teams should always inquire about other cats in the household. If there are cats from the same household with existing records at the practice, asking about them during the visit for the scheduled patient can help detect and educate clients about needed care for the other cat(s). When seeing a new client, team members should ask about all the pets in the household and recommend that all cats receive routine veterinary care. Developing a true partnership with cat owners is important and can pave the way to working together as a team to provide cats with quality health care. Although surveys suggest that cat owners in general are more highly educated than dog owners, they may not necessarily have enough information to always make the best decisions for their cats, and they may be open to seeking increased services with effective communication from a veterinarian.8 This highlights the opportunity for veterinarians to substantially increase overall preventive health care for cats by providing thorough explanations and recommendations to owners regarding the benefits for their cat(s). Recommendations made during a consultation should be supported with written information, and it can be helpful to point clients to additional educational resources such as those in Study findings also reveal that owners with the strongest bonds with their pets are more likely to seek preventive health care and to follow a veterinarian’s recommendations regardless of cost.8 Especially during kitten appointments, veterinarians have the opportunity, over multiple visits, to enhance the client–cat bond by informing clients about normal cat behavior, how to meet the cat’s needs, and how to prevent behavior problems. This is also the perfect time to make sure that clients seek veterinary advice first for any behavior questions or concerns. Although the Internet is a popular source of information for pet owners, those that visit a veterinarian are more likely to use the veterinarian as a source of information,13 and more than 90% want their veterinarian to recommend good sources of online information, providing a great opportunity for veterinarians to recommend appropriate resources.14 Ensuring owners understand cat behavior, the ways in which the environment and various resources can enhance cat welfare, and when to seek advice and help has an enormous role to play in maintaining healthy and happy pet cats. Education about the ongoing care needs of adult cats should occur at the last kitten visit (e.g., comprehensive examination and history, dental prophylaxis, weight management, and vaccinations). Prebooking the next preventive health care visit (scheduling the appointment before the owner leaves) also increases adherence. Promoting the benefits of preventive health care for adult cats is especially important due to the lack of routine veterinary care during this life stage, and the silent diseases that commonly occur (e.g., obesity and dental disease). Poor intercat relationships often go unnoticed during this life stage too and may lead to behavior problems and relinquishment of cats. Early detection and intervention for these problems positively impacts the welfare of adult cats. Consistency in health care messages increases credibility and owner buy-in. Unfortunately, there is a large variation in recommendations for dental care, parasite prevention, behavior, and vaccinations from one veterinary practice to another. The AAFP/AAHA Feline Life Stage Guidelines3 provide a comprehensive care plan for all feline life stages, allowing veterinarians to make consistent recommendations, and increase credibility within the profession. It also needs to be recognized that not all owners will want (or can afford) all preventive health care recommendations, but it is important that recommendations are made and that the needs and abilities of the individual owner are explored, and a plan is agreed upon. Getting agreement and owner buy-in through mutual decision-making, even if the agreed protocol may fall short of the “gold standard,” is more likely to result in long-term adherence and success. Consistent recommendations from all veterinary team members within a practice are also crucial. Does every cat that presents for preventive health care receive all the recommendations? Making a detailed checklist of every preventive health care service that is recommended and reviewing each patient’s record to determine which recommendations are appropriate for each visit are paramount to making consistent recommendations and preventing missed services for individual patients.10 An example of a checklist is provided in Using resources that are already available to help educate clients on the importance of preventive health care services saves time and increases credibility. Excellent resources are available from AAFP (https://catfriendly.com), Cat Healthy (http://www.cathealthy.ca), and International Cat Care (https://catcare4life.org). In addition, there are public awareness campaigns such as National Pet Wellness Month (October) that have client materials and websites. Other resources are listed in Dividing preventive health care recommendations into the feline life stages allows one to focus on the specific physical and behavior changes and needs of each life stage (e.g., congenital defects in kittens, obesity prevention in young adult cats, and degenerative joint disease (DJD) management in senior cats). Senior cats have previously been identified as cats 7 years and older. However, many cats live more than half their lives in their “senior” years by this definition and so this age group can be broken down further into senior and geriatric (or “super senior”) stages (Fig. 8.2). Providing the cat’s age in comparison with the equivalent human age helps owners recognize that cats age much faster than people (see Fig. 8.2). It is important to remember that, as with people, individual animals and body systems age at different rates, and that any individual can have a condition not common to that life stage (e.g., hyperthyroidism in a 5-year-old cat). Additionally, recommendations must be based on the individual’s lifestyle (e.g., indoor only, supervised outdoor access, free roaming), history, clinical signs, and physical examination findings (Chapter 3, Deciphering the Cat: The Medical History and Physical Examination). It is important to start with open-ended questions (questions that allow owners to express their opinions or concerns, rather than questions that can be answered with a yes or no).15 These questions can be followed with more specific as well as closed-ended questions to identify further information. For example, asking the open-ended question, “What behavior changes have you noticed since the last visit?” will help with early detection of both behavioral and medical concerns, because the earliest signs of both pain and sickness are usually changes in behavior. In fact, 20%–50% of behavior cases seen at a behavior clinic have underlying medical problems.16,17 Asking more specific questions, such as, “How often does your cat go outdoors?” or “Does your cat catch mice or other live animals?” provides information needed to individualize care for that patient. Comprehensive or holistic feline preventive health care consists of several components to maintain the overall health and welfare of the cat. Although each life stage requires care from each category, they are individualized by life stage as needed. Table 8.1 provides recommended topics for client education and action items for preventive care. Table 8.1 Adapted from: Quimby J, Gowland S, Carney H, et al. 2021 AAHA/AAFP feline life stage guidelines. J Feline Med Surg. 2021;23:211–233. In contrast to dogs, most cats live in multiple cat households, with 31% of owners having two cats, and 24% having three or more cats.1,18 Around 70% of cats are adopted or acquired at no cost to the owner and may be “impulse acquisitions” without owner education.5 Preadoption or preacquisition counseling is therefore also an important service, providing an opportunity to give realistic information about living with a cat, how to set up the home for success, and if the owner wants to adopt more than one cat, how to adopt an existing social group such as siblings. A preventive health care examination and consultation is recommended at least annually for all cats. Veterinarians and veterinary organizations often recommend semiannual preventive health care examinations for cats of all life stages because changes in health status may occur in a short period of time; ill cats often show no signs of disease; and earlier detection of ill health, body weight changes, and dental disease allows for earlier intervention. In addition, semiannual examinations provide an opportunity for more frequent communication with the owner regarding behavioral and attitudinal changes, and education about preventive health care. Both the AAFP Senior Care Guidelines19 and the AAHA Senior Care Guidelines for Dogs and Cats20 recommend semiannual examinations for apparently healthy cats 7 years of age and older. Cats with previously diagnosed health conditions may need more frequent examination. Further research is needed to identify the optimal examination schedule to maximize the health and longevity of all cats. Most cat owners do not leave a veterinarian due to the cost of care8 but clients may use more than one veterinarian for different purposes (e.g., obtaining preventive care at a lower cost clinic and management of disease with someone whose knowledge they value). Economic realities must be considered. It is important to address the cost of care and the value of the service, and to give clients a schedule and treatment plan (including cost estimate) for upcoming visits so that they can plan expenses. All pet owners should be encouraged to consider their ability to meet unexpected veterinary expenses and how they can manage these expenses. A variety of options are available including use of specific savings accounts, credit card reserves, and medical payment plans. However, proactive planning through monthly budgeting for pet care expenses, pet health insurance, or a pet health plan is a better option – see also the AAHA Statement on Meeting the Cost of Pet Care ( Pet health insurance has become a good method of mitigating health care expenses. The proportion of cats insured varies greatly among different countries, but it is almost invariably lower than the proportion of dogs insured. Pet insurance can provide excellent value and allow patients to receive expensive urgent care and crisis management when costs may otherwise prove prohibitive. Some policies also offer preventive health care coverage. Each insurance company works differently, with cheaper policies providing a lower level of coverage; clients are encouraged to review policies carefully. Few clients are aware of pet insurance without a specific veterinary recommendation; the veterinary team should explain benefits and possible limitations of pet insurance. In the United States, there is a website that compares pet insurance for cats ( To address the physical, emotional, and mental health of feline patients, behavior must be incorporated into preventive care recommendations. Additionally, because cat owner considerations focus on well-being – including behavior, play, and nutrition – these will be addressed first, followed by the more traditional preventive care recommendations. Addressing these topics will build client loyalty and are the foundation to building strong human-cat relationships. Preventing problem behaviors helps protect and strengthen the human–cat–veterinary bond and increases the quality of life for both cats and cat lovers. Despite continued advances in feline health care, prevention of behavior problems is the weakest area of most preventive health care programs for cats. It is also the most serious problem when it comes to disruption of the human–animal bond and may result in relinquishment and/or euthanasia of pet cats. The two most common feline problem behaviors leading to surrender are house soiling and intercat conflict.21 The following findings indicate the enormous impact of problem behaviors in cats: Fortunately, and importantly, if potential triggers and causes of problem behaviors that clients are unaware of are recognized and addressed early, the problem behaviors may never arise. It is crucial that veterinary teams and clients are educated about preventive behavior health care. During preventive health care appointments, there are two ways to help clients with cat behavior. First, client concerns and behavior changes are identified via the medical history; and second, client education is used to improve welfare and prevent behavior problems. The medical history is critical for early detection of problem behaviors and to identify risk factors that might lead to problem behaviors. Obtaining information about indoor versus outdoor lifestyle, other cats in the household and how they interact, and other potential stressors for the cat is vital. An excellent question to ask is, “What changes in behavior or undesirable behavior have you noticed?” This allows veterinarians to detect problems early, educate clients that behavior changes are often due to underlying medical problems, and address the client’s concerns about unwanted behavior. Since owners are often unaware of potential stressors, veterinarians should ask about intercat relationships, and specifically if the cats have positive physical contact (e.g., grooming one another, sleeping while touching each other), or if a cat hides or is withdrawn from other cats. It is also important to ask about essential resources and their placement to ensure that each cat has unrestricted and appropriate access. Using behavioral and/or environmental resource checklists for owners may be a useful way of highlighting potential problems. The second behavior opportunity during preventive health care appointments is client education about normal cat behaviors and environmental needs. With informed owners, cats can retain their normal behaviors in ways that are also acceptable to cat owners. Client education should be started at the earliest appointments and reviewed during each life stage. Dog obedience training and the receipt of advice regarding companion animal behavior reduces the risk of relinquishment to an animal shelter and increases human–companion animal interactions.22 A similar approach can be taken for cats by having training or “Kitten Kindy” classes (see Chapter 14, Kitten Socialization and Training Classes) that promote owner education and understanding of normal cat behavior, cat needs, and prevention of problem behaviors. Such an approach may help reduce the relinquishment of cats and enhance human–cat relationships. Veterinarians must also educate clients to contact the veterinary practice with behavior questions and concerns, hopefully preventing misinformation from other sources. If more advanced behavior care is required, referral to a board-certified specialist is important to help maintain the human–animal bond and the practice’s relationship with the client. A list of board-certified veterinary behavior specialists can be found through the American College of Veterinary Behaviorists, the European College of Animal Welfare and Behaviour Medicine, and the Australian and New Zealand College of Veterinary Scientists ( Controversy exists over whether cats should be kept indoors only or in an indoor/outdoor environment. These debates usually reflect geographic and cultural differences. An indoor/outdoor lifestyle may provide a more natural and stimulating environment for cats, but also increases the risks of infectious disease and trauma, as well as predation on wildlife. Supervised or controlled outdoor access (e.g., a safe outdoor cat enclosure, leash walking) has been recommended to reduce some of the risks otherwise associated with access to the outdoors (Figs. 8.3 and 8.4). An indoor-only lifestyle may decrease the risks of infectious disease and trauma and increase longevity, but also may increase the risks of compromised welfare and illness due to environmental limitations. The AAFP has released a position statement32 that encourages safe outdoor access for cats to improve their behavioral welfare. Appropriate environmental resources are essential for maintaining the mental, emotional, and physical well-being of cats housed indoors.6,33,34 Addressing the cat’s species–specific environmental needs is important for all cats, even if they only spend part of their lives indoors, and critically important in cats where there is no access to other environments. Providing essential environmental resources allows cats to perform normal behaviors, which are like those of their ancestors, in a manner that is acceptable to cat owners. Cats need resources in the house to allow them to perform normal behavior such as cat scratching posts in desirable locations; and cat trees, perches, or shelves to allow for climbing, resting, and to increase overall space in the home (Figs. 8.5 and 8.6). Encouraging normal feeding behaviors (e.g., multiple small meals, using puzzle feeders) and provision of multiple toileting (litter box) areas are also necessary. Many cats also like hiding spots, especially in multicat households or where there are children or visitors in the house. Play is an important component of the cat’s day and playing with siblings is important for social development. Cats often enjoy both interactive toys and hunting games, but they also enjoy playing on their own and rotation of toys helps prevent boredom. See Fig. 8.7 for a summary of feline environmental needs. Excellent resources are available to educate veterinary teams and cat owners about cats’ environmental and other needs ( Meeting the cat’s environmental needs helps prevent behavior problems and is also necessary for management of most problem behaviors, either as the only intervention or as an important component of the treatment plan. Multimodal environmental modification has been suggested to decrease clinical signs of feline idiopathic cystitis, as well as respiratory and gastrointestinal diseases,30,35 although more controlled studies are needed to confirm efficacy of this intervention. The more cats present in the household, the more space is needed, and the more resources are required to ensure good welfare for the individual cats and help prevent problem behaviors. Litter boxes are an excellent example of an important resource and why cats need multiple resources in different locations.6 The usual recommendation is for one litter box per cat plus one extra, so that if there are three cats, there should be four litter boxes in the household, and importantly these should be put in different locations to allow free access by all cats.6 In a multiple floor dwelling, a minimum of one box should be placed on each floor to which the cats have access. This allows each cat to have easy access to a litter box regardless of where they are in the house and lessens concerns about another cat blocking access to or bothering the cat in the box. Boxes should be in easily accessible areas, but not in high traffic areas. Most cats prefer unscented clumping litter,36 and some cats may find scented litters aversive. Litter boxes should be scooped a minimum of once daily, and changed completely at least once weekly for clay litter, and once every 2 weeks for clumping litter. Cats also prefer larger litter boxes, so that they can comfortably turn around in the box. A suggested length is approximately 1.5 times the size of the cat, from the tip of the nose to the base of the tail.25 Most commercial cat litter boxes are too small; plastic sweater storage boxes and litter boxes for small dogs can make excellent choices (Fig. 8.8). It is important to have a low lip or edge at the entrance to the box for cats with impaired mobility or other health problems to prevent difficulty getting into and out of the box; dog litter boxes often already have easy access, or an opening can be cut out of a sweater or other plastic storage box (Fig. 8.8). Cats learn best through rewarding and reinforcing desired behavior, while ignoring or redirecting undesired behavior. Cats should never be punished verbally or physically! Verbal client communication should be supported with client handouts or other educational materials. Excellent client education handouts are available through the AAFP and International Cat Care ( Kittens have a strong drive to play. Intercat social play peaks at about 12 weeks of age,37 after which object play becomes more prevalent. Toys offer an outlet for normal predatory sequences as part of play and help prevent play biting. The primary sensitive period of cats is from around 2–7 weeks of age.38 If kittens associate positive experiences with exposure to a variety of people (e.g., men, women, adults, and children) during this age, they are more likely to accept being approached and held by people later on in life.39 Kittens should be handled gently and positively. They should be exposed as early as possible (and repeatedly during the sensitive period) to any stimuli or handling techniques the cat may encounter during their lifetime (e.g., children, dogs, nail trims, tooth brushing, car rides) (Figs. 8.9 and 8.10). Positive cat carrier, car, and veterinary experiences as early as possible can also improve future veterinary visits (Fig. 8.11). Positive behaviors should be rewarded using food or other appropriate rewards; kittens should never be punished as it may elicit defensive aggression. It is important during this life stage to teach owners to continue training so the cat will allow manipulation of mouth, ears, and feet. Intercat relations may change when a cat reaches social maturity at 2–4 years of age (when free-living offspring tend to leave the family unit), and intercat conflict may develop.6 Stress associated with the change in intercat relationships can lead to house soiling or urine spraying. It is critical to provide needed resources in multiple areas. Synthetic feline facial pheromone (e.g., Feliway Classic diffuser and spray, Ceva Animal Health) and synthetic feline appeasing pheromone (Feliway Friends or Feliway Multicat, Ceva Animal Health) therapy may help enhance intercat relations and may help provide emotional stabilization,40 but their use is not a substitute for careful environmental and other management strategies. More information about pheromone therapy is found in Chapter 17: Behavioral Therapeutics. A decline in play activity in adult and mature cats increases susceptibility to weight gain, whereas increased activity through play may lead to weight loss.41 Senior cats with behavior changes (e.g., vocalization, changes in litter box usage) should always be evaluated for an underlying medical problem. One study found 28% of pet cats aged 11–14 years develop at least one behavior problem, increasing to greater than 50% of cats over 15 years of age.42 Clients can be educated about subtle behavior changes that are not “just old age.” Cats in this age group need easy access to the litter box, bed, and food, and should be monitored for signs of pain and mobility problems. Senior cats may also have decline in cognitive function, with confusion and vocalization, although the latter may also be caused by other senior conditions (e.g., vision or hearing loss, hypertension, hyperthyroidism). It is important that we help clients assess quality of life issues. A mobility and cognitive dysfunction questionnaire is provided in the AAFP Senior Care Guidelines to help clients identify problems earlier,19 and tools to assess mobility such as the Feline Musculoskeletal Pain Index have been developed.43 End-of-life care should focus on maximizing patient comfort and minimizing suffering through partnering with caregivers. Scratching is a normal feline behavior used for stretching activity, to condition claws, and to mark territory both visually and with scent. It is important to educate clients that this is a normal behavior, and that it can be directed to areas that they consider appropriate. Scratching materials preferred by most cats include wood, sisal rope, and rough fabric. Since cats often stretch and scratch upon awakening, scratching posts should be placed next to where the cat sleeps. Most adult cats prefer vertical scratching posts that consist of rope, whereas senior cats prefer carpet.44 However, if a cat continues to scratch on undesired objects, provide different scratching posts and in different locations. For example, a cat that scratches where new scents enter the home, such as the front door, does better with a post placed at the door. Vertical and angled posts should be sturdy, and tall enough for the cat to get a good stretch. In multicat households there should be several scratching posts, both vertical and horizontal, located throughout the house. Kittens and cats can be trained to scratching posts by enticing the cat to the post with catnip, treats, or toys, and rewarding behavior on the scratching post. Use of the synthetic interdigital pheromone on the scratching post (FeliScratch, Ceva Animal Health) may also help. If the cat scratches elsewhere, the cat should be picked up gently and taken to the scratching post, and then rewarded. If the cat continues to go to the other area, double-sided sticky tape can be used on the area, or it can be covered with a texture the cat doesn’t like to make this area less appealing. Cats should be rewarded for desirable behavior, and never punished verbally or physically. Feline onychectomy or declawing is illegal in many European countries, Australia, New Zealand, Brazil, and Israel. In the past, declawing was considered routine in the United States and Canada but is now strongly opposed by AAFP (https://catvets.com/guidelines/position-statements/declawing) and AAHA (https://www.aaha.org/about-aaha/aaha-position-statements/declawing). The American Veterinary Medical Association (AVMA), AAFP, and AAHA all address the welfare implications of acute and chronic pain due to declawing, and inability to perform normal behaviors. There are good alternatives to onychectomy, including training cats to scratching posts and nail trimming. In most cases, clients can be taught to trim nails, especially with kittens. Nail trimming should be performed in a calm environment, with positive reinforcement for the cat. In addition to nail trimming demonstrations, at home education can be reinforced with client education handouts or a video on nail trimming ( A study comparing 137 declawed with 137 non-declawed cats found increased undesirable behaviors (e.g., biting, inappropriate elimination) and back pain in the declawed cats. An optimal surgical technique where P3 was removed in entirety was associated with fewer adverse outcomes but cats remained at increased risk of undesirable behavior compared to control cats.45 Although most cats do not need bathing, regular combing helps identify skin or coat problems more quickly and prevents matting and ingestion of excess fur. Longer hair coats need more care. Brushing only cares for the topcoat but combing or using special grooming tools (e.g., FURminator, Spectrum Brands) will allow care of the undercoat as well. Overweight cats or those with impaired mobility may have difficulty grooming themselves and need added attention, especially to the back half and underside of the body. Providing optimal nutrition is a crucial part of preventative health care for cats at all life stages. Feline nutrition is covered in more detail in Section 3 of this book, but some of the basics relating to preventive health care are briefly reviewed here. Cats are obligate carnivores, with a predatory rather than scavenging natural lifestyle and a preference for consumption of small frequent meals. Their natural diet (largely wild rodents) is one that is relatively high in protein and fat and studies show cats have a preference for diets that mimic this profile.46 As obligate carnivores, cats have a high dietary protein requirement and a number of animal-derived nutrients are obligatory in their diets such as the amino acids taurine and arginine; vitamins A, D, and B3 (niacin); and the essential polyunsaturated fatty acids, although requirements also vary with life stage.47,48 The precise energy and nutrient requirements of cats vary depending on various factors such as age (e.g., increased nutrient demand during growth and reduced digestibility in older cats), neuter status, activity levels, pregnancy, etc. Although home-prepared diets may be used to support all feline life stages, ensuring all macro- and micronutritional needs are adequately provided in such foods can be highly problematic, and there may be risks associated with the use of, or feeding of, raw foods (such as transmission of infectious diseases). Commercially available dry or wet foods that meet the Association of American Feed Control Officials nutrient requirements of cats at different life stages (e.g., for kittens and lactating queens) and that have been tested using feeding trials are most likely to be satisfactory. Development of food preferences in cats is a complex subject and is incompletely understood. In general, cats display strong neophilic feeding behavior – that is, they seek out different and varying food types and may develop a “monotony effect” – an aversion towards foods that have formed a large part of their diet. This behavior may be protective in the wild, as consuming a variety of foods should reduce the likelihood of an unbalanced or deficient diet. The natural neophilic tendency appears to be much stronger in free-living cats and can be abrogated in cats raised on nutritionally complete diets. Kittens are also strongly influenced in their food preferences by the queen,49,50 and some cats develop a strong preference for their weaning or normal diet.49,51 A good example is the kitten that only ate dry food and will not accept canned food as an adult. Thus, while many cats may prefer to consume a variety of foods, some will develop very strong preferences (likely influenced by early experiences and reinforced by owners feeding a constant diet) so that switching to an alternative diet or food source may be problematic. It is impossible to replicate the natural diet or feeding conditions of wild cats, but partially mimicking hunting through provision of dry food in foraging devices (e.g., food puzzles) and/or to feeding multiple small meals in several widely dispersed places in the home (including the use of “hidden” food) may help to slow food intake and provide mental and physical stimulation for the pet cat (AAFP FelineFeeding Programs, Neither wet (canned) or dry commercial foods mimic the texture, consistency, or energy density of the natural feline diet, but both have been demonstrated to be effective in maintaining optimal nutrition. In healthy cats, there is no evidence to suggest either dry or wet foods are better nutritionally, and the choice of which to use depends largely on owner preference.52 However, there is some evidence that the feeding of dry food as a substantial part of the diet may increase the risk of obesity (and obesity-related diseases)53,54 and that feeding at least 50% of the diet as wet food may help reduce this risk. In certain disease conditions where increased water intake is desirable, feeding wet rather than dry foods may help improve daily water intake. Feeding at least some wet food from kittenhood onwards may have benefits if there is a subsequent need to increase the proportion of wet food in the diet. A change of diet may be necessary at various times in the life of the cat, for medical or other reasons. Changing the diet can be problematic for several reasons, including those associated with food preference. Whether a cat has been fed a single food or a variety of foods does not seem to be associated with an easier ability to introduce a new food. General considerations with the introduction of a new food are to provide an isocaloric intake compared with the old food (unless specific adjustments are necessary); and to offer the new diet along with the old diet for a period of time, potentially mixing the two or placing side by side and gradually increasing the proportion of the new diet. Mixing the diets together may increase acceptance of the new diet by some cats and minimize the risks of any gastrointestinal disturbance that might occur with a sudden change. Where necessary, warming the new diet and increasing palatability by adding fish juice may help. However, in cats that are nauseous, vomiting, or in pain (as may occur in many sick cats) there is a high risk of inducing food aversion if a new diet is offered. In this situation, it is essential to manage the nausea, vomiting, and pain before attempting to introduce a new food. Additionally, a new diet should not be started while a feline patient is hospitalized as food aversion may occur due to a stressful environment. Instead, offer the regular diet and if a new diet is recommended, instruct the owner to gradually introduce it after the cat has returned home. Obesity, generally defined as ≥20% above ideal body weight, is prevalent in cats in many Western and other developed countries. Estimates of the proportion of overweight cats is as high as 63%,55 and obesity is associated with a number of other diseases such as diabetes mellitus, hepatic lipidosis, DJD, and lower urinary tract disease.56 Obesity is most prevalent in middle-aged cats; other risk factors include neutering, sex (more prevalent in males), lack of exercise (indoors only, no other animals in the house), owner underestimation of the cat’s body condition, and feeding over 50% of the diet as dry food, even in young adults.53,54 Interestingly, in a study from the Netherlands, it was shown that there is an association between the degree of obesity in dogs and the body mass index of the owner, but no such relationship has been found for cats and their owners.57 Nevertheless, the complex human–pet interactions associated with feeding are undoubtedly an important component in the high prevalence of obesity.58 Neutering appears to be a major contributory factor to the development of obesity, with both male and female cats being less active after neutering and undergoing hormonal changes that also contribute to obesity through a lack of regulation of food intake.59–61 Prevention of obesity during the postneutering period is a crucial goal in preventive veterinary medicine, and careful discussions with clients should include the need to restrict caloric intake following neutering by carefully measuring daily food allocations, avoiding ad libitum feeding, encouraging activity, and considering the value of a different diet type (e.g., increased moisture, air, and/or fiber) to help control caloric intake. Regular monitoring of body weight and body condition score along with appropriate adjustments of caloric intake are vital. Neutered cats are likely to need approximately 30% fewer calories than typically indicated on feeding guidelines on cat food packaging.62 The use of cat food puzzles, hidden food, encouraging foraging through other means, and regular periods of play can be of value in both aiding exercise and avoiding overeating at mealtimes (Fig. 8.12).6,41
Preventive Health Care for Cats
Abstract
Keywords
INTRODUCTION
THE BENEFITS OF FELINE PREVENTIVE HEALTH CARE
CURRENT BARRIERS TO FELINE PREVENTIVE HEALTH CARE
Understanding the Problem
The Opportunities
e-Box 8.1).
e-Box 8.1 and e-Table 8.1.
e-Fig. 8.1.
e-Box 8.1.
FELINE LIFE STAGE PREVENTIVE HEALTH CARE
COMPONENTS OF A COMPREHENSIVE FELINE PREVENTIVE HEALTH CARE PROGRAM
General Discussion and Action Items for All Ages
Kitten (Birth to 1 Year)
Young Adult (1–6 Years)
Mature Adult (7–10 Years)
Senior (>10 Years)
General
Frequency of veterinary visits (an examination is recommended at least annually); Early and subtle signs of pain or illness; Prevention and early detection of disease; Financial planning; Disaster preparedness; Estate planning; Identification; Pet insurance; Breed health care predispositions; Claw care and alternatives to declawing; Congenital and genetic disease concerns; Food and water intake; Appropriate diets and feeding management.
Specific management of mature and older cats is described in the AAFP Senior Care Guidelines (20) and AAHA Senior Care Guidelines for Dogs and Cats (21).
Behavior and environment
Intercat interactions and social play may decline with maturity; Provide continued training to allow manipulation of mouth, ears, and feet; Review environmental needs; Teach techniques to increase the cat’s activity (e.g., retrieve a toy); Encourage object and interactive play as a weight management strategy.
Increased importance of easy accessibility to litter box, bed, food.
Medical/surgical history; sterilization
Discuss sterilization, including pros and cons of surgery at different ages.
Perform sterilization if not yet done; Discuss establishing baseline data to assess subsequent changes (e.g., weight, BCS, MDB); Discuss baseline adult data to assess subsequent changes (e.g., weight, BCS, MDB); Ask about vomiting, hairballs, and diarrhea; Ask about changes in behavior; ask about changes in grooming habits.
Elimination
Litter box setup, cleaning, and normal elimination behavior.
Confirm that litter box size accommodates growing cat.
Review the size and edge height of litter box to ensure that the cat can enter easily as it ages.
Adjust litter box location, size, height, and cleaning regimens as necessary.
Nutrition and weight management
Monitor for weight changes and feed to moderate body condition; Note that caloric needs decrease after sterilization and increase in breeding females; Feed to moderate body condition; Monitor weight, BCS, and muscle condition score and modify food intake accordingly.
Feed to moderate body condition; Monitor weight, BCS, and muscle condition score and modify food intake accordingly.
Oral health
Monitor and discuss.
Monitor and discuss.
Monitor for oral tumors, inability to eat, and decreased quality of life from painful oral or dental disease.
Parasite control
Continue fecal exams 1 to 4 times per year depending on health and lifestyle factors.
Vaccination
Review, complete, continue vaccination series; screening for FeLV and FIV.
Frequency of Examination
Meeting the Costs of Veterinary Care
e-Box 8.1).
Pet Health Insurance
e-Box 8.1). In Europe, pet insurance is available from a wide range of companies, some of which specialize in pet insurance. An alternative or addition to pet insurance is a Pet Health Plan where owners pay a monthly fee that covers all aspects of routine preventive health care for their pet, including consultation fees, vaccinations, parasite control, etc. These are things that insurance generally does not cover and allows costs of care to be spread over time for the owner.
General Preventive Health Care Recommendations
Behavior
e-Table 8.1). In areas where behavior specialists are not available, alternatives include telephone or video consultations with a specialist or referral to a veterinarian with a special interest and extensive training in feline behavior.
INDOOR VERSUS OUTDOOR LIFESTYLE
MEETING THE CAT’S ENVIRONMENTAL NEEDS
e-Box 8.1).
e-Box 8.1), and include the following topics:
BEHAVIOR NEEDS INDIVIDUALIZED BY LIFE STAGE
Kitten (Birth to 1 Year)
Young and Mature Adult (1 to 6 Years)
Senior (>10 Years)
Claw Care and Grooming
e-Box 8.1). Alternatives to declawing should be explored (
e-Box 8.1) including temporary synthetic nail caps that can be applied every 4–6 weeks.
Nutrition and Weight Management
DIET BASICS
FEEDING REGIMENS
e-Box 8.1). Cats should be fed away from toileting areas (e.g., litter boxes) and quiet areas should be chosen, especially for nervous cats. For healthy cats, there is no evidence to suggest that feeding a single diet or feeding a variety of diets (or flavors), is beneficial or detrimental and preferences may vary among individuals (see earlier).
FACTORS TO CONSIDER WHEN CHANGING A CAT’S DIET
WEIGHT MANAGEMENT
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