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Journal of Feline Medicine and Surgery (2021) 23, 211–233

SPECIAL ARticle

2021 AAHA/AAFP Feline

Life Stage Guidelines

Abstract: The guidelines, authored by a Task Force of experts in feline clinical medicine, are an update
and extension of the AAFP–AAHA Feline Life Stage Guidelines published in 2010. The guidelines are
published simultaneously in the Journal of Feline Medicine and Surgery (volume 23, issue 3, pages 211–233,
DOI: 10.1177/1098612X21993657) and the Journal of the American Animal Hospital Association (volume 57,
issue 2, pages 51–72, DOI: 10.5326/JAAHA-MS-7189). A noteworthy change from the earlier guidelines is Jessica Quimby
DVM, PhD, DACVIM*
the division of the cat’s lifespan into a five-stage grouping with four distinct age-related stages (kitten, young Co-Chair of 2021
adult, mature adult, and senior) as well as an end-of-life stage, instead of the previous six. This simplified AAHA/AAFP Feline
grouping is consistent with how pet owners generally perceive their cat’s maturation and aging process, Life Stage Guidelines
Task Force
and provides a readily understood basis for an evolving, individualized, lifelong feline healthcare strategy. The Ohio State University,
The guidelines include a comprehensive table on the components of a feline wellness visit that provides Department of Veterinary
Clinical Sciences,
a framework for systematically implementing an individualized life stage approach to feline healthcare.
Columbus, Ohio, USA
Included are recommendations for managing the most critical health-related factors in relation to a cat’s life
Shannon Gowland
stage. These recommendations are further explained in the following categories: behavior and environmental
DVM, DABVP
needs; elimination; life stage nutrition and weight management; oral health; parasite control; vaccination; Co-Chair of 2021
zoonoses and human safety; and recommended diagnostics based on life stage. A discussion on AAHA/AAFP Feline
Life Stage Guidelines
overcoming barriers to veterinary visits by cat owners offers practical advice on one of the most challenging Task Force
aspects of delivering regular feline healthcare. OVC Smith Lane Animal
Hospital, Ontario Veterinary
Keywords: Feline life stage; kitten; adult; senior; veterinary; healthcare examination; medical history; College, Guelph, Ontario,
Canada
behavior; risk assessment; elimination
Hazel C Carney
Abbreviations: BCS (body condition score); DER (daily energy requirements); DJD (degenerative joint DVM, MS, DABVP
WestVet Emergency
disease); FCV (feline calicivirus); FeLV (feline leukemia virus); FHV-1 (feline herpesvirus type 1); FIC (feline and Specialty Center,
idiopathic cystitis); FPV (feline panleukopenia virus); GI (gastrointestinal); HARD (heartworm-associated Garden City, Idaho, USA
respiratory disease); MCS (muscle condition score); RER (resting energy requirements); T4 (thyroxine) Theresa DePorter
DVM, MRCVS, DACVB,
DECAWBM
Introduction Oakland Veterinary Referral
These guidelines were prepared by a Task Force Services, Bloomfield Hills,
of experts convened by the American Animal
The feline patient’s life stage is the most fun‑ Michigan, USA
Hospital Association (AAHA) and the American
damental presentation factor the practitioner Paula Plummer
Association of Feline Practitioners (AAFP) and
encounters in a regular examination visit. LVT, VTS (ECC, SAIM)
Texas A&M University
were subjected to a formal peer-review process.
Most of the components of a treatment or Veterinary Medical Teaching
This document is intended as a guideline only, not
healthcare plan are guided by the patient’s life Hospital, College Station,
stage, progressing from kitten to young adult,
an AAHA or AAFP standard of care. These guide- Texas, USA
lines and recommendations should not be con-
mature adult, and senior and concluding with Jodi Westropp
the end‑of‑life stage. Because a cat can transi‑
strued as dictating an exclusive protocol, course DVM, PhD, DACVIM
University of California,
of treatment, or procedure. Variations in practice
tion from one life stage to another in a short Davis, School of Veterinary
may be warranted based on the needs of the
period of time, each examination visit should Medicine, Davis, California,
USA
individual patient, resources, and limitations unique
include a life stage assessment. The “2021
to each individual practice setting. Evidence-based
AAHA/AAFP Feline Life Stage Guidelines” *Corresponding author:
support for specific recommendations has been
provide a comprehensive age‑associated [email protected]
cited whenever possible and appropriate.
framework for promoting health and longevi‑
Other recommendations are based on practical
ty throughout a cat’s lifetime. The guidelines
clinical experience and a consensus of expert opin-
were developed by a Task Force of experts in
ion. Further research is needed to document some
feline clinical medicine. Their recommenda‑
of these recommendations. Because each case is
different, veterinarians must base their decisions on
the best available scientific evidence in conjunction
with their own knowledge and experience.

DOI: 10.1177/1098612X21993657
© 2021 by American Animal Hospital Association, American Association
of Feline Practitioners and International Society of Feline Medicine
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tions are a practical resource to guide individ‑ 3Table 1

ualized risk assessment, preventive healthcare Feline life stages
strategies, and treatment pathways that
evolve as the cat matures.
An evidence‑guided framework for manag‑
ing a cat’s healthcare throughout its lifetime
has never been more important in feline prac‑
tice than it is now. Cats are the most popular
pet in the United States.1 A great anomaly in
feline practice is that although most owners
consider their cats to be family members, cats
are substantially underserved in the primary Kitten Young adult Mature adult Senior
care setting compared with dogs.2 In 2006, Birth up 1–6 years 7–10 years >10 years
owners took their dogs to veterinarians more to 1 year
than twice as often as cats: 2.3 times/year for
End of life
dogs versus 1.1 times/year for cats.3 This Variable
healthcare use imbalance persists to the
present day. Cat owners often express a belief Image © Voren1/iStock, spxChrome/E+, AaronAmat/iStock,
AngiePhotos/iStock via Getty Images Plus
that their pets “do not need medical care.” Using
Two reasons for this misconception are that
signs of illness and pain are often difficult to feline-friendly improve compliance with preventive health‑
detect in the sometimes reclusive or stoic cat, handling care recommendations.
and that cats are perceived to be self‑sufficient. These guidelines complement and update
Specific objectives of the guidelines are (1) to techniques earlier feline life stage guidelines published in
define distinct feline life stages consistent with 2010.6 An important distinction of the 2021
how pet owners generally perceive their cat’s to reduce guidelines is the Task Force’s decision to
maturation and aging process, and (2) to pro‑ stress will give reduce the number of feline life stages from
vide a readily understood basis for an evolv‑ six to four distinct age‑related stages as well
ing, individualized, lifelong healthcare strategy the patient as an end‑of‑life stage (five stages overall;
for each feline patient at every life stage. In this Table 1). Although the physiologic basis for
regard, the Task Force has identified certain and owner six feline life stages remains valid, a five‑stage
common features of each feline life stage that a positive grouping makes clinical protocols easier to
provide an incentive for regular healthcare implement and simplifies the dialog between
visits and inform a patient‑specific healthcare experience that the practice team and cat owners. In this
approach. These life stage characteristics are regard, the guidelines are not only a useful
defined in a comprehensive table listing the
will carry over resource for practitioners but also the basis for
client discussion topics and action items for to future client education that is tailored to the feline
each feline life stage. In effect, the table defines patient’s life stage progression.
what needs to be done at each life stage. This examination The items to perform or discuss during
prescriptive approach to healthcare manage‑ visits. each life stage are highlighted in Table 2.
ment based on a cat’s life stage is explained and Veterinary professionals should use this table
justified in the well‑referenced narrative that to identify the differences between each life
makes up the rest of the guidelines. The Task stage. The text in the rest of the guidelines
Force considers end of life and its precursor document identifies select areas in the table
events to be a separate feline life stage. Rather that warrant further explanation, but is not
than discussing end of life in these guidelines, intended as a comprehensive review.
practitioners can access this topic in previous‑
ly published “2016 AAHA/IAAHPC End‑of‑ Importance of feline-friendly
Life Care Guidelines”4 and the “2021 AAFP handling
End of Life Online Educational Toolkit”.5
A recurring emphasis throughout the Both AAHA and the AAFP understand that a
guidelines is the importance of feline‑friendly major barrier to feline veterinary visits is the
handling techniques in the waiting area and concern about the level of stress the patient
examination settings. Using feline‑friendly will be experiencing during the visit. There are
handling is a critical factor in eliminating the many recommendations available to help
barriers to regular feline healthcare. This decrease the stress of feline patients during
patient‑centric approach can reduce the cat’s transportation to, and time spent in, the
stress, improve handler safety, and create a veterinary practice. Unless otherwise specified,
more positive experience for the patient, the reader should assume that these stress‑
client, and care provider. Together, these out‑ reduction recommendations and techniques are
comes have the potential to increase the applicable to all aspects of the veterinary visit
frequency of feline examination visits and at all life stages described in these guidelines.

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Table 2 Items to perform or discuss during each life stage (continued on page 214)

A L L C AT S N E E D A F U L L T H O R O U G H P H Y S I C A L E X A M I N AT I O N
Kitten (birth up to 1 year) Young adult (1–6 years) Mature adult (7–10 years) Senior (>10 years)
Discussion < Frequency of visits: minimum of annual examinations and at least every 6 months for seniors
items for all < Educate the client on:
life stages – The subtle signs of behavior, illness, pain, and anxiety
– Normal feline behaviors and the significance of changes in the cat’s behavior
– The importance of preventive healthcare and carrier acclimation
– Disaster preparedness
– Identification options such as microchipping
– Sterilization
– Claw care, natural scratching behavior, and alternatives to declawing
< Discuss elimination habits and any house-soiling
< Present pet insurance and financial planning options
< Obtain previous medical/surgical history (including medications and supplements)
< Evaluate personality and temperament; make recommendations for optimal future examinations
< Evaluate patient demeanor to determine the appropriate approach to the physical examination
< Ask about daily food and water intake
< Discuss diets and feeding as well as make recommendations
< Assess and discuss quality of life when clinically relevant
< Veterinarians should familiarize themselves with common breed predispositions
Medical < Discuss breed healthcare < Ask about vomiting, < Ask about changes in appetite and hydration
history predispositions and vomiting hairballs, and < Ask about polyuria, polydipsia, vomiting, and diarrhea
congenital/genetic concerns diarrhea < Ask about increased nocturnal activity and vocalization
< Ask about changes < Discuss early signs of cognitive decline
in grooming habits < Ask about changes in mobility
< Ask about changes < Ask about changes in vision
in behavior < Ask about changes in grooming habits
< Ask about masses
Examination < Discuss congenital/genetic < Increase focus on < Increase focus on oral examination, abdominal palpation,
focus (extra findings (murmurs, hernias, cardiorespiratory and and ophthalmic (fundic), cardiorespiratory, and musculoskeletal
attention and dentition) dermatologic findings examination
during < Discuss infectious disease < Focus on oral examination < Concentrate on thyroid gland and kidney palpation
physical to detect periodontal disease < Conduct thorough pain assessment
examination) and tooth resorption
< Record body weight, BCS, and MCS
< Consider (dorsal and lateral) photographs of patient to help identify future changes
< Monitor for changes in usual patient demeanor
< Record successful feline-friendly handling techniques and preferences
Nutrition < Discuss diet, quantity being < Monitor for weight gain < Monitor for weight loss and weight gain
and weight fed, intake amounts, and < Discuss obesity risks < Discuss diseases associated with changes in appetite
management frequency of feeding < Provide ongoing advice for or weight
< Introduce variety of food enrichment, play, and exercise < Discuss use of appropriate therapeutic diets
flavors and textures
< Introduce food foraging toys
and puzzles
< Feed to ideal BCS and MCS
Behavior and < Discuss importance of: < Discuss that intercat < Environmental needs may change: ensure good/easy
environment – Introducing kittens to interactions may decline accessibility to litter box, warm soft bed, food/water
various people and pets < Discuss that intercat or < Educate clients about subtle behavior changes that
during the socialization period human–cat relationships may are not “just old age”
– Acclimating to handling, change with maturity or < Monitor cognitive function
brushing, nail trimming, following stressful events
grooming, and medication < Encourage acceptance of
administration manipulation of mouth, ears,
– Acclimating to carrier, car, and feet by providing gentle
and veterinary visits handling
< Discourage use of hands
or feet as toys during play < Ensure number, distribution, and location of resources is adequate
to avoid risk of future
aggressive behavior
< Encourage teaching
cue/response, such as
come or sit, using positive
reinforcement
< Discuss importance of number, distribution, and location of resources for each cat in the home
< Ask about housing (indoor/outdoor/partial outdoor access), hunting activity, and children and other pets in the home
< Discuss housemate cats and their usual interactions. Ask if there are any concerns
< Ask about problematic or changes in behavior
< Ensure environmental needs of the cat(s) are met (toys, scratching posts, resting places, play)
< Discuss managing unwanted behaviors; discourage punishment and encourage positive reinforcement

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Table 2 Items to perform or discuss during each life stage (continued from page 213)

A L L C AT S N E E D A F U L L T H O R O U G H P H Y S I C A L E X A M I N AT I O N
Kitten (birth up to 1 year) Young adult (1–6 years) Mature adult (7–10 years) Senior (>10 years)
Elimination < Discuss litter box setup, < Confirm that litter box < Review the location of the litter boxes to avoid stairs for
cleaning, and normal size (length and height) painful cats including those with DJD
elimination behavior accommodates the growing < Review and adjust litter box size (length and height), location,
< Start with unscented cat and cleaning regimens as necessary
clumping sand litter and/or
the litter type the kitten was
previously using
< Allow kittens to choose litter
preference by offering a variety
of litter types
< Discuss elimination habits
< Ask if any urination or defecation occur outside the litter box
– Distinguish between toileting and marking behaviors
< Discuss litter box management (number, size, location, litter type, and cleaning)
< Educate clients about how to assess stool appearance and litter ball size
Oral health < Acclimate to mouth < Recommend dental diet < Monitor for oral tumors, inability to eat and decreased quality
handling and brushing/wiping if clinically indicated of life from painful dental disease
of teeth
< Examine for malocclusion
or developmental dental issues
< Perform detailed dental examination; discuss dental disease, preventive healthcare, dental prophylaxis, and importance of
treatment/home care with brushing/wiping of teeth
Parasite < Assess risks of exposure based on lifestyle, geographic location, and travel
control < Educate clients that even indoor-only cats have a real risk for parasitic infections
< Recommend year-round broad-spectrum antiparasitics with efficacy against heartworms, intestinal parasites, and fleas for
all patients, regardless of indoor/outdoor status
< Recommend tick control as indicated by risk assessment
< Perform fecal examination as appropriate
< Discuss and mitigate zoonotic risks

Vaccination < FCV, FHV-1, FPV, FeLV, and < FCV, FHV-1, FPV, and rabies are considered core vaccines. < The risk/benefit of
rabies are considered core Ongoing FeLV vaccination is based on risk assessment of vaccinating senior cats should
vaccines. The interval between exposure to infected cats. Intervals between FCV, FHV-1, and be carefully considered in the
the initial series vaccines FPV revaccinations depend on vaccine label, type of vaccine, light of their overall health
varies depending on the route of administration, and risk assessment status. Where appropriate,
infectious disease, age at initial < Cats should be revaccinated 12 months after the last dose FCV, FHV-1, FPV, and rabies
vaccination, vaccine label, type in the kitten series, and then annually for cats at high risk7 are considered core vaccines
of vaccine (inactivated, for healthy seniors. FeLV
attenuated live, and vaccination is based on risk
recombinant), and route of assessment
administration (parenteral
versus intranasal)
< FCV, FHV-1, and FPV
revaccination is administered
at 6 months of age7
< For rabies vaccinations, AAHA and the AAFP recommend following vaccine label instructions and local laws.
Chlamydia felis and Bordetella bronchiseptica vaccines are considered non-core vaccines

Safe and gentle handling will reduce the examination may stress that individual cat so
stress response of the patient. By applying those components can be saved until the end
feline‑friendly handling techniques, the during future visits.
team can proactively perform the entire Using feline‑friendly handling tech‑
examination and diagnostic procedures niques to reduce stress will give the
in a way that improves patient comfort FELINE-FRIENDLY STRATEGIES patient and owner a positive experience
and time efficiency as well as the Feline-friendly handling and cat-friendly that will carry over to future examination
strategies are described in detail in the
patient, client, and practice team expe‑ “AAFP and ISFM Feline-Friendly Handling
visits. The patient will often retain this
rience. In efforts to reduce stress, keep and Nursing Care Guidelines”,8,9 as well as positive conditioning, allowing the prac‑
the most invasive parts until the end, the AAFP Cat Friendly Certificate tice team to provide the best possible care
such as the dental examination, temper‑ Program10 for individuals and throughout the cat’s lifetime. A feline‑
ature assessment or nail trim, sample col‑ Cat Friendly Practice® Program.11
friendly approach will also positively impact
lection, and imaging. It is important to note the practice team dynamic and confidence
in the patient record which aspect(s) of the when handling, treating, and caring for cats.

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Life stage definitions and other relevant information is not missed or

relevant clinical perspectives left to the end of the consultation.
Discussions regarding anticipated costs of
The Task Force has designated four age‑ care and presentation of pet insurance options
related life stages (Table 1): the kitten stage, can help clients to plan ahead for future care
from birth up to 1 year; young adult, from needs. In some cases, estate planning may be
1 year through 6 years; mature adult, from appropriate to discuss. Many other topics will
7 to 10 years; and senior, aged over 10 years. be revisited and modified during subsequent
The fifth, end‑of‑life stage can occur at any examinations, including preventive health‑
age. These guidelines focus on the life stages care and nutritional recommendations.
of kitten through to senior. These age designa‑ Discussing what normal behaviors are expect‑
tions help to focus attention on the physical ed at each life stage, relating this to the
and behavioral changes, as well as the evolv‑ patient, and reviewing subtle signs of anxiety,
ing medical needs, that occur at different illness, and pain in cats encourages clients to
stages of feline life. Examples include detec‑ be vigilant and seek care early in the course of
tion of congenital defects in kittens, obesity disease.14 Veterinarians should educate own‑
prevention in the young adult cat, and ers of purebred cats about breed predisposi‑
increased vigilance for early detection of renal tions, keeping in mind that most North
disease in mature adult and senior cats. It The Task Force American cats are not purebred, and that
must be recognized, however, that any age recommends these conditions are not necessarily restricted
groupings are inevitably arbitrary demarca‑ to particular breeds.15
tions along a spectrum and not absolutes. a minimum Taking a few moments to evaluate and
Although ages have been used to identify discuss the temperament, demeanor, and
life stages, it is recognized that there may be of annual handling preferences of the patient is time
significant variation among individual cats. examinations well spent in terms of setting the stage for a
For example, some senior cats aged 10 years reduced‑stress, thorough physical examina‑
and older may remain in excellent physical for all cats, tion and for obtaining diagnostic samples.
condition and would be best treated as a Observing how the cat is reacting to the envi‑
mature adult at the veterinarian’s discretion. with increasing ronment may give clues as to its state of
The guidelines are intended to be a starting frequency as arousal. If the cat is a new patient to the vet‑
point from which individualized care recom‑ erinarian, the client may know from previous
mendations can be developed. appropriate for experience what works well for their pet.
For example, does the cat relax when handled
Discussion items for all life stages
their individual in a towel? What is the cat’s favorite treat?
The Task Force recommends a minimum of needs. What handling methods have worked well
annual examinations for all cats, with increas‑ or poorly in the past? This knowledge and an
ing frequency as appropriate for their individ‑ understanding of reduced‑stress handling
ual needs.6 Senior cats should be seen at least techniques can help to tailor the approach to
every 6 months and more frequently for those each patient. Noting these important details in
with chronic conditions. More information the physical examination record will facilitate
can be found in the “AAFP Senior Care successful, reduced‑stress future visits and
Guidelines”.12 Seeing patients and clients at help to develop individualized approaches
least annually provides an excellent opportu‑ that work well for each patient. Decreasing
nity for client education. Table 2 lists a stress may reduce confounding results during
number of discussion items relevant to all life physical examination and diagnostic testing,
stages. Some topics such as sterilization, claw as well as when taking vital signs.
care, the importance of identification and
microchipping, and disaster preparedness Lifestyle risk assessment
may be covered once in an initial consultation. Understanding the lifestyle of the cat is
The AAFP Position Statement entitled “Early important for making thorough and accurate
spay and castration” is a source of further preventive healthcare and medical recommen‑
information on timing of pediatric spay/ dations. The traditional classification of a cat
neutering.13 as “indoor” or “outdoor” is oversimplified as
Open‑ended questions and requests such there may be additional risk factors that war‑
as, “What would you like to discuss with me rant consideration.16 Determining whether the
today?” or, “I hear that [cat’s name] hasn’t cat is primarily indoor or has any outdoor
been eating well, tell me more about that” are access is, nevertheless, a starting point. Further
an excellent start to setting the agenda for the questioning may reveal details including
consultation. An appointment template can be whether outdoor access is through an enclo‑
valuable to guide more specific questions sure or leash walking versus free roaming, and
such as, “Has there been any urination or if there is exposure to other cats – be they
defecation outside the litter box?” to ensure housemates, visiting cats, or foster cats from a

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Table 3 Diseases and conditions that require particular focus during examination, by life stage

Kitten (birth up to 1 year) Young adult (1–6 years) Mature adult (7–10 years) Senior (>10 years)

Diseases and < Genetic and congenital < Feline bronchial disease < Chronic enteropathies (GI lymphoma, inflammatory bowel
conditions conditions < Cardiomyopathy disease)
of relevance < Infectious diseases: < Chronic enteropathy < Chronic kidney disease
that require parasitic, viral, retroviral, feline < FIC and urolithiasis < Hyperthyroidism
increased infectious peritonitis, upper < Feline atopic dermatitis < Diabetes mellitus
vigilance* respiratory infection, enteric (non-flea, flea allergy < Neoplasia
< Dermatophytosis dermatitis, non-food allergic < Cognitive dysfunction syndrome
dermatitis) < Periodontal disease and tooth resorption21,22
< Systemic fungal disease < DJD: osteoarthritis and spondylosis deformans23
*This is not intended to represent a comprehensive list

Diseases and conditions that require addi‑

Understanding the lifestyle of the cat is important tional focus during the examination by each
for making thorough and accurate preventive life stage are listed in Table 3.

healthcare and medical recommendations. Kittens

Kittens will have different health risks
depending on their lifestyle and history,
shelter – and whether the cat attends boarding including exposure to other cats and the level
facilities or cat shows. For primarily indoor of care provided. Vaccination and parasite
cats, environmental needs are likewise evalu‑ control history, health status of related cats, if
ated. Noting human–cat interaction is also known, and clinical signs of upper respiratory
important to determine zoonotic risks.17 For or parasitic disease are all important areas of
example, a young adult cat hunting outdoors focus. Nutritional status and weaning history
may need different preventive healthcare from are also important areas of inquiry as
a mature adult indoor cat living in a retirement orphaned or undersocialized kittens may
home and interacting with residents. For fur‑ have behavior concerns.24 Changes in
ther information, readers are referred to the demeanor, activity level, and behavior are
“2019 AAFP Feline Zoonoses Guidelines”17 additionally key to note and trend over time.
and the “2020 AAFP Feline Retrovirus Testing Asking specific questions as to whether the
and Management Guidelines”.18 The role and kitten is displaying any unwanted behaviors,
relationship of the cat with respect to the client counselling clients on normal kitten behavior,
(i.e., the human–cat bond and the care and giving advice on positive methods to mod‑
philosophy of the owner) is also essential to ify unwanted behavior are critical discussion
understand. points at this stage. Breed‑related predisposi‑
tions, signs of genetic disease, and the avail‑
Medical history and physical examination ability and accuracy of genetic testing to detect
focus based on specific life stage disease should be discussed when relevant.
For new patients, a detailed history including The physical examination for kittens typi‑
any previous medical or surgical information cally focuses on detection of congenital issues
is important to record, including any past or such as a heart murmur, hernia, or cleft palate.
current medications or supplements. A detailed oral examination is performed to
An assessment of the cat’s current diet, detect abnormalities of dentition. The use of
including intake amount, frequency of feed‑ fecal scoring charts is very helpful to ensure
ing, and the manner in which the cat is fed,19 that the client can accurately identify stool
is an important part of each consultation, as is consistency.25,26
making a nutritional recommendation to con‑
tinue or change the current diet. Young adult cats
Evaluation and recording of body weight, Lower airway disease is common in young
body condition score (BCS), and muscle con‑ adult cats.27 Coughing is a typical sign of
dition score (MCS) are important components feline bronchial disease; however, the veteri‑
of the physical examination at all life stages to narian must consider the role of heartworm‑
allow early detection of changes and identifi‑ associated respiratory disease (HARD),
cation of trends.20 Obtaining dorsal and later‑ transtracheal migration of roundworm
al photographs of the patient is recommended (Toxocara cati), and lungworm. Asking specific
to facilitate monitoring BCS/MCS as the cat questions regarding the presence of coughing
ages, and can help the owner recognize subtle is helpful for early diagnosis and treatment.
changes. Coughing is not typically a hallmark of

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Behavior and environmental

From kitten to senior, an appreciation of the needs
behavioral needs of the cat is essential for
Understanding and enhancing behavior
preventing behavior problems. by life stage
Feline health and welfare are intricately inter‑
related at all life stages. From kitten to senior,
cardiac disease in cats, in contrast to canine an appreciation of the behavioral needs of the
patients, nor is it caused by hairballs. Young cat is essential for preventing behavior prob‑
adult cats developing cardiac conditions such lems. Problem behaviors may be manifesta‑
as hypertrophic cardiomyopathy are often tions of normal feline behaviors, ranging from
asymptomatic or may display changes in undesirable to pathological misbehaviors.
activity level or exercise tolerance. Such problems continue to be a primary
Asking specific questions concerning reason for relinquishment.32 House‑soiling
whether vomiting, vomiting hairballs, or diar‑ (marking or toileting outside the litter box)33
rhea is occurring, and the frequency of each, and aggression toward people, housemate
is recommended as some clients may consider cats, or housemate dogs34 are commonly
vomiting or vomiting hairballs to be normal for reported reasons for relinquishment.
their cat. Additionally, discuss the importance The focus of this section of the guidelines is
of monitoring weight, and ask about any the identification of key interventions at vari‑
chronic enteropathy or gastrointestinal (GI) ous life stages. An outline of behavior and
signs that could indicate early stages of disease. ways to enhance the cat’s welfare at each life
stage is presented in Table 2. For detailed rec‑
Mature adult and senior cats ommendations about normal cat behavior and
The medical history and examination of mature management, readers are referred to the
adult and senior cats will be focused on early “AAFP Feline Behavior Guidelines”.35
detection of disease. Adult and senior cats are The ideal Many of the cat’s natural patterns are con‑
often diagnosed with comorbidities. Specific sistent with those of their ancestor, the African
questions regarding changes in appetite, occur‑ feline home wild cat.36 Although cats have become a
rence of polyuria and polydipsia, vomiting, favored companion around the world, they
vomiting hairballs, or diarrhea are of key
environment are not considered fully domesticated. Cats
importance to guide diagnostic testing. requires are highly social to those individuals they
Discussion should also be held with the client have experienced positive interactions with
about increased nocturnal activity and vocal‑ plentiful and during their critical socialization period,
ization as well as changes in the cat’s normal while at the same time showing independent
habits or activity. These may indicate cognitive
thoughtfully daily activities.37 They use a wide territory in
dysfunction, disease‑reduced mobility, pain, or distributed natural settings, quite unlike the limited
reduced vision. Detecting signs of pain or anx‑ environments within human homes. Thus, the
iety and evaluation of quality of life are most resources ideal feline home environment requires plen‑
commonly of concern in the mature adult or including tiful and thoughtfully distributed resources
senior cat but may be relevant at any life stage. including resting areas, feeding stations,
During the physical examination, particular resting areas, water sources, scratching posts, and litter
focus is on pain assessment and abdominal boxes.38 Cats develop patterns of resting and
and thyroid palpation. A detailed musculo‑ feeding stations, hiding in the home that should be comple‑
skeletal examination to detect signs of water sources, mented by a variety of appealing places. They
osteoarthritis is critical as this condition is one may naturally seek their preferred hiding
of the most significant and underdiagnosed scratching spots if startled or fearful. Some cats prefer to
diseases in cats.23,28 A fundic examination is go high, which is consistent with the natural
key to detecting signs of ophthalmic disease
posts, and behaviors of the African wild cat, whereas
or hypertension.29 Practices should employ a litter boxes. other cats retreat to low spaces.36
validated pain assessment scale or tool to Cats are popular pets that reside in 25% of
diagnose, monitor, and assist in the evaluation U.S. households with a mean of 1.8 cats per
of patients for subtle signs of pain.30 household,39 a demographic statistic that
Changes in grooming habits, particularly highlights the importance of understanding
increased grooming, may signal a dermato‑ often complex feline interrelationships. Many
logic issue such as atopy, food allergy, an people believe their cats get along, whereas in
immune‑mediated skin condition, infectious reality, they may display overt aggression
or parasitic disease, endocrine condition, or (hissing or swatting) or become passively
paraneoplastic syndrome.31 Reduced groom‑ avoidant. In contrast, affiliative relationships
ing by the cat may also indicate underlying ill‑ are characterized by behaviors such as
ness, bladder pain, degenerative joint disease allogrooming, nose touching, or sleeping in
(DJD) pain, or reduced mobility. close contact.40,41

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Feline communication signs special social bonds. Ideally, kittens should

Although cats may be distressed, they are have pleasant interactions with people for
stealthy in their ability to hide anxiety. 30–60 minutes per day.37,46 Kittens should be
A content cat will hold its ears forward, gently, gradually, and positively acclimated to
whiskers loose or relaxed, muscles soft, and any stimuli (e.g., people including children,
tail loosely wrapped. Practitioners should noises, animals, car transport, veterinary prac‑
closely observe feline body language postures tice) or procedures (e.g., nail trims, grooming,
for even the most subtle signs of anxiety and medicating) they may encounter during their
tension. Clinical signs of fear or stress in cats lifetime. This can be accomplished by pairing
are displayed through characteristic body conditioning stimuli with food or other entic‑
postures, vocalizations, and activity. A cower‑ ing rewards. Avoid stressful or unpleasant
ing (tense, flattened) position where the head first encounters. Owners should introduce
is lower than the body may be indicative of kittens to humans and other pets by allowing
stress or fear in cats. A state of distress may the kitten to approach and engage on their
also be characterized by crouching, crawling, own terms.
and muscular tension; activity may range Gentle, respectful handling will prepare the
from either freezing or hiding to frantic flee‑ kitten for a lifetime of positive handling. The
ing. The ears may be held flat, rotated to the kitten that is startled or subjected to rough
side or all the way back when the cat is handling may develop fears that last a life‑
aroused, agitated or stressed. Dilated pupils time. Kittens have a high play drive and learn
indicate greater distress. The whiskers may be predatory behavior by watching, swatting,
straight and directed forward. The paws may Practitioners chasing, pouncing, and catching. Intercat
be flat on the examination surface so that social play peaks at around 12 weeks of age,47
the cat is ready to flee (versus the cat laying should closely and then object play becomes more prevalent.
with them curled into the body in a typical Throughout the first year, kittens will often
relaxed pose).
observe feline engage in predatory‑type play. Clients should
Vocalizations, including hissing, yowling, body language be taught not to use their hands or feet as toys
growling, or screaming, may indicate defen‑ during play, as cats will learn that this is an
siveness. A rapid respiratory rate not associat‑ postures for appropriate form of play and it can lead to
ed with disease or exertion may also be even the most scratching or biting injuries.
observed. The tail may flip or twitch as the cat
becomes agitated; the rate and intensity of subtle signs of Toileting
the tail movement correlates with the cat’s Cats are innately fastidious. As a result, they
distress. Other activities and body language anxiety and may be naturally attracted to sand‑type sub‑
postures representing a fearful or distressed tension. strates for elimination. Elimination tends to
feline state include avoidance and carrying occur away from primary resting locations,
the tail low or tucked and swishing. and feces and urine are often covered, pre‑
It is important to be aware of these signs of sumably to avoid risk of discovery by preda‑
distress and to respect them. The cat must tors. Some practitioners believe that kittens
have a way to tell people to “please stop” or are most accepting of the litter they observe
“I need a break.” When those signals are their queen using, which may influence future
ignored or disregarded, then the cat’s fear preferences. With this in mind, it may be
increases and the signaling escalates. beneficial to offer a young kitten a variety of
toileting substrates, with a view to them
Kittens evolving into an adult with greater acceptance
Genetics, in utero stresses, and poor maternal for an array of litter types.33 (See “Elim‑
nutrition may affect physical and psychologi‑ ination” section later in the guidelines.)
cal development.37,42,43 Personality in kittens is
strongly influenced by the tom and is thus Incorporating kitten socialization into
genetic in nature rather than observed or the examination visit
learned.44 Important aspects of kitten behav‑ The initial veterinary examination visit is an
ior are learned from the queen, including ideal opportunity to create a positive experi‑
acceptance of foods, toileting habits, substrate ence and set the stage for a lifetime of regular
preferences, and a fear response to other veterinary care. Practice team members
species (including people and dogs).35,43,45 should educate and show the cat owner how
The sensitive socialization period for new to read the cat’s body language, and identify
experiences, people, and other animals begins signs of stress and fear, such as cowering, flat‑
as early as 2–3 weeks and may be closing by tened ears, and hissing. They may even use
9–10 weeks.32,42 This period is fluid and can tactics to encourage comfort such as slow‑
vary for each individual cat – what is truly blink eyes.48
important is the quality of the experience. Kittens should be allowed to explore and
Social interactions with littermates provide interact with practice team members. Provide

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may even be taught to accept a novel use of

The initial veterinary examination visit is an the old‑style “pet piller” by letting the kitten
ideal opportunity to create a positive experience lick moist food off the end of the piller. While
the kitten is eating, the piller plunger (not the
and set the stage for a lifetime of regular piller itself) is advanced to deliver another
morsel of food into the kitten’s mouth.49,50
veterinary care. It is imperative to educate cat owners that
scratching is a normal feline behavior. Positive
reinforcement for nail trimming warrants
toys that take advantage of the kitten’s strong special consideration because many cats will
prey drive, as well as palatable foods or treats. scratch on undesirable surfaces including car‑
Kittens are more open to accepting foods and peting, window and door frames, curtains,
should be offered tidbits to divert their atten‑ and couches. Keeping the nails shorter can
tion from more unpleasant aspects of the minimize the damage to household items as
examination such as vaccination. well as to people. Moreover, meeting the cat’s
Currently, in North America, opportunities environmental needs may be beneficial in
to attend kitten classes or structured socializa‑ reducing scratching of unwanted surfaces.38
tion sessions are limited. Until these opportu‑ Any intercat‑related issues should be identi‑
nities increase, veterinary professionals fied and addressed as soon as possible, as
should consider each kitten’s visit as an these can lead to increased territorial scratch‑
opportunity to create a positive experience ing behaviors.51
and familiarize the kitten with the practice Scratching posts and a variety of other
team and environment. Team members scratching surfaces should be provided for
should be trained to use appropriate interac‑ cats as soon as they enter the home. Cats may
tions including positive reinforcement, gentle have individual scratching habits, but consid‑
handling, and use of food or rewards to er provision of posts near resting areas and
desensitize and countercondition kittens to high‑traffic pathways. Available scratching
veterinary or handling procedures;8 aversive substrates include rope, cardboard, carpet,
handling or punishment should always be and wood. One study revealed that rope was
avoided. most frequently used when offered, although
carpet was offered more commonly.52 Cats
Training kittens in preparation to be scratched the preferred substrate more often
adult cats when the post was a simple upright type or a
Kittens, and even older cats, can be taught cat tree with two or more levels and at least
many behaviors with well‑timed positive 3 ft high. Narrower posts (base width less than
reinforcement. For example, teaching a cat to or equal to 3 ft) were used more often than
come when called for a tasty treat can be used wider posts (base width greater than or equal
in carrier training, which will help build a to 5 ft). Cats between the ages of 10 and 14
positive association with the carrier and, in years preferred carpet substrate. All other ages
turn, assist with getting to the veterinary prac‑ preferred rope.52 The preference of older cats
tice. It may be helpful for a cat owner to for carpet may be due to age‑related musculo‑
reward a cat for getting on a small mat so the skeletal changes or because these cats may
cat will be better prepared for the veterinary not have had the opportunity to use the range
examination. Interested cat owners can also of substrates as kittens. “Claw Counseling:
teach their cats agility, fetching, or tricks. Helping Clients Live Alongside Cats with
Moreover, cats can be taught to voluntarily Claws”51 is one of several resources in the
accept grooming, nail trimming, instillation of AAFP Claw Friendly Educational Toolkit.53
ear treatments, application of topical anti‑
parasitics, and administration of medications Young adult cats
both orally and subcutaneously. Ultimately, Young adult cats do not require as frequent
almost every cat is going to require medica‑ routine medical care as kittens, so it is integral
tion at some time in its life, so it is prudent to to educate the client about why regular
acclimate cats to these types of procedures. healthcare examinations remain so important.
Kittens may be taught to accept pilling by Routine examinations can help identify
administration of a tasty morsel of food behavioral changes or medical concerns that
instead of a pill. By giving treats that are soft may affect a cat’s health long before they
enough that they may be wrapped around a become significant, painful, or more costly to
pill, the young cat is exposed to those foods treat. Clients should be educated about the
before the need for a pill. Commercially avail‑ subtle changes in behavior and day‑to‑day life
able pill pockets may be given empty or with of the cat that may possibly be significant.
a hard piece of kibble hidden inside to accli‑ Encouraging owners to routinely record
mate the cat to the change in texture. Kittens behaviors in a journal and/or with photos and

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video will provide a basis for documenting These debates reflect geographical and cultur‑
any such changes. Simply asking the client, al differences as well as individual owner
“Is your cat happy?” may help them think preferences.60–65 The focus should be on pro‑
about their cat’s welfare. viding an appropriate, stimulating, and safe
Urine marking is most often displayed by environment for the cat.38 All cats should be
intact male cats, although one study reported microchipped for permanent identification.
that about 10% of sterilized cats marked their
territory with urine.54 The onset of this behav‑ Play
ior can coincide with sexual maturity. Both Declining play activity increases susceptibility
males and females may urine spray. to weight gain. In one study, three 10‑ to 15‑
Cats may discontinue litter box use for a minute exercise sessions per day led to a
variety of reasons including the litter sub‑ loss of approximately 1% of body weight in
strate offered, litter box cleaning and environ‑ 1 month with no food intake restrictions.66
mental hygiene, litter box style (e.g., covered,
electronic), litter box size, location prefer‑ Senior cats
ences, illness, or stress in the home, including Senior cats exhibiting new or unusual
conflict between housemate cats. Although behavior should be evaluated for medical con‑
individual preferences can vary, of the avail‑ ditions.12 Changes in litter box usage may
able litter types, most adult cats prefer clump‑ indicate urinary tract disease, constipation, or
ing litter, and most cats prefer plain unscented diabetes but may also be due to reduced mus‑
litters.55 Some cats may find scented litters culoskeletal strength, impaired balance, or
significantly aversive.56 Cats have shown a onset of pain. Vocalization, especially night‑
tendency to prefer larger litter boxes.57,58 time waking, is a common concern and may
represent sensory changes (declining hearing
Intercat relations and vision), cognitive dysfunction syndrome,
The reduction in social play combined with pain, hyperthyroidism, or hypertension.
the dispersal effect (when free‑living off‑ Veterinary visits may be more challenging for
spring leave the family unit at about 1–2 years the senior cat, in part because many cat own‑
of age) means that intercat aggression may ers do not seek wellness visits, but present
develop at this stage of life. Conflict may their cats only for acute care.3 The use of
occur when a new cat is introduced. pheromones or pre‑veterinary visit pharma‑
Alternatively, a housemate cat may become ceuticals such as gabapentin or trazodone
the target of aggression following a stressful may reduce stress while allowing thorough
event (e.g., returning home from a veterinary evaluations.68–71 As many senior patients may
visit) or owing to redirected aggression trig‑ be experiencing some level of pain related to
gered by a cat outside the home. their disease or secondarily to DJD, analgesics
Controversy exists over whether cats should may also be indicated for veterinary visits.
be kept indoors only or in an indoor/outdoor DJD and/or muscle weakness may initially
environment (see the “Lifestyle choices” box). manifest as a change or reduction in jumping

tL i f e s t y l e c h o i c e s
Whatever
< Indoor-only: An indoor-only lifestyle may decrease the risks
of injury, predators, poisoning, and exposure to infectious and the specific
parasitic agents. At the same time, it may increase risks of
compromised welfare, illness, obesity, and behavior problems lifestyle, the
due to environmental limitations. Appropriate environmental focus should
enrichment is thus essential for maintaining the mental and
physical well-being of cats.38 be on providing
< Partial outdoor access: An indoor/outdoor lifestyle may
allow a cat to express normal feline behaviors and provide a
an appropriate,
stimulating environment, but it also may increase the risks of stimulating,
infectious and parasitic agents, injury, poisoning, and
exposure to wildlife and predators. Supervised or controlled and safe
outdoor access (e.g., during leashed walks or via cat-proof
enclosures) may reduce some of the risks otherwise associat-
environment
ed with access to the outdoors. for the cat.
For more information, refer to the AAFP Position
Statement “Impact of lifestyle choice on the compan-
Image © Sdominick/iStock/Getty Images Plus
ion cat: indoor vs outdoor”.59
via Getty Images

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tP u n i s h m e n t
Cats should not be punished. Yelling shock collars. Withholding resources,
at or startling the cat, spraying the cat
Punishment such as food, is likewise never
with water, or other physical forms of impairs the appropriate. Punishment impairs the
punishment only serve to scare the human–animal bond. Instead, desir-
cat and may lead to cats running human–animal able behaviors should be rewarded –
away or responding aggressively. see the AAFP Position Statement on
bond.
Cats should never be subjected to positive reinforcement.67

or climbing in senior cats. Because of the General litter box considerations

challenges of diagnosing feline arthritis, it Litter boxes should be provided in different
can be difficult to tell how many cats are locations that are easily accessible throughout
affected. Estimates from published studies the house to the extent possible, particularly
suggest that 40–92% of all cats may present in multicat households. The rule of thumb is
with clinical signs associated with DJD.72 one litter box for each cat plus one additional
These studies show that arthritis, in box, or one litter box for each social group
addition to being very common in cats, is plus one additional box, if the number of
much more prevalent and severe in older cats, social groups is known. Placing litter boxes in
and that the shoulders, hips, elbows, knees multiple quiet locations that are convenient
(stifles), and ankles (tarsi) are the most fre‑ for the cat, and provide an escape route if
quently affected joints. DJD is the inclusive necessary, could help facilitate conditions for
terminology that includes the two most normal elimination behaviors.
common changes in aging cats – osteoarthritis If different litters are offered, it may be
and spondylosis deformans of the interverte‑ preferable to test the cat’s preferences by pro‑
bral disc. Owners may report changes in viding choices in separate boxes, because indi‑
behavior such as “not getting on the counters vidual preferences for litter type have been
as much” or “doesn’t like his window seat documented.33,58 For cats with a history of
anymore.” urinary problems, unscented clumping litter
Although it is important to ask about jump‑ may be preferred.55,60 Litter boxes should be
ing and climbing, it is critical to listen careful‑ cleaned regularly and replaced, as well as
ly to descriptions of changes in behavior, even scooped daily. Soap or strong chemicals
seemingly positive changes. Senior cats may should be avoided; hot water is best. Some
have reduced muscle mass or orthopedic con‑ cats seem quite sensitive to dirty litter boxes.74
ditions such that they would benefit from Litter box size and whether the box is open
comfortable and warm resting locations. It is or covered may also be important to some
also beneficial to increase resource availability cats.75,76 It is recommended that the litter box
to reduce the distance seniors might have to be at least one and a half times in size based
move in order to reach food, water, or a litter on the length of the cat from nose to tip of the
box. Conflict with housemate cats may occur tail, which means most manufactured boxes
at any age but may be especially problematic are not large enough. Using items such as
for the senior cat (e.g., may have little patience larger storage containers is likely to achieve
for a kitten). proper litter box size.
The litter box edges should not be too high
Elimination in order for a kitten or senior cat to enter and
exit easily. For kittens, discuss appropriate
House‑soiling is a common reason for cat own‑ litter box management and locations with the
ers to seek veterinary advice,33 yet according client to assure proper use by the cat. Litter
to a 2016 study, only 31.7% of cats with box rejection can stem from a variety of
house‑soiling behavior were evaluated by causes, and choices can be offered for the
a veterinarian for this condition.73 kitten to express their preference. If
Asking specific questions regarding house‑soiling is noted by the owner, the
elimination habits and inquiring HOUSE-SOILING BEHAVIOR kitten should be evaluated for underly‑
whether any house‑soiling has Detailed information on the treatment ing conditions such as congenital abnor‑
occurred since the last examination is and prevention of house-soiling and the malities of the lower urinary or GI tract,
an important discussion item for each design of the optimal litter box is GI parasites, or other infectious diseases.
visit. Clients may assume these behav‑ provided in the “AAFP and ISFM
Guidelines for Diagnosing and
Mature adult and senior cats may house‑
iors are normal or cannot be corrected. Solving House-Soiling soil secondarily to medical or behavioral
Timely intervention is critical to address Behavior in Cats”.33 conditions. Clients should be encouraged to
these behaviors effectively. seek veterinary assistance promptly, in order

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to diagnose life‑threatening conditions such tI n v e s t i g a t i n g u r i n e m a r k i n g

as urinary tract blockage, and to avoid having
the behavior become entrenched. < Where does the voiding occur?
Cats should never be reprimanded for toilet‑ < Volume of urine?
ing in undesired locations and should never < Is the cat defecating and urinating in the litter box?
be taken to a litter box punitively. < What is the frequency of these behaviors?
< What is the litter box setup and cleaning regimen (number of litter boxes,
Urine marking type[s] of litter, size of boxes, how often they are scooped and cleaned)?
If cats at any life stage present with lower uri‑ < How many cats, other pets, and humans are in the household?
nary tract signs, the practitioner must obtain < Are there external cats or animals that might be considered stressors?
a definitive history to differentiate various
underlying causes for the signs. Urine mark‑ Consider asking the owner to draw a floor plan of their home showing the
ing, which is recognized as a normal felid location of the litter box(es) in order to help identify other stressors. (Other
behavior,77 is certainly not desirable for solely relevant information could be added such as resting places of housemate
indoor‑housed cats. Most cats that mark have cats that could be blocking access to the box, places with no easy escape
a characteristic posture, whereby their tail is routes, loud appliances such as a washing machine, high-traffic areas, kids’
lifted and voiding often occurs on vertical sur‑ playroom nearby, etc.)
faces. However, cats can mark on horizontal
surfaces, especially on owners’ personal
items. A detailed physical examination and
environmental history, including a descrip‑ urine marking could also help prevent the
tion of the behaviors, should be obtained for onset or reduce the severity of FIC.81 Not all
these cases. For some questions to consider, cats will require intense multimodal environ‑
see the “Investigating urine marking” box. mental modification therapy, giving practi‑
Urine marking, although often associated Because tioners scope to adapt environmental change
with intact male cats, can be displayed by both recommendations based on the cat’s needs
feline sexes, intact or neutered. Neutering is environmental and owner’s desire and commitment to this
nonetheless advisable, supported by a study stressors process.
showing that urine‑spraying behavior in a
small group of 17 free‑roaming domestic cats can trigger Senior cats
almost disappeared when the cats were evalu‑ For all cats, but especially senior cats, that pre‑
ated after neutering.78 Unfortunately, neuter‑
urine-marking sent with elimination issues, a thorough diag‑
ing will not eliminate or prevent spraying in behavior, nostic evaluation is recommended. Disorders
all cats. Because environmental stressors can that result in polyuria or polydipsia such as
trigger urine‑marking behavior, assuring that assuring diabetes mellitus, chronic kidney disease, and
the environmental needs of the cat are met is that the hyperthyroidism can lead to elimination
critical.38 behaviors. If the cat is defecating outside the
environmental litter box, a fecal score should be obtained and
Lower urinary tract disease recorded to help follow potential trends and
If young adult or mature cats are presented needs of the guide diagnostic and therapeutic approach‑
with lower urinary tract signs, such as pollaki‑ cat are met es.25,26 Veterinarians should discuss other
uria, hematuria, or periuria, feline idiopathic potential problems such as DJD that can lead
cystitis (FIC) is the most likely differential.79 is critical. to elimination problems in senior cats. Litter
Although this is currently a diagnosis of boxes should be easily accessible. Cats with
exclusion, this disease can be exacerbated by mobility issues may need a lower litter box
a variety of stressors perceived by the cat. height, with the box placed close to their core
Notably, there is evidence that complex inter‑ areas. Avoiding the need to climb stairs can be
actions exist between “susceptible” cats and beneficial.
“provocative” environments in the develop‑
ment of chronic lower urinary tract signs.60 Life stage nutrition and
A study evaluating multimodal environmen‑ weight management
tal modification suggested that this form of
therapy can be beneficial for helping manage All life stages
cats with FIC.80 Affected cats were followed In the wild, cats are exclusively solitary
for 10 months, primarily by phone contact, hunters and often will predate animals of
and significant (P <0.05) reductions in lower much smaller body mass than their own. This
urinary tract signs were noted. requires them to hunt and feed several times
Although urine‑marking behavior and FIC during the day.82 Because of evolutionary
are different conditions, the environmental changes, the domestic cat has lost key
management of both of these elimination metabolic enzymes, and this has resulted in
problems is similar. Tailoring an environment very narrowly defined nutritional require‑
that is optimal for the indoor cat to reduce ments.83 All cats require protein, which is

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composed of 23 different amino acids; 11 are young adult active cats have been shown to
considered essential for the cat. Deficiencies have higher energy requirements compared
in any essential nutrients could result in with senior cats.90
health problems.83 No matter the life stage, to The amount fed should be adjusted to main‑
help avoid potential nutrient insufficiencies, tain or encourage ideal body condition, and a
cats should be fed diets labeled with an BCS should be documented by the veterinari‑
Association of American Feed Control an at each visit.91 Photographs (dorsal and lat‑
Officials statement of nutritional adequacy. eral) of the cat can be obtained and recorded.
AAHA and the AAFP do not advocate or A BCS of 6/9 or 7/9 is considered overweight,
endorse feeding cats any raw or dehydrated and a score of greater than or equal to 8/9 is
non‑sterilized foods, including treats that are considered obese.92 The prevalence of obesity
of animal origin.84 in cats ranges from 1.8 to 40% in published
In order to make a nutritional recommenda‑ studies.60 Being overweight or obese can
tion, the practice team can assess nutritional predispose to a variety of chronic health
status based on age, reproductive status, BCS, conditions including diabetes mellitus,93,94
MCS, activity level, presence of disease, and lameness (presumably related to osteoarthri‑
future health concerns for the individual cat.85 tis and soft tissue injury),93,94 non‑allergic skin
A diet is selected to best meet the nutritional disease,93,94 urethral obstruction,95 and,
needs of the patient, and a specific feeding according to one study, an increase in the
plan is then developed. Clinical discretion is prevalence of oral disease.93
applied to allow gradual transitioning to the Neutering is a risk factor for obesity in cats,
new diet over 7–10 days.85 especially males,96 and dietary energy restric‑
tion may be appropriate to prevent weight
Kittens gain.97 Free‑choice feeding is a common strat‑
Kittens can be weaned onto commercially Behavioral egy used by cat owners and can predispose to
balanced kitten foods starting at 3–5 weeks of overconsumption. Maintenance of a healthy
age. Growing kittens at 10 weeks of age have and ethological body weight requires monitoring and control
a very high energy requirement of 200 kcal/kg research of caloric intake. A good starting point is to
body weight/day compared with 80 kcal/kg/ calculate the adult feline patient’s resting
day at 10 months of age. Generally, kitten food suggest that energy requirements (RER) according to
preferences have been reported to be highly the following calculation: RER (kcal per day)
influenced by the queen (i.e., the primary cats prefer to = 30 × (body weight in kg) + 70. Daily energy
effect),86 although these preferences can be eat individually requirements (DER) are determined based on
modified in the adult cat based on experi‑ multiplying by a needs factor, which in the
ences.83 Behavioral and ethological research in a quiet case of young, healthy adults is 1. Food
both suggest that cats prefer to eat intake can be determined by comparing DER
individually in a quiet location where they
location where with the caloric density of the patient’s
will not be startled by other animals, sudden they will not be foods.85,98–100
movement, or activity.87,88 Natural feline Prescription diets are indicated for obesity
feeding behavior also includes predatory startled by treatment. These weight loss diets are
activities such as stalking and pouncing. other animals, formulated to provide adequate vitamins and
These may be simulated by hiding small minerals with reduced caloric content. It is
amounts of food around the house, or by sudden important to inform owners of overweight
using a food puzzle from which the cat has to cats that simply feeding less of a maintenance
extract the food (if such interventions appeal movement, diet in order to reduce caloric intake may
to the cat).19 Implementing these options or activity. result in vitamin and mineral deficiencies.
during the kitten life stage is recommended
and also provides opportunity to enrich the Mature adult and senior cats
environment. Mature adult and senior cats have changing
Obesity prevention starts with kittens. As dietary needs, and it is extremely important to
neutering is associated with weight gain,89 this provide guidance on daily feeding amounts.
is an excellent time to evaluate the nutritional DER for mature adult cats (aged 7–10 years)
needs, obesity risks, and prevention strategies may be equivalent to RER, although adjust‑
for the individual patient. Recommendations ments should be made based on the needs of
can be found in the AAFP’s “Feline Feeding the individual patient. For senior cats (greater
Programs Consensus Statement”.19 than 10 years of age), the RER will need to be
multiplied by a factor of 10–20%, and in some
Young adult cats cases as high as 25%.101 Senior cats may also
Energy requirements of cats are influenced by experience a reduction in digestive capabili‑
a variety of factors including age (i.e., life ties, leading to decreased BCS and thus
stage), BCS, MCS, neuter status, health status, increased caloric intake.92 Being underweight
and activity level. Using indirect calorimetry, is a common problem in senior cats.102–104

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tH y d r a t i o n Oral health

Some cats seem to have preferences with regard to their drinking habits, Lifelong proactive dental care will improve a
a predilection the practitioner or owner can evaluate. Water-related factors to cat’s health and well‑being and should begin
consider include freshness, taste, movement (e.g., provided by water foun- with the initial kitten visits. If the practice
tains, dripping faucets, or aquarium pump–bubbled air into a bowl), and team starts to discuss the importance of oral
shape of container (some cats seem to resent having their vibrissae touch the health at kitten wellness appointments, the
sides of the container when drinking). As with foods, changes in water- owner will come to think of the cat’s dental
related factors should be offered in such a way that permits the cat to health as being a significant contributor to its
express its preferences. Additionally, water bowls should be cleaned regular- quality of life.107 After the practitioner has
ly, as should food bowls. Diets higher in water content, such as canned determined that no malocclusion or dental
foods, may improve overall water intake. eruption problems are present,108 practice
team members can instruct owners on how to
examine the cat’s mouth and how to brush the
teeth. Providing videos, written and verbal
instructions, and samples of products that
Prescription therapeutic diets may be indicat‑ have Veterinary Oral Health Council approval
ed more often for cats in the mature adult or will also encourage the owner to begin pro‑
senior life stage for a variety of reasons (e.g., viding oral care.109,110 If these training sessions
chronic kidney disease, obesity, hyperthy‑ include a treat reward or palatable toothpaste,
roidism, chronic enteropathies, osteoarthritis). the kitten will learn that handling of its mouth
If a dietary change is indicated, offering the normally is not aversive.110,111
new diet in a separate, adjacent container If adult cats will not allow routine tooth‑
(rather than removing the usual food and brushing, a dental diet may be benefi‑
replacing it with the new food) will permit the cial.107,111–113 If both the owner and practitioner
cat to express its preference. Dietary changes routinely examine the cat’s mouth as it
should be implemented in the home setting matures, a diagnosis of dental disease, masses,
rather than in the practice in order to avoid or orofacial pain can be made before problems
stress‑related food aversions. However, intro‑ escalate and cause pain and hyporexia.107,113,114
duction of novel diets to inappetent, hospital‑ The use of photographic or radiographic
ized cats should not be avoided if food images of sequential oral examinations, as
consumption is a concern. well as scoring sheets for dental pathology,
There is a lack of consensus regarding opti‑ generally better communicates the degree and
mal dietary protein levels in mature adult progression of pathology. Improved client
cats. A published study demonstrated that education can encourage cat owners to comply
aging cats should in fact receive diets higher with veterinary recommendations regarding
in protein to avoid loss of lean muscle mass.105 dental care. Periodic complete dental prophy‑
Healthy mature adult/senior cats should not laxis, including full oral dental radiography,
be protein restricted; a diet with a minimum even if gross pathology is not present, can
protein allowance of 30–45% dry matter is be beneficial.107 The use of feline‑friendly
considered to be moderate protein and is handling techniques and anxiolytics will allow
recommended. However, cats with chronic a more thorough oral examination. Only after
kidney disease may benefit from prescription the patient has been anesthetized can a
renal diets, which have restricted, high‑ complete and thorough oral evaluation be
quality protein and restricted phosphorus successfully performed. The comprehensive
levels, as well as other ingredients that may examination includes a tooth‑by‑tooth visual
promote renal health. Ongoing research is assessment, probing, mobility assessment,
examining the role of antioxidants in the pro‑ radiographic examination, and oral examina‑
gression of renal disease; one study demon‑ tion charting.115,116 Anesthesia‑free dentistry is
strated the benefits of feeding a diet with not appropriate because of patient stress, injury,
highly bioavailable protein supplemented risk of aspiration, and lack of diagnostic capa‑
with fish oil, L‑carnitine, antioxidants, and bilities. Furthermore, because this procedure is
amino acids to senior cats in early renal fail‑ intended only to clean the visible surface of the
ure.106 Further studies are needed to develop teeth, it provides the pet owner with a false
definitive recommendations. sense of benefit to their pet’s oral health.117–119

If the practice team starts to discuss the importance of oral health

at kitten wellness appointments, the owner will come to think of the cat’s
dental health as being a significant contributor to its quality of life.

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Parasite control Veterinarians should vaccinate every animal

For kittens and newly adopted cats with an with core vaccines and give non-core vaccines
unknown history of medical care, it is prudent
to administer prophylactic treatment for para‑ no more frequently than is deemed necessary
sites with broad‑spectrum products efficacious based on risk exposure.
against heartworms, intestinal parasites, and
fleas.17,120,121 This approach will eliminate exist‑
ing infections, as well as decrease the risk of
further infestation and subsequent associated The Task Force supports the “2020
clinical problems. Canine and feline house‑ AAHA/AAFP Feline Vaccination Guidelines”7
mates may be at risk of transmission of infec‑ and the World Small Animal Veterinary
tious parasites including roundworm and fleas Association’s recommendation that veterinari‑
and therefore should be treated in synchronicity ans should vaccinate every animal with core
with newly acquired kittens or cats. Preventing vaccines and give non‑core vaccines no more
cats’ access to gardens and children’s play sand frequently than is deemed necessary based on
areas will, combined with parasite prophylaxis, risk exposure.126 Revaccination against FPV,
decrease environmental contamination with FHV‑1, and FCV at 6 months of age to poten‑
infectious and zoonotic agents such as hook‑ tially reduce the window of susceptibility in
worms and Toxoplasma gondii.33 kittens with maternally derived antibodies
Routine, regular use of broad‑spectrum toward the end of the kitten series (16–18
products is likely to be beneficial for the major‑ weeks) is recommended.7 Feline leukemia
ity of pet cats, regardless of lifestyle. Certain virus (FeLV) vaccination is considered core for
outdoor lifestyles, geographic location, and kittens and young cats owing to age‑related
whether a cat spends time away from the susceptibility, especially those with a high risk
home (travel, boarding facilities, groomer, etc.) of regular exposure. It is recommended to
may increase the existing risk of parasitic revaccinate for FeLV 12 months after the last
infection. Thus, recommendations for preven‑ dose in the kitten series, and then annually for
tion and control should reflect knowledge of individual cats at high risk. Veterinarians have
the risks and benefits for the individual cat. considerable ability to use biologics in a dis‑
Fecal examinations, when appropriate, may cretionary manner but also should be aware of
diagnose specific infections and guide thera‑ any state‑ or provincial‑specific restrictions in
py; however, negative testing does not rule out their veterinary practice act relating to imple‑
infection. Ectoparasite prevention will lower mentation, especially in regard to rabies.
the risk of cutaneous and systemic diseases.120 Detailed information regarding the role of
As tick populations increase in number and vaccination as an essential component of
expand geographically, the prevention of tick preventive healthcare is given in the “2020
infestations in cats is becoming increasingly AAHA/AAFP Feline Vaccination Guidelines”.7
important. Ticks may act as vectors of feline Feline injection‑site sarcoma is a real, albeit
diseases such as rickettsial infection and low, risk for cats receiving injectable vaccines.7
hemotropic mycoplasmosis, and cats may act Feline injection‑site sarcomas are aggressive,
as transport hosts of infected ticks to locally invasive neoplasms that are difficult to
humans.122,123 There has been an upward trend diagnose and surgically remove.7 Practitioners
in heartworm incidence reported by veterinar‑ should follow the “3‑2‑1 rule” when investi‑
ians over the past 3 years in the United gating suspicious masses.7,127 In order to facili‑
States.124 Prevention of heartworm infection, tate surgical excision or amputation in the
and subsequent feline HARD or heartworm event of sarcoma formation, and the opportu‑
disease, is preferable, as diagnosis is challeng‑ nity to obtain two or three surgical planes, all
ing at best and treatment difficult because of vaccines should be administered in the lower
the inherent risks associated with therapy.125 limbs or tail, as recommended in the “2020
AAHA/AAFP Feline Vaccination Guidelines”.7
Vaccination Distal limb injections should be administered
below the elbow or stifle; tail injections should
Practitioners can develop individualized be in the distal third of the tail. Because com‑
vaccination protocols consisting of core vac‑ plete surgical excision of a mass is most diffi‑
cines (rabies virus, feline herpesvirus type 1 cult in the intrascapular space, administration
[FHV‑1], feline calicivirus [FCV], and feline at this location is not recommended. Education
panleukopenia virus [FPV]) and non‑core vac‑ of owners regarding injection‑site reactions is
cines based on exposure and susceptibility prudent. Practitioners are strongly advised to
risk as defined by the patient’s life stage, keep complete, accurate records of antigen
lifestyle, and place of origin as well as by administration site and route of vaccine
environmental and epidemiologic factors. administration.

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Zoonoses and human safety Control, Prevention, and Biosecurity

Guidelines”.129 The practice team should
Healthy humans are at very low risk of infec‑ Basic ensure proper hand hygiene and personal
tion with a zoonotic agent through exposure to protection at all times and alert coworkers to
a healthy cat.17 However, immunocompro‑ preventive likely infectious animals so that possible expo‑
mised individuals (e.g., older adults, children healthcare sure can be mitigated.
younger than 5 years of age, pregnant women, Pet food, particularly raw or undercooked
or immunosuppressed individuals) are at (e.g., internal meat, is also a source of potential zoonotic
increased risk of acquiring zoonotic disease agents.130 Many veterinary and human health
from pets. Common zoonotic diseases in cats and external organizations, including AAHA and the
(e.g., toxocariasis, toxoplasmosis, ringworm, parasite AAFP, do not advocate or endorse feeding
bartonellosis [cat scratch fever]) are described pets any raw or dehydrated non‑sterilized
in detail in the “2019 AAFP Feline Zoonoses control, foods, including treats that are of animal ori‑
Guidelines”,17 as well as within the Centers for gin.84 Safe food handling should be practiced
Disease Control and Prevention’s “healthy
vaccination) with all pets.
pets, healthy people” resource.128 This informa‑ protects both Avoiding situations that may lead to cat
tion can aid in education of the practice team bites or scratches is a key part of human safety
and help guide discussions with pet owners. feline and and, in turn, a means to help prevent zoonoses
Basic preventive healthcare (e.g., internal human health. associated with these injuries. This is another
and external parasite control, vaccination) important reason for the practice team to learn
protects both feline and human health and is and engage in feline‑friendly handling tech‑
further enhanced by management to prevent niques8 and to teach owners techniques to help
pet roaming. Understanding and instituting them avoid being bitten or scratched by their
proper biosecurity measures is a basic tenet of pet. The risk of cat scratch fever, a zoonotic dis‑
preventing zoonoses. Detailed guidance for ease caused by Bartonella henselae transmitted
assessing and instituting biosecurity protocols by fleas, can also be reduced by the use of
can be found in the “2018 AAHA Infection regular, effective flea prevention.17

Table 4 Recommended diagnostics based on life stage*

Kitten (birth up to 1 year) Young adult (1–6 years) Mature adult (7–10 years) Senior (>10 years)

Complete blood count: + ++ +++

hematocrit, red blood cells, white blood
cells, differential count, cytology, platelets

Serum biochemistry panel: + ++ +++

at a minimum include total protein,
albumin, globulin, alkaline phosphatase,
alanine aminotransferase, glucose, blood
urea nitrogen, creatinine, potassium,
phosphorus, sodium, calcium

Urinalysis: + ++ +++
specific gravity, sediment, glucose,
ketones, bilirubin, protein

T4 + ++ +++
Symmetric dimethylarginine + ++ +++
and other renal indices

Blood pressure + ++ +++

Retroviral testing +++ + + +
Fecal examination +++ + + +
Testing frequency† Single baseline, then as Single baseline, then as Every 1–2 years At least yearly
needed needed (every 6 months
recommended)

Detailed information on heartworm testing is available in the American Heartworm Society guidelines125
*Diagnostics should be tailored to the individual cat and based on history/physical examination. These recommendations are based on the opinion
of the Task Force for apparently healthy cats and do not include recommendations for preanesthetic laboratory work. In most cases, these tests are
recommended to establish baseline data and to detect unapparent clinical disease
†
These tests may be done as a single baseline evaluation or at repeated intervals based on the specific needs of the individual cat
+ = consider based on individual patient; ++ = recommended; +++ = strongly recommended

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sis and management of diseases in mature

GUIDELINES AND TOOLKITS adult and senior cats are described in the
< “2016 AAFP Guidelines for the Management of Feline “AAFP Senior Care Guidelines”.12 Consensus
Hyperthyroidism”.131 guidelines and toolkits for the diagnosis and
Available at: catvets.com/hyperthyroidism treatment of specific medical conditions are
available for more detailed information (see
< “2016 ISFM Consensus Guidelines on the Diagnosis and
“Guidelines and toolkits” box).
Management of Feline Chronic Kidney Disease”.132
For cats of all ages, timing and frequency of
Available at: guidelines.jfms.com; DOI: 10.1177/1098612X16631234
diagnostics may depend on lifestyle, exposure
< “2018 AAHA Diabetes Management Guidelines for Dogs and Cats”.133 risks, and geographic location. Retroviral test‑
Available at: aaha.org/diabetes ing recommendations are discussed in detail
< “2019 AAFP Diabetes Educational Toolkit”.134 in the “2020 AAFP Feline Retrovirus Testing
Available at: catvets.com/diabetes and Management Guidelines”.18 In addition
< “2015 ISFM Consensus Guidelines on the Practical Management of to routine deworming, fecal examination
Diabetes Mellitus in Cats”.135 should be performed regularly at intervals
Available at: guidelines.jfms.com; DOI: 10.1177/1098612X15571880 based on patient health and lifestyle factors.
Heartworm infection is more difficult to diag‑
< “2017 ISFM Consensus Guidelines on the Diagnosis and Management
nose in cats than in dogs because of lower
of Hypertension in Cats”.29
worm burden, single‑sex infections, and infre‑
Available at: guidelines.jfms.com; DOI: 10.1177/1098612X17693500
quency of microfilaremia. HARD, which is an
< “2021 AAFP Hypertension Educational Toolkit”.136 asthma‑like inflammatory reaction of the pul‑
Available at: catvets.com/hypertension monary tissue to immature larval stages, is an
< “2018 ACVIM Hypertension Consensus Statement”.137 added complexity relating to heartworm expo‑
Available at: DOI: 10.1111/jvim.15331 sure in cats. Interpretation of antibody and anti‑
gen test results is challenging, and a thorough
understanding of the limitations of both tests is
Recommended diagnostics necessary. More detailed information is avail‑
based on life stage able in the American Heartworm Society guide‑
lines.125 Testing does not need to be performed
Recommended diagnostics according to life before starting preventive treatment.
stage are outlined in Table 4. These recom‑ N‑terminal probrain natriuretic peptide has
mendations are intended for apparently been investigated as a diagnostic tool for
healthy cats and do not extend to preanesthet‑ cardiac disease in cats.138 However, limited
ic laboratory work. Although specific data information exists about using this test as a
documenting benefits are not available, the screening tool and recommendations cannot
Task Force concluded that regular preventive be made on the frequency of use for the gen‑
healthcare examination and collection of asso‑ eral population. The decision to use this test
ciated medical data can be valuable, allowing should be on an individual basis, and inter‑
early detection of disease or trends in clinical pretation of test results should be made with
or laboratory parameters that may be of con‑ an understanding of the sensitivity and speci‑
cern. Examples include increasing creatinine, ficity of the assay.
symmetric dimethylarginine, total thyroxine
(T4), or blood pressure and decreasing urine Practice team training and
specific gravity. Additionally, these diagnostic client education
results provide a baseline for interpretation of
data recorded at subsequent visits. Team training and education of clients are
Specific recommendations regarding fre‑ integral to implementing successful life stage
quency of laboratory testing by life stage recommendations. These two factors will
depend on many factors. One consideration allow the practice team to appropriately
regarding testing frequency is that the inci‑ accomplish physical examination and diag‑
dence of many diseases increases as cats age. nostics, and institute treatment protocols
Although limited incidence studies have been when indicated for the patient. Feline‑specific
performed to identify the age of onset of training for the practice team should be deliv‑
hyperthyroidism in cats, the Task Force rec‑ ered on a regular basis, incorporating contin‑
ommends that veterinarians strongly consider uing education as well as staff meetings and
T4 testing in the apparently healthy mature team‑building events held at the practice.
adult cat. More robust incidence data are
needed to develop firmer recommendations.
Comorbidities are extremely common in Team training and education of clients are
the senior cat and can impact diagnostic, integral to implementing successful life stage
treatment, and management approaches.
Additional considerations relating to diagno‑ recommendations.

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tC o n d u c t i n g e f f e c t i v e p a t i e n t h i s t o r i e s
Equipping the team with the skills to obtain a thorough history questions and make accurate recommendations. For example,
is imperative. The aim during an examination visit should be to asking the question, “How often does your cat drink water?”
obtain detailed information regarding the patient’s instead of “Is your cat drinking normally?” can
health (current and past), clinical signs, nutrition, Often, a small encourage the owner to be more thorough in
water intake, behavior, environment, and lifestyle. describing exactly how much water their cat
Use of open-ended questions will encourage change in the drinks. Likewise, “Is your cat eating normally?” is
owners to provide the team with as much useful way a question unlikely to elicit as much information as the more
information as possible; closed-ended questions specific question, “Can you describe to me your
that lend only yes or no answers may, by contrast, is asked can cat’s diet and daily eating habits?” If the owner
provide only limited information. doesn’t know the cat is exhibiting an abnormal or
Often, a small change in the way a question is
yield extra subtle behavior, or a clinical sign of a disease, they
asked can yield extra information, allowing the information. might not naturally bring it up at the visit, which
veterinarian to follow up with additional probing could preclude an early diagnosis.

Team training will ensure all staff members

are knowledgeable and are following practice
protocols for life stage recommendations.
From the front office staff and veterinary tech‑
nicians to the veterinarians, everyone will
know what is expected of them and how to ADDITIONAL CLIENT EDUCATION
respond appropriately in the light of the feline RESOURCES
patient’s life stage. Team training events to To help educate clients about the importance of
increase knowledge and confidence when an individualized, lifelong healthcare strategy for
their cat, both AAHA and the AAFP have handouts
taking patient histories (see “Conducting available to members and non-members.
effective patient histories” box) and providing Additionally, more extensive information is
client education are just as important as available at: aaha.org/felinelifestage
further education on feline‑friendly handling, catvets.com/life-stage
disease processes, and technical skills. catfriendly.com/life-stage

Ideally, client education is a key responsibil‑

ity for all staff members. Every life stage will
have specific items that should be discussed
in the veterinary visit (see Table 2), and both
veterinary technicians and veterinarians they understand that pet owners can become
should be familiar with current recommenda‑ overwhelmed at veterinary visits. Moreover,
tions and practice protocols in order to edu‑ communicating that the cat owner is an inte‑
cate clients on the most critical health‑related gral part of the healthcare team can reinforce
factors relevant to each life stage. The practice the veterinary–client–patient relationship, as
team can better connect with clients when well as improve compliance.

SUMMARY points
< The “2021 AAHA/AAFP Feline Life Stage Guidelines” define four distinct age-related feline life stages: kitten (birth up
to 1 year), young adult (1–6 years), mature adult (7–10 years), and senior (greater than 10 years).
< End of life and its precursor events are a fifth life stage that is not age specific, and are discussed in separate “2016
AAHA/IAAHPC End-of-Life Care Guidelines”4 and the “2021 AAFP End of Life Online Educational Toolkit”.5
< Within these “2021 AAHA/AAFP Feline Life Stage Guidelines”, the Task Force offers evidence-guided recommendations
for eight clinical aspects of feline medicine that should be managed in relation to a cat’s life stage: behavior and
environmental needs; elimination; nutrition and weight management; oral health; parasite control; vaccination;
zoonoses and human safety; and diagnostics.
< Additionally, important topics include feline-friendly handling practices, overcoming barriers to examination visits,
environmental enrichment, understanding feline behavior, practice team training, and client education.
< Integrating clinical management with appropriate patient handling, and practice team and client collaboration,
all tailored to the cat’s life stage, forms the basis for an effective, individualized healthcare strategy that
can be applied throughout the feline patient’s lifetime.

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Acknowledgments 7 Stone AE, Brummet GO, Carozza EM, et al. 2020

AAHA/AAFP feline vaccination guidelines. J Feline Med
The Task Force gratefully acknowledges the contribution of Surg 2020; 22: 813–830.
Mark Dana of Scientific Communications Services, LLC, and the 8 Rodan I, Sundahl E, Carney H, et al. AAFP and ISFM feline-
Kanara Consulting Group, LLC, in the preparation of the guide‑ friendly handling guidelines. J Feline Med Surg 2011; 13:
lines manuscript. 364–375.
9 Carney HC, Little S, Brownlee-Tomasso D, et al. AAFP and
Conflict of interest ISFM feline-friendly nursing care guidelines. J Feline Med
Surg 2012; 14: 337–349.
Hazel C Carney has received speaking fees from Royal Canin. 10 AAFP. AAFP Cat Friendly Certificate Program. Available at:
Jessica Quimby is a consultant/key opinion leader for Boehringer catvets.com/certificate.
Ingelheim Animal Health USA Inc., Dechra Veterinary Products, 11 AAFP. Cat Friendly Practices. Available at: catvets.com/cfp.
Elanco Animal Health, Hill’s Pet Nutrition, Inc., IDEXX 12 Pittari J, Rodan I, Beekman G, et al. American Association of
Laboratories, Inc., Kindred Biosciences, Inc., Nestlé Purina Feline Practitioners. Senior care guidelines. J Feline Med Surg
Petcare, and Royal Canin. Jodi Westropp has received speaking 2009; 11: 763–778.
fees from Bayer Animal Health, Nestlé Purina Petcare, Hill’s 13 AAFP Position Statement. Early spay and castration.
Pet Nutrition, Inc., and Royal Canin; served as a consultant/ Available at: catvets.com/public/PDFs/PositionStatements/
key opinion leader for Nestlé Purina Petcare; and served on the EarlySpay&Neuter.pdf.
academic board for the International School of Veterinary 14 AAFP. Client brochures for cat owners. How do I know if
Postgraduate Studies. The other members of the Task Force have my cat is in pain? Available at: https://catvets.com/guide-
no conflicts of interest to declare. lines/client-brochures.
15 Gough A, Thomas A and O’Neill D. Part II: cat breeds.
Funding In: Gough A, Thomas A and O’Neill D (eds). Breed predispo-
sitions to disease in dogs and cats. 3rd ed. Chichester, UK:
Boehringer Ingelheim Animal Health USA Inc., CareCredit, John Wiley & Sons, 2018, pp 225–255.
Dechra Veterinary Products, IDEXX Laboratories, Inc., Merck 16 Hosie MJ, Addie DD, Boucraut-Baralon C, et al. Matrix
Animal Health, and Zoetis Petcare supported the development vaccination guidelines: 2015 ABCD recommendations for
of the “2021 AAHA/AAFP Feline Life Stage Guidelines” and indoor/outdoor cats, rescue shelter cats and breeding catter-
resources through an educational grant to AAHA. ies. J Feline Med Surg 2015; 17: 583–587.
17 Lappin MR, Elston T, Evans L, et al. 2019 AAFP feline
Ethical approval zoonoses guidelines. J Feline Med Surg 2019; 21: 1008–1021.
18 Little S, Levy J, Hartmann K, et al. 2020 AAFP feline retro-
This work did not involve the use of animals and, therefore, ethi‑ virus testing and management guidelines. J Feline Med Surg
cal approval was not specifically required for publication. 2020; 22: 5–30.
19 Sadek T, Hamper B, Horwitz D, et al. Feline feeding pro-
Informed consent grams: addressing behavioral needs to improve feline
health and wellbeing. J Feline Med Surg 2018; 20: 1049–1055.
This work did not involve the use of animals and, therefore, AAFP Consensus Statement available at: catvets.com/
informed consent was not required. For any animals individually guidelines/practice-guidelines/how-to-feed.
identifiable within this publication, informed consent (either 20 AAHA. Body condition scoring (BCS) systems. Available at:
verbal or written) for their use in the publication was obtained aaha.org/globalassets/02-guidelines/weight-management/
from the people involved. weightmgmt_bodyconditionscoring.pdf.
21 Whyte A, Gracia A, Bonastre C, et al. Oral disease and micro-
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Available online at jfms.com and catvets.com/life-stage

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Appendix: Client brochure

Your Cat’s Life Stages

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Down to-print t
easy- formats a
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broch atvets.co
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client

Additional supplemental resources for the Life Stage Guidelines can be found at catvets.com/life-stage

The client brochure may be downloaded from catvets.com/life-stage and catfriendly.com/life-stage, and is also available as supplementary material
at jfms.com. DOI: 10.1177/1098612X21993657

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