Managing Chronically Ill Pets With Cognitively Impaired Caretakers: Annie's Story

A case highlighting deficiencies in my medical training, gaps in societal social support, and raising a number of ethical questions.

Dear Readers:

Earlier last month I shared an abridged story on LinkedIn about a difficult case I was managing. I was overwhelmed by the outpouring of love and concern for my patient and her owner, as well as the level of support I received. Below, I share the case and my thoughts in greater detail.

This case raises a number of practical and moral questions, and has taught me a lot about life, medicine, and the power of community. If any of you out there have parallel experiences to share, I would love to hear them. I’m still learning every day.

Thank you to all ♡

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I’m managing a difficult case at the moment.

Not that the medicine itself is a challenge—I know exactly which tests to run and the medications to prescribe. I’ve seen this exact constellation of signs a thousand times.

The patient, let’s call her “Annie,” is a 12 year old Jack Russell Terrier who is compliant and well-behaved. She doesn’t have any comorbidities or peculiarities complicating her case. In fact, the challenge presented here has nothing to do with Annie at all.

The greatest challenge in this case is Annie’s owner—because Annie’s owner has dementia.

She can’t recall the last time Annie ate and tells me a different story every time. She can’t keep track of the meds, and pill boxes are of no use, because although organized by time and day, she confuses which day it is. At Annie’s last appointment, she showed up 1 hour late because she mistakenly brought Annie to her physician’s office instead of to the vet.

She knew she had to go to A doctor, she simply couldn’t remember which one.

If Annie wasn’t sick, this wouldn’t be an issue.

An extra walk or a skipped meal never did anybody any harm. But Annie has a serious disease—one that she could die from if not managed properly. If she misses a few pills, she could relapse. If she receives too many pills, she could develop a severe (perhaps life-threatening) gastric ulcer, especially if she receives those pills on an empty stomach.

Because after all, is Annie eating?

Well, nobody really knows.

This isn’t something I was taught in veterinary school. Nobody tells you how you’re supposed to manage chronically ill patients when the only other member of their care team is cognitively impaired and on the decline. And as veterinarian, I’m certainly not licensed in the treatment of human dementia myself.

So, what am I supposed to do?

Many people will read this and say that the dog should be put to sleep. Or that the owner should give her to someone who is better equipped to care for her — because if managed appropriately, Annie can still go on to live a very good life. But is euthanasia or the rehoming of a 12 year old dog really what’s in the best interest of either of them?

I’m not so sure.

And yet, I’ve seen this before and I know how it goes…

When I was 15 years old, my grandfather was diagnosed with dementia. With the exception of my short and not-frequent-enough visits, the dog was the only company he had. His decline was slow at first, but when his dog passed and he no longer had anyone to care for, his decline very obviously accelerated. So, with his dog, also went his: cognition, day to day happiness and mental wellbeing, activity level, socialization, and overall life quality.

I didn’t realize it then, but it’s clear to see now that the dog was the only thing keeping him going.

Annie’s owner seems to share a similar story.

At age 80, she spends the majority of her days alone. She has no children or nearby family. All her friends have since come and gone, and Annie is the only companion that she has left.

But Annie is more than just a companion.

She gives her owner a reason to get out of bed in the morning. She gives her a routine—someone to walk, someone to feed, someone to care for. She gives her a sense of purpose.

And though she may no longer be fully equipped to provide Annie with the highest standard of care at home, is that to say that this elderly woman shouldn’t maintain the right to enjoy the numerous benefits of pet ownership?

Studies show that dog owners who walk their dogs are 2.5 times more likely to achieve moderate physical activity than non-dog walkers. Walking a dog has also been associated with higher social interaction among older adults — a crucial element for dementia management and overall senior wellbeing.

And the benefits of pet ownership extend far beyond the physical.

Dog ownership alone has been found to be associated with a lower risk of dementia, and a study just recently published in JAMA found that pet ownership may be associated with slower cognitive decline among older adults living alone.

Without the daily routine, companionship, and sense of purpose that Annie provides, her owner would surely suffer and decline.

And Annie needs her, too.

At age 12, Annie has never known another home. She’s very attached to her owner and becomes visibly distressed when held in the arms of anyone else. The added stress of rehoming would be terrible for controlling her autoimmune disease, and is that what this dog really deserves in the last years of her life? To be ripped from the arms of her loving owner and the only home she’s ever known?

Is that what you would want for your old dog?

I don’t have the answers today.

No tips, life hacks, or pieces of advice. Only an excerpt from my experience to offer, and an understanding of the mutual need and love that these two share.

They deserve to stay together.

But as their veterinarian, and one of the very few remaining members of their community, I’m struggling to find a way to safely make that happen.

Take care of each other,

Dr. Sami

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