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members to become thoroughly knowledgeable with the EOL guidelines, too.2 Although the 2012 guidelines can be considered a companion reference to the newer guidelines, an important distinction between the two is the task force’s decision to reduce the number of canine life stages (preEOL) from six to four. Note: All subsequent discussion of the number of the life stage categories will focus on and refer to the four life stages preceding EOL. The physiologic basis for six canine life stages remains valid. However, categorizing the dog’s lifespan into four segments makes clinical protocols easier to implement and, very importantly, simplifies the pet healthcare dialog between the practice team and its pet owners. Everyone in the practice, including technicians and support staff, should have an understanding of how a dog’s life stage forms the basis for patient-specific healthcare recommendations. Thus, there is a dual rationale for the four life stage approach to managing the canine patient, simplifying implementation of and adherence to clinical protocols and facilitating client communication, which is the key to compliance. The life stage guidelines represent a framework for the clinician but are not intended to be all inclusive. The AAHA website (aaha.org/ caninelifestage) contains useful supporting information and resources for using life stages to guide preventive healthcare and treatment protocols for the canine patient. Definition of Life Stages For practical purposes, rather than attempt to calculate age equivalents to humans, the task force suggests that life stage be defined both by age and characteristics (Table 1). Life stage divisions, although arbitrary, provide a framework for creating individualized plans for preventive care specific to each dog’s needs at the appropriate time. Table 1 provides broad-based definitions of the four life stages used in these guidelines. These guidelines focus on life stages that require different approaches to preventive care. The spectrum of care within each life stage is affected by the age, size, lifestyle, health status, and breed of the dog.3–5 Physiological and behavioral developmental periods do not start and end abruptly, but phase in and out gradually. Within each life stage category there will also be variation that demands clinical judgement. Because variation increases toward the latter years, estimates of inclusive ages are not uniform and therefore are not proposed for the life stages of mature adults and seniors. Estimation by the practice team of an individual dog’s lifespan, generally predicted by breed lifespan, permits more accurate targeting of life stage–specific preventive care.6 Table 2 provides a checklist of items to discuss with each pet owner based on life stage. Table 3 offers suggestions for resources to help predict longevity in various common breeds. Using Life Stages to Individualize Patient Care Each member of the veterinary team plays a vital role in providing individualized patient care to dogs regardless of life stages. At all life stages, pet owners should be encouraged to acclimate dogs to safe travel in an automobile and/or carrier prior to the veterinary visit. The team should require all pet owners to restrain dogs on a leash or in a carrier upon entering the practice and arrange the reception area to minimize encounters with other animals. Planning appointments 268 JAAHA | 55:6 Nov/Dec 2019 to minimize wait time, separating animals in the waiting room, and/or moving dogs directly into a quiet, calm environment can help to decrease dog and owner anxiety. Furthermore, for known anxious, fearful, aggressive, or premedicated animals, a strategy should be devised that potentially involves initial contact outside the building and entering/exiting through a door that avoids the client waiting area. The entire veterinary team should be trained in stress-reducing handling techniques and, as appropriate, use positive reinforcement (e.g., food, treats, toys, mats) to facilitate the physical examination, diagnostic sample collection, and treatment implementation.7,8 A calm, quiet body language and voice as well as canine pheromones may be helpful alone or in conjunction with other techniques to decrease patient stress and fear.7,9,10 For more anxious dogs, previsit anxiolytics or sedation should be used to reduce patient stress and fear as well as provide safety for the veterinary team.7 Should undue stress or fear develop in the dog, consider sending the dog and pet owner home, using positive reinforcement techniques only during the visit, and consider rescheduling with previsit anxiolytics. Formal communication training, including relationshipcentered communication, should be encouraged for the entire veterinary team to develop optimal communication skills. Pet owners want to be involved in the decision-making process (shared decision making) through explaining their dog’s condition, available options including a recommended option, and respect of the decision they make in partnership with their veterinarian.11 To achieve a shared decision, the veterinary team should gather information use openended questions (who, what, when, where, why?) and two-way communication. Implementation of two-way communication requires strategies to listen to and confirm the pet owner’s perspective (e.g., reflective listening) and asking follow-up questions based on information
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