In the October 1 issue of JAVMA (Journal of the American Veterinary Medical Association) researchers posed this question: should the veterinary profession invest in methods to assess quality of life in healthy dogs and cats?
The question was posed and then addressed by Nathaniel Spofford; MPH, Sandra Lefebvre, DVM, PhD; Sandra McCune, PhD; and Lee Niel, PhD. The article starts off with an overview of the current health crisis confronting Americans and their pets: with current health advances in both human and pets large numbers are still suffering from largely preventable diseases. In spite of medical advances,Western humans and their pets are suffering more, not less often from debilitating, life altering diseases that medicine can prevent.
According the statistics provided by the article, between 2007 and 2011, diabetes mellitus among dogs has increased 32%, while the same disease has increased in cats 16%. A simple correlation to this is the fact that overweight and obese dogs and cats have risen 37% and 90% respectively.
According to the researchers these statistics along with similar elevations in the prevalence of heartworm disease, flea infestation, behavioral issues and other preventable health conditions are due to a prevention gap.
According to the researchers,"Such increases are of particular concern because many of the most common health conditions in dogs and cats, such as dental disease, overweight and obesity, diabetes mellitus, heartworm disease, flea infestation, and behavioral issues, are largely avoidable through routine preventive care. The increase in the prevalence of these common diseases coincides, perhaps not surprisingly, with a decade-long decrease in the annual number of veterinary visits for dogs and cats. Taken as a whole, the data suggest the existence of a prevention gap similar to that in human medicine, with many pets not receiving care that would help them maintain an optimal level of health."
Veterinarians in conjunction with the AVMA (American Veterinary Medical Association) have launched many initiatives to try to bring more pets into their hospitals in an effort to stem the tide of morbidity and mortality in pets from preventable diseases. The results, thus far, have not been positive.
The researchers state that some of the apathy on owner's parts may stem from the fact that there is little hard evidence that preventive care of the sort advocated in the article (and by the AVMA) of regular exams for healthy pets actually provides longer, healthier lives in those pets.
According to the researchers an interesting detection bias arises in any retrospective study that tries to examine the advantages of regular veterinary care (bear with me here - this is really interesting). Veterinarians write their findings in medical records (dental disease, diabetes, etc...). Dogs and cats seen more often have more such notes mentioned - because testing and exams have found these issues. This creates a bias - wherein healthy populations seeing veterinarians regularly appear sicker than healthy populations seeing their veterinarians less often. Lastly, veterinarians rarely note a return to health in these cases.
This is where a quality of life (QOL) assessment comes into play. If all pets coming into a veterinarian receives a QOL assessment (say 1-5) then good and ill health are evenly represented and a return to good health can be recorded, thus largely ridding science of that detection bias.
QOL can also better help owners understand that what they do today will affect future health. The researchers realize that any QOL discussion is subjective, and creating an effective tool that could be used in all hospitals and for all owners could take some time, however, with decreasing veterinary visits fueling a resurgance in preventable diseases, they see it as a reasonable place to begin the discussion. Another benefit of a standardized QOL would be the successful divorcing of judgement from what can often be awkward conversations with pet owners
"Despite the challenges of developing a wellness-based QOL assessment tool, we believe the benefits would be worth the effort. Information on QOL could potentially provide evidence on the effectiveness of preventive health-care services, and QOL discussions during wellness examinations could help engage clients in conversations that would help them better understand and appreciate the value of regular veterinary care. In our experience, many pet owners believe their pets are doing well if disease is not apparent, despite the fact that ailments such as dental disease, parasitic infection, and overweight body condition may be causing their pets discomfort and putting them at risk for worse problems later in life. A conversation about a pet's QOL could help transform the discussion from one of cost savings (eg, whether dental cleaning now will cost less than tooth extractions later) to one of cost-effectiveness (eg, dental cleanings make for a healthier, more content pet). Providing clients with an easier way to conceptualize that impact has the power to transform the way they think about preventive health care."
Every pet owner has their own list of QOL assessments. It will be interesting to see what the veterinary community defines as QOL. If it is true to its purpose it will be offensive to some; QOL goes down as weight and dental disease goes up, behavioral issues will have to be addressed as will exercise and perhaps even time spent interacting with fellow members of its own species and our own.
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The full JAVMA article is available for purchase here.