As our pets age, we start to become aware of their own mortality but it isn’t the quantity of their life that should be the priority, but the quality. Quality of life is a phrase that’s banded around a lot in veterinary medicine but what does it actually mean and how do you assess it?
What is ‘quality of life’?
The definition of ‘quality of life’ is the ‘level of enjoyment, comfort and health in someone’s life’. This will mean different things to different people, and animals, and is generally a very subjective measurement. However, for our pets, their life must always fulfil the Five Freedoms of Animal Welfare:
- 1. Freedom from hunger and thirst
- 2. Freedom from discomfort
- 3. Freedom from pain, injury or disease
- 4. Freedom to express natural behaviour
- 5. Freedom from fear and distress
These are the absolute basics that any living animal ought to be able to live by and they are a necessity for any animal under ownership or in captivity. Beyond these, the factors that make up the quality of an animal’s life will vary greatly – for example, for a working sheepdog to have quality of life, they must be allowed to work, have a large amount of mental and physical stimulation, and spend a lot of time outdoors, whereas a small-breed companion to an elderly couple would (likely) prefer to be indoors, go out for a short walk twice a day and spend a lot of time curled up on a lap. Now these are very stereotypical examples but imagine if each of those dogs was made to live the life of the other. In that situation, it is unlikely that either would feel they had a good quality of life.
From a more medical point of view
When animals get older, we often have to weigh up quality vs quantity of life when thinking about treatment options for them. A very common scenario is the use of certain anti-inflammatory medications in elderly arthritic animals. To use anti-inflammatory drugs would certainly help any pain they would be feeling and therefore improve their quality of life but there may be concerns about how long term use might compromise their kidney function and therefore potentially shorten their lifespan. However, to deny them the medication would preserve their current kidney function but could leave them in discomfort and therefore negatively affect the quality of their life. Would they prefer a shorter life in comfort or a longer one in discomfort? It is also helpful to realise that animals don’t have any foresight – they live ‘in the moment’ and have no concept of their future life, only what is happening to them in the present.
Quality of life and euthanasia
One of the most common things I hear from owners when thinking about the end of their dog’s life is how they wish they could die peacefully at home or slip away in their sleep. Unfortunately, in reality, this rarely happens. For them to truly die in comfort and peace in their sleep without knowing anything about it would be a blessing, but more often than not, owners have to make that choice to put their animal to sleep in order to prevent suffering. Sadly, I know of many pets that have not had that ‘good death’ that euthanasia can offer.
For many owners, making that final decision is understandably incredibly difficult, but I always say that they know their dog the best and if they are even starting to consider euthanasia for them, then it is very unlikely to be a wrong decision. Owners can become blinded to trying to keep their dog living as long as possible, often benefiting them, not their dog. This is not an intentionally cruel way to behave but a natural response to the thought of losing their companion. They may start to turn a blind eye to certain behaviours or symptoms, just putting it down to old age, or come up with excuses as to why they are behaving a certain way. Many people will use appetite as a guide to whether an animal is happy. Yes, if they are unwell, many animals will go off their food, but as they age, a loss of appetite may be quite far down the line of symptoms that they are not coping well with life.
Have the conversations early
It can be very helpful to have a meaningful discussion with your vet about your dog and when the right time might be to consider euthanasia. I find owners will obviously offer very valuable emotive and subjective insight into their dog’s life whereas we as medical professionals, can give a much more objective opinion. Although we can and will empathise with owners, being as many of us are pet owners ourselves, we can help identify those aspects that may have been overlooked.
Assessing quality of life
In order to summarise and visualise the good and not so good aspects of an old dog’s life, it can be helpful to utilise a ‘Quality of Life’ scale. This is not designed as a ‘do we euthanise/do we not’ test, but can help owners to see when their pet’s quality of life may be slipping. There are many assessments available but one of the most commonly used is the HHHHHMM scale, first developed by a veterinary oncologist as a way of seeing if an animal is able to continue hospice care or whether euthanasia ought to be considered. It encompasses a range of aspects of a pet’s life that need to be graded from 0-10, with 10 being the ideal and a total score of more than 35 seen to be an acceptable level at which to continue care. The seven letters stand for:
Hurt
Ensuring the animal is not in pain and can breathe comfortably
Hunger
Ensuring the animal is still eating. This may mean changing their diet to something more palatable and for some, may involve the use of feeding aids such as feeding tubes, but only if accepted by the pet.
Hydration
Ensuring adequate fluid intake
Hygiene
Ensure the pet can still groom and maintain body hygiene or is happy to be assisted in doing so. Pets that soil themselves on a regular basis can often become distressed.
Happiness
Does the pet seem happy? As mentioned before, this will mean different things to different pets, but I often ask owners is the dog able to do things that bring them enjoyment, be it exercise, play or simply being with and interacting with their owners?
Mobility
Again, this can be relative, but in basic terms, is the dog able to get up and move around enough to be able to carry out what they want to do? This may simply mean pottering around the garden then going back to bed, rather than going for a 5 mile walk, but if they seem content to just do this, then that’s ok.
More good days than bad days
Aging pets will have good days and bad days. Bad days may consist of physical negatives such as vomiting, pain or seizures, but also mental negatives like stress, frustration or confusion. Quite simply, when the bad days outnumber the good days, it may be time to think about saying goodbye.
Quality of life is not based on a single element but rather encompasses a variety of aspects of life that all need to be considered. This therefore means that it isn’t an easy thing to do, nor does it come down to a ‘good’ quality of life or a ‘bad’ quality of life. Trust your instinct and advocate for your dog.
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