You know your senior pet better than anyone else, but knowing when to say goodbye can seem impossible. As your pet enters their final life-phase, complicated emotions, including grief, guilt, and denial, may cloud your judgment, making your pet’s suffering or struggle difficult to acknowledge. Here are five quality-of-life assessment techniques recommended by Dr. Stephanie with Golden Years Veterinary Services to help you make end-of-life decisions, and ensure compassion and dignity for your beloved pet.

#1: Essential pillars of life

When considering quality of life for pets, general and specific categories must be evaluated—key elements that make life survivable, comfortable, and enjoyable. It is easy to focus on the physical needs (e.g., eating, drinking, walking), but the emotional and social needs should make up equal parts of the QOL equation. Use these parameters as a guideline to determine what that means for your pet:

  • Physical needs — Your pet’s physical quality of life includes consistent eating and drinking habits, exercise/mobility, elimination, and grooming. Important questions to ask yourself include:
    • Does my pet have some level of independent mobility?
    • Can my pet eliminate in the correct place without assistance, or am I required to facilitate the process (e.g., bladder expression, enemas)?
    • Is my pet still grooming and maintaining hygiene, or have I taken over all tasks?

  • Emotional needs — No one needs to tell a pet owner that animals feel emotions. Their needs are similar to ours. Are they happy? Do they feel safe? Are they stressed and anxious when you try to help them or give them medicine?

  • Social needs — Pets are social creatures who crave interaction and attention from human and pet family members. It is common for older animals to spend less time around the family due to many age related reasons such as:
    • Mobility issues (i.e., they can no longer make it up the stairs at bedtime to sleep)
    • Hygiene reasons (i.e., they can’t control their bladder or bowels and are now confined to one room. 
  • If such care is needed by your senior animal, make sure adequate extra quality time is  provided to meet their core social needs.

After confirming these core needs are met, you can take a more objective approach to quantify ‘quality of life’ using one of the following methods. We recommend assessing your pet regularly (e.g., daily or weekly) as their condition changes. At the end of life, when our pets are sick, the ‘good’ days quickly out shine the ‘bad’. Keeping track of trends allows us to stay objective.

#2: The HHHHHMM scale for assessing your pet

The HHHHHMM scale is a seven-part quality of life assessment in which you score your pet on a 1 to 10 point scale. In addition to determining when to euthanize, the HHHHHMM scale can help you make key decisions, such as when to begin hospice care for a terminally ill pet. The evaluation categories include:

  • Hurt — Is your pet in pain? (see #3 below) Is additional medicine needed for comfort? 
  • Hunger — Is your pet eating well? Do they require assistance or enticing to eat?
  • Hydration — Is your pet dehydrated? Are they always thirsty due to disease? 
  • Hygiene — Does your pet groom themselves or make an effort to stay clean? Are you able to keep your pet clean and dry?
  • Happiness — Is your pet responsive to household activity, or are they depressed and isolated?
  • Mobility — Does your pet have any independent mobility? Can they eliminate outside or in the litter box themselves? How much assistance does your pet require?
  • More good days than bad 

#3: Recognize pain—is your pet hiding their hurt?

Identifying pain in pets isn’t always easy—their ability to adapt to chronic pain, and their instinctive need to hide weakness and suffering can make their pain and discomfort almost impossible to recognize. But, visible or not, pain has the biggest negative impact on your pet’s quality of life—therefore, pet owners must learn to spot these subtle warning signs to ensure prompt veterinary care and prevent unnecessary suffering. Pain scales are available to help you determine your pet’s level of discomfort—check out our previous blog post for help with this.

#4: Four favorite things—do they still bring your pet joy?

The “favorite things” method has helped many pet owners create a simple, intuitive decision-making framework around their pet’s emotional quality of life.

The premise is simple, but revealing—write down your pet’s top four favorite activities, the things that have made them who they are to you! Examples may include greeting you at the door when you come home, crawling on your lap while you watch TV, waking you up in the morning for breakfast. Then, keep track of these actions day to day! Did they do all the actions that day? Great, 4/4! Only 2 of them? Ok, 2/4. When you notice more days of 1, 2, or 0/4 it may be time to plan to say goodbye.

#5: Good days versus bad days—tracking your pet’s quality of life

As your pet’s condition changes, you can easily lose sight of the big picture. On a “good” day you may feel hopeful, while a “bad” day can leave you prematurely grieving over your pet. Because of these alternating highs and lows, which may be normal for some end-of-life pets, owners may have trouble finding peace with their decision, no matter what they choose.

Rather than relying on an in-the-moment decision, record your pet’s daily quality of life in a journal. This could be detailed, including their activities, behavior, and mentation (e.g., happy, calm, depressed), or super simple with ‘+’ for a good day and ‘-’ for a bad day. Review your notes weekly to look for trends or patterns, and then discuss any negative trends with your veterinarian.

The decision to say goodbye to a pet is highly individual and personal, but Dr. Stephanie and the Golden Years Veterinary Services team can guide you through the process, and provide the compassionate care that your pet deserves. No matter how you decide to evaluate your pet’s quality of life, if you prioritize your pet’s comfort and dignity, you’ll always make the right decision.

For a one-on-one evaluation with Dr. Freed, schedule a phone or virtual quality of life assessment. This may be followed by an in-person consultation or, if necessary, we can assist your pet’s peaceful passing with a compassionate in-home euthanasia.