Visiting Vet: Old, loud cats

It’s five am. My 15-year-old cat looms over me where I lie in bed, pretending I don’t see her. “Meow,” she says plaintively. I gently shrug her off. “Meee-oooooow,” she insists. She is the last of our cats. At our peak, we had seven, but they passed away, one by one. Now there is just one tiny, ancient, orange cat named Tigerlily, screaming at me to get up. l dutifully do so, following her down the stairs, which she takes slowly, favoring one hind leg. When we get to the kitchen, I make sure the step stools are lined up correctly so she can climb onto the counter where her food bowls are. I open a can of food, which she sniffs, then refuses: “Meeee-ooow.” I open a different flavor, but Tigerlily has wandered off. “Meeee-ooooowwwwww,” she calls.

Tigerlily reminds me of my mother, who just turned 100 years old. Both are frail, fragile, and suffering from dementia. My mother asks for food, then forgets she wanted it, and pushes it away, only to ask for food again minutes later. At night she gets confused, calling out for her mother … forgetting that her mother died in 1949. Extreme old age. It presents challenges with pets just as it does with people. Geriatric cats, in particular, often exhibit a behavior that drives owners crazy. Yowling. A lot. Especially late at night. Why is Tigerlily wandering around randomly meowing loudly when she never did this before? And what can we do about it?

Many things can contribute to Tiger’s behavior. Diagnostics start with a complete exam, and lab tests. One common metabolic abnormality associated with increased vocalization is hyperthyroidism. In this condition, a benign but hormone-secreting tumor of the thyroid raises the basal metabolic rate, making cats feel wired and edgy. Correcting underlying hyperthyroidism (either through radioiodine treatment or daily medication to suppress excess hormone production) may lessen the howling. But not always.

Next we check for high blood pressure. Hypertension in cats can be secondary to thyroid, cardiac, or kidney disease, but can also be “primary,” with no known underlying cause. Hypertension is the “silent” disease. Sometimes the first sign owners notice is when Tiger suddenly starts bumping into things. Increased blood pressure can cause hemorrhages in the retinas, then retinal detachment, and blindness. Measuring blood pressure in cats is not technically as easy as in humans but, like people, Tiger may get “white coat syndrome” — situational anxiety causing transient hypertension. When in doubt, I do a follow-up measurement at home, where a cat is less stressed. Hypertension is treated with daily medication, which may lessen the yowling. But not always.

Maybe Tigerlily is in pain. Cats usually hide any vulnerability, since in the wild, it’s dangerous to show weakness. But just like old people with chronic pain may feel restless and have trouble sleeping, creaky old cats can also have insomnia. The best way to rule this out is with a trial course of pain medication to see if behavior or mobility improve. There are both daily oral and monthly injectable options you can discuss with your veterinarian. Treating pain may lessen the howling. But not always.

With advancing age, Tigerlily may not see or hear as well as she used to. Even her sense of smell may be declining. This is called sensory deprivation. Your veterinarian can assess vision. Hearing is harder to test, but you may notice at home Tiger sleeps through loud noises like the vacuum cleaner. At nighttime, sensory deprivation exacerbates confusion. Nightlights may help, but in general it is not treatable.

Once we’ve ruled out all those things, we are left with primary central nervous system disease. Brain tumors can cause behavioral changes. Definitive diagnosis requires consultation with neurologists for advanced imaging, and sometimes treatment. I knew one senior cat who had a brain tumor removed with a good outcome, but most owners opt not to pursue aggressive testing and surgery in elderly kitties. Then we have the condition called “cognitive decline,” also known as cognitive dysfunction syndrome in animals. In people, cognitive decline and dementia are classified into different categories, such as Alzheimer’s, vascular, Lewy body, et cetera, based on precise symptoms and underlying pathophysiology. For pets, we rarely get so specific. All we know is they seem confused. Maybe they urinate or defecate inappropriately, or get sleep-wake cycles reversed. One study suggests more than half of cats over 15 years old show behavioral issues related to senile cognitive decline. Two medications that have been tried to improve this are selegiline, a drug used to treat Parkinson’s disease in people, and S-adenosylmethionine (SAMe), a nutritional supplement. There are also commercial pet foods touted to support brain function. The efficacy of all of these in cats is unclear.

We try to entertain my mother during daytime so she stays awake, then sleeps better at night. The same thing can help Tigerlily, using environmental enrichment and social interaction to keep her active and engaged. Cat perches, new toys, interactive games, cardboard boxes, and paper bags to explore. Don’t overdo it. Too much change and activity can be stressful for seniors. Just do enough that Tigerlily is pleasantly tired by bedtime. It’s like we say about puppies. A tired puppy is a good puppy. A tired old cat may yowl less at night. But not always.

When we have exhausted all the above, and Tigerlily is still yowling and making you crazy, what can we do? If possible, have the cat sleep in a different space. I know several people who put their old cats in their guest houses at bedtime. Try not to cater to the howling, as that reinforces the behavior. An automatic feeder may help. Finally, talk to your veterinarian about medications to reduce nighttime anxiety (the cat’s, not yours) or mild sedatives to increase relaxation so everyone can get some sleep. Whether it’s your 100-year-old mother or your 15-year-old cat, the goal is to give both patients and their caregivers the best possible quality of life.