For elderly humans, some physicians now offer a type of medical care called “integrative geriatrics.” Many aspects of integrative human geriatrics also apply to cats. For both species, practitioners advocate for patient-centered, primarily non-pharmacological approaches.

As noted by researching physicians, “Most current geriatric practices overprescribe medications and procedures and underutilize non-pharmacological, low-cost, high-touch methods. Patients, however, often show reluctance towards these standard practices, as the interventions they rely upon are often invasive. The practice of integrative geriatrics is rooted in lifestyle interventions, such as nutrition, movement therapies, and mind-body and spirituality approaches, that allow patients to have different path to their healthcare—one that utilizes pharmaceuticals and invasive procedures only when safer integrative approaches are not available or not effective.”¹

The National Institutes of Health (NIH) National Center for Complementary and Integrative Health (NCCIH) defines integrative health as a type of medical practice that brings together conventional and complementary care in a coordinated way. Integrative health combines interventions, such as physical rehabilitation, with treatments like medical acupuncture, massage, photomedicine, botanical medicine, and pulsed electromagnetic field (PEMF) therapy. It emphasizes treating the whole individual rather than zeroing in on one or two organ systems.

Benefits to senior cats

For feline seniors, integrative medicine makes sense, particularly when one considers the risks of long-term medications, along with cats’ aversion to being medicated.

Offering options that cats enjoy receiving improves the human-animal bond, both for the family as well as for the veterinarians who care for them.

Moreover, a multimodal approach to mobility issues, chronic pain, and lingering diseases in older cats gives clients flexibility in trying treatments and seeing what works best.

As cats’ needs evolve over time, so can the interventions selected. For example, cats with arthritis or pain from other causes could begin with several sessions of medical acupuncture, massage, and laser therapy, accompanied by consultations about home care and additional ways to keep cats comfortable between visits.

This may include renting a low-powered laser device specifically designed for clients or, alternatively, purchasing a hand-held unit with light-emitting diodes (LEDs) for under $200. Clients might also add a PEMF device, heated cat bed, scratching pads for stretching, and carpeted stairs, ramps, or windowsill retreats specifically suited to adapt to the needs of their senior feline.

Maintenance treatments every few weeks or months give the veterinarian opportunities to update their patient’s status and adjust the integrative procedures and/or medications as warranted.

Understanding integrative medicine

Knowing the science of integrative medicine is part and parcel of practicing good medicine. We do not describe how drugs and surgery work by relying on myths and metaphors; in the same vein, we should not promote unfounded notions of how integrative therapies work by resorting to primitive, folkloric descriptions.

Instead, veterinarians should have a solid grasp on the mechanisms of action of the treatments they recommend, as well as their risks and benefits.

The acceptance of integrative healthcare depends heavily on the ability of practitioners to explain what they do in accordance with modern medical principles and rational mechanisms of action.

For example, over five decades of research have demonstrated acupuncture works not by moving invisible energy, but by acting on the nervous system and connective tissues. That is, acupuncture restores quality of life and alleviates pain by modulating central, peripheral, and autonomic nervous system activity as well as by removing restrictions in myofascia.^2,3

Thus, cats with arthritis and back pain often benefit by acupuncture’s ability to reduce central and peripheral nervous system sensitization, relax tension in the back and neck, and counter inflammation driven by heightened sympathetic tone.

Acupuncture also improves digestion, appetite, circulation, immune function, peripheral nerve function, and proprioception.⁴ Especially important for older cats, evidence is accumulating regarding the value of acupuncture for individuals with chronic kidney disease.^5,6 For diabetic peripheral neuropathy, a major complication of diabetes mellitus, studies have shown that acupuncture improves nerve conduction and lessens discomfort.⁷

Practicing integrative medicine

Many veterinary medical acupuncturists combine photomedicine with their treatments.  Laser therapy and LEDs induce physiologic effects through photonic, or light, stimulation, rather than physical or electrical transduction. Still, its influences are predominantly modulatory (i.e. balancing physiologic tone, rather than blocking enzymes or growth factors as drugs often do). The term “photobiomodulation” (PBM) aptly describes its actions, involving light (“photons”) impacting the body (“bio”) in a restorative, homeostatic manner (“modulation”).

One significant element of PBM involves its ability to enhance tissue repair.⁸ It accomplishes this through a combination of cell proliferation and promotion of stem cell differentiation. PBM also counters inflammation and provides pain relief through neural, circulatory, and myofascial effects.

Integrative feline geriatric conditions often treated with PBM include osteoarthritis, nerve injuries and neuropathies, myofascial dysfunction, and inflammatory conditions affecting the kidneys and urinary tract. Although limited evidence exists for the treatment of gingivostomatitis in cats with PBM, abundant evidence exists for photomedicine in cases of oral mucositis in humans, stemming from chemotherapy and radiotherapy.⁹

Senior cats generally tolerate laser therapy well, but side effects could include overheating with too much treatment intensity from high-power units. I recommend avoiding treatment of the feline head with Class IV lasers due to unknown risks for the feline eye and brain. Especially when lower powered devices are readily available, there is no reason to risk overheating of vulnerable tissues and neural systems.

Along with photomedicine, many integrative practitioners include massage for their patients. In fact, veterinary massage has a long history. An 1882 issue of the Journal of Comparative Medicine and Surgery claimed, “The use of rubbing, kneading and similar movements has been rapidly gaining in favor of late. Especially is this the case among the German veterinarians connected with the army.”¹⁰

The article proceeds to describe Swedish massage techniques, such as effleurage, which “consists in giving long, gentle strokes of the hand from the periphery toward the center (sic).  This motion empties the superficial veins and lymphatics.  It is very useful in bruises and sprains of the joints.”

While no research exists yet for massage in cats, geriatric humans derive numerous and substantive benefits, including improvement in gastrointestinal motility,¹¹ depression,¹² and musculoskeletal function.¹³ Even regular brushing in a manner a senior cat enjoys may allow clients to deliver some of the positive effects of massage, by mobilizing soft tissues, stimulating mechanoreceptors that augment endogenous analgesia, improvement in circulation, and supporting digestion.

Finally, PEMF therapy gives geriatric cats yet another non-invasive, non-thermal treatment that delivers pain control, promotes tissue healing, and reduces inflammation.  Increasing numbers of veterinarians are recommending PEMF to treat non-union fractures, encourage healing of chronic wounds, resolve edema, and address many of the needs of patients struggling with arthritis.¹⁴ As PEMF devices generate a field of electromagnetic energy, they possess the unique advantage of operating “in the background” (i.e. without having someone physically touch the cat). That is, clients could purchase a PEMF mat with embedded coils and have that as an option for where the cat rests.

Not all cats enjoy the sensation of the field, however, so as with light or heat or even music therapy, feline patients need to have the ability to relocate if or when they choose to do so.

Narda Robinson, DO, DVM, MS, FAAMA, practices osteopathic medicine and veterinary medicine. In 2016, Dr. Robinson established her own academy in Fort Collins, Colo., where she teaches medical acupuncture, integrative rehabilitation, medical massage, and other integrative medical approaches. 

References

1. Kogan, Mikhail, and Andrew Weil (eds), Integrative Geriatric Medicine, Weil Integrative Medicine Library New York, 2017; online edn, Oxford Academic, 1 Jan. 2018), https://doi.org/10.1093/med/9780190466268.001.0001, accessed 3 May 2023.
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