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Quality-of-Life Scale


Each and every pet has certain needs that should be recognized and respected. Quality of life is a way to refer to and discuss the day-to-day life and lifestyle of a pet reaching the end of its life. If we can successfully meet an ailing or chronically ill pet's basic needs, then we can feel confident that our efforts in preserving life are justified.

"If we can successfully meet an ailing dog’s basic needs, then we can feel confident that preserving life is justified."

Most senior pets develop one or more medical conditions that tend to worsen over time.

Examples of chronic medical conditions common in older pets include:

  • Cancer—The risk of cancers of all types increases with age.
  • Chronic renal disease—This degenerative kidney disease leads to the decreased ability of the kidneys to filter biological waste from the blood.
  • Osteoarthritis—Painful inflammation and deterioration of the joints.

Dr. Alice Villalobos, a veterinary oncologist, has developed a quality-of-life scale for pets so owners can act on behalf of their beloved animal family members as a pet’s end of life approaches. The quality-of-life scale provides guidelines that help owners and veterinarians work together to maintain a healthy human–animal bond. The scale provides a tool with which to measure the success of a palliative care or hospice plan for a pet with life-limiting disease and to fine-tune that care/plan.

Dr. Villalobos’ quality-of-life scale looks at seven different parameters and scores each parameter from 1 to 10, with 10 being the best. A score above 5 in each category, or an overall score greater than 35, suggests that the pet's quality of life is acceptable and that it is reasonable to continue end-of-life care and support.

The categories to be measured can be remembered as “HHHHHMM.” This list of letters stands for Hurt, Hunger, Hydration, Hygiene, Happiness, Mobility, and More good days than bad.

The quality-of-life scale helps owners act on behalf of their beloved animal family members as a pet's end of life approaches.

What does each category mean for a pet approaching the end of its life?

The HHHHHMM scale:

Hurt: 1–10

Adequate pain control, including the ability to breathe properly, is an absolute necessity. Most pet owners do not know that being able to breathe is ranked as an important pain management strategy. Some methods of controlling pain may include oral or injectable medication.

Hunger: 1–10

If a dog cannot eat properly or willingly, first try hand-feeding. If this is not successful, then it may be appropriate to consider a feeding tube, particularly if oral medication must be given. Blended or liquid diets may offer another alternative.

Hydration: 1–10

Fluid under the skin is an easy and well-tolerated way to supplement what an ailing pet is drinking. This is not a “heroic” measure and can really help an older pet feel better. If your veterinarian recommends on-going fluid therapy, you can recurring appointments with our technicians or an appointment wherein a technician can demonstrate how to give fluids at home.

Hygiene: 1–10

Can the pet be brushed, combed, and kept clean as normal? Is the coat matted? Can the pet move away from stool or urine if it has an accident? Is there a tumor that has outgrown its blood supply and now has an odor or discharge? It is also important to turn bedridden pets regularly, keep them clean and dry, and ensure that they have adequate padding underneath to prevent bedsores.

Happiness: 1–10

Is your pet experiencing joy or mental stimulation? Pets communicate with their eyes, wagging their tails, and purring. Is the ailing pet interacting with family members and with the environment as he or she usually does? Placing comfortable beds near family activities helps a pet remain engaged in life. Dogs are social animals and can become depressed when they are separated from their “pack.”

Mobility: 1–10

If your pet can no longer move around on its own, it may be time to consider one of the many mobility devices that are available. For dogs: A sling or harness for support may be all that is required. Believe it or not, both dogs and cats can be surprisingly accepting of other options, depending on how much support is needed, include two-wheel carts, four-wheel carts, and wagons. Mobility and hygiene go together when a pet is bedridden. The veterinarian is an important resource when working through mobility issues.

More good days than bad: 1–10

When there are too many bad days in a row, or if your pet seems to be “turned off” to life, quality of life is compromised. Bad days may mean nausea, vomiting, diarrhea, seizures, frustration, unrelenting pain/discomfort, or inability to breathe.

"A healthy human–animal bond requires a two-way exchange, and when that exchange is gone, the time for humane euthanasia has arrived."

A healthy human–animal bond requires a two-way exchange, and when that exchange is gone, the time for humane euthanasia has arrived (See "End of Life Decisions" for further reading). It is important to plan for the end of life before that time arrives, and the quality-of-life scale can help with that planning. You can help your pet maintain a good day-to-day life experience by using this scale to regularly measuring the parameters that evaluate how well your pet's basic needs are being met. This scale can also help you clarify the decision for euthanasia, hopefully relieving anxiety and regret about your beloved pet's end of life. Please remember, this scale is a tool and should be used alongside the guidance of your veterinarian. We are often asked to help pet owners with this heart-breaking decision and we are here to help you with this very difficult decision.

If you have recently lost a pet, WSU offers a grief and loss hotline.

This client information sheet is based on material written by: Robin Downing, DVM, CVPP, CCRP, DAAPM

© Copyright 2012 LifeLearn Inc. Used and/or modified with permission under license.

We have modified it to fit Lien Animal Clinic's views and guidelines.

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