Coming of age
CVM seeks to shine spotlight on geriatric horse care and pain management
Horses are living longer than ever thanks to advances in veterinary care. This extended lifespan also means research and treatments are playing catch up when it comes to the specialized care these older equines require.
Typically, horses ages 20 and older are considered geriatric. They’re a demographic that has long captured the interest of Alex Bianco, DVM, MS, DACVIM, an assistant professor in the Department of Veterinary Population Medicine at the University of Minnesota College of Veterinary Medicine (CVM) and a clinical faculty member at Piper Equine Hospital.
She likes taking on tough large animal cases involving critical care and pain management, given her background in pharmacology. Frequently, those cases involve geriatric horses.
That makes them a little bit special and makes you want to give them a little bit of extra care.
Alex Bianco
“I just like old horses. And I feel like they’re forgotten in a sense because oftentimes they are retired or are ‘pasture pets’ and have emotional value to people but not a lot of other value,” she says. “That makes them a little bit special and makes you want to give them a little bit of extra care.”
Like other species, horses aren’t immune to the aches, pains, and chronic conditions that develop as their bodies age. The care of geriatric horses presents a number of challenges, one of which is the lack of research into effective care and pain management. Equine research usually focuses on better understanding, treating, and preventing health conditions in performance horses and foals. While owners often have strong, emotional attachments to their older horses, funding for research into improving their quality of life doesn’t often present itself.
That’s not to say there isn’t interest in geriatric medicine. Bianco posits that primary care veterinarians are often the ones treating geriatric horses but they don’t necessarily have the time or resources to explore the topics of improving care and pain management. Bianco recently conducted a review of available research into geriatric horse pain management and shared her findings at the 2021 Veterinary Meeting and Expo (VMX) in Orlando, Fla., along with recommendations for veterinarians to help them better understand and treat older horses.
Recognizing pain
Another hurdle to geriatric horse care involves recognizing how pain and other conditions present in these equines. Pain scoring systems have long been part of diagnosing potential issues in a hospital setting, but it’s important to understand that not all pain presents the same way.
Clinical signs of acute pain often are more obvious than chronic pain. For example, a horse that is in pain following surgery would likely display more overt signs than a horse that has been living with an untreated or chronic injury.
“There are other conditions that have a lower degree of pain or a slower onset of pain,” Bianco says. “As things get more painful gradually over time, it’s harder to recognize the signs.”
By nature, horses aren’t exactly forthcoming about experiencing pain. Deep down, they are prey animals wired to know that showing any sign of weakness could end in death if a predator is on the hunt and detects that vulnerability.
Both veterinarians and owners play important roles in recognizing signs of pain, but the subtlety of these signs can prove difficult to decipher, especially for horse owners. In general, it can be difficult for an owner to recognize signs of pain and know to take their horse in for evaluation, especially if the horse is boarded offsite or placed in a pasture for long periods of time. A disconnect in the mind of owners between changes in a horse’s gait or the onset of lameness and the presence of pain is another barrier to pain management in older horses.
This all underlines the importance of regular veterinary evaluation and preventative care. As horses age, they’re more likely to develop health issues so regular vet visits can be key to preventing, uncovering, and treating those conditions as early as possible. As such, it’s important for veterinarians to advise owners of how care changes for geriatric horses and encourage at least annual visits for health evaluations—ideally twice yearly.
Under new management
Recognizing pain and diagnosing its cause is only half the battle in geriatric horse care. Finding effective treatment options and preparing a horse for possible end-of-life care is the other.
The presence of pain doesn’t always mean a horse’s quality of life has slipped to the point of considering euthanasia to spare it from suffering. It’s possible for horses to live a high quality of life with managed pain.
There's a difference between pain and suffering. Most of us probably live with some degree of pain, but we’re not necessarily suffering. We’d say we're fine, but recognize that we still have pain.
Alex Bianco
“There's a difference between pain and suffering,” Bianco says. “Most of us probably live with some degree of pain, but we’re not necessarily suffering. We’d say we're fine, but recognize that we still have pain.”
Traditionally, chronic pain in geriatric horses has been managed through the use of medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) and local therapy (e.g. joint injections) all of which come with their own set of risks.
Gaining popularity as marketed treatments for pain are nutraceuticals, which can include herbal supplements and cannabinoids—most commonly cannabidiol (CBD). Little research has been done into the efficacy of these products when it comes to treating pain in horses, and they have no FDA regulation to ensure they contain what they advertise and are safe. Use of any supplements should be discussed with the primary care veterinarian, and hopefully more non-biased, peer-reviewed, research can be funded.
More than the basics
What pain management looks like for a horse also depends on its role. A companion equine might receive more elaborate measures to manage its pain than a working horse. It also can come down to an owner’s vision and perceptions of the horse’s quality of life.
The idea of horse hospice is one that Bianco is hoping to popularize as geriatric horse care advances. Treatments can extend a horse’s life but an important factor to consider is the quality of that life. Just meeting basic requirements, such as being able to eat and walk, is not enough for a horse’s quality of life to be considered good.
“It's more important to keep a horse comfortable over the time it has left,” Bianco says, adding that sometimes owners or veterinarians balk at the idea of administering medications for extended periods of time due to potential side effects. “In essence, that horse lives in pain because people perceive that the potential side effects are worse than the actual pain.”
Veterinarians and owners can work together to create end-of-life plans that prioritize the horse’s quality of life-based on medical and financial resources available and with the acknowledgment that certain treatments may result in adverse side effects, with plans to address them at the time they present.
As part of this planning, veterinary professionals also can discuss options for euthanasia prior to the conversation being necessary/immediate. It can be a difficult topic to broach, but Bianco points out that there are worse options, including leaving a horse to suffer from no treatment or care.
Planning doesn’t end once the horse passes. Veterinarians and owners also should explore options for the disposal of the horse’s body. Traditionally, equine carcasses have been buried, cremated, or picked up for rendering or disposal at a landfill. Another option that Bianco advocates for is composting. Composting a carcass is a cost-effective and environmentally friendly method of disposal that, if done properly, results in no odor or attraction of scavengers.
In the end, Bianco hopes to see more research conducted into geriatric horse care as well as more owners and veterinarians working together to better understand the needs of aging horses in order to provide them with a high quality of life as the animals approach their twilight years.
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