End-of-Life stage: Assessing Quality of Life

It is common for pet owners to outlive many pets throughout their lifetime. Every time, it can be emotionally devastating to witness our beloved companion age, become ill, and ultimately have to decide when it is time to say goodbye.

Deciding when to let go of a pet that is sick or old is a difficult and heartbreaking decision that many pet owners face. It's essential to consider the pet's comfort, stress levels, and pain before deciding to prolong or end its life. Consulting with your pet’s family doctor can help pet parents understand the limits of ethical treatment and financial constraints. In-home quality-of-life assessments can help reassure caregivers that it's the right time to let go or turn the visit into a palliative care visit to optimize the pet's quality of life.

Quality of Life Scale: The HHHHHMM Scale

The HHHHHMM Scale is a quantitative tool developed by Dr. Alice Villalobos to help pet parents get a better understanding and a measurable insight into the Quality of Life of their four-legged family member as the disease or end-of-life process progresses. The letters in the scale stand for Hurt, Hunger, Hydration, Hygiene, Happiness, Mobility and More Good Days than Bad.

Assign scores from 0-10 on each of the criteria on the scale. A score of 35 or more indicates acceptable Life Quality.

Please Select Based on the Following Reference Points:

1 = Extremely Poor 10 = Higher Quality of Life

Hurt

Adequate pain control, including the ability to breathe, is the most important aspect of quality of life and it is first and foremost on the scale. Many pet owners may not realize that not being able to breathe easily can be one of the most painful experiences for an animal.

Hunger

Can your animal eat on its own? Has it lost interest in food? If your pet is not receiving adequate nutrition, by hand or force feeding, then a feeding tube should be considered, especially for cats. Malnutrition develops quickly in sick animals if the care giver is not knowledgeable about pet nutrition.

Hydration

Is your animal hydrated? Fluids that are injected beneath the animal’s skin are a very effective method to supplement the water intake of ailing pets. You can learn from your veterinarian how to perform this procedure on your own.

Hygiene

Some questions to consider include: Can your pet be kept brushed and cleaned? Is the coat matted? Is your pet situated properly so that it will not have to lie in its own waste after elimination? Can your pet control its waste output?

Happiness

One important question to consider when contemplating euthanasia is: “Is your pet able to experience any joy or mental stimulation?” Pets often communicate their thoughts and emotions with their eyes. You should try to answer questions such as: Is your pet responsive and willing to interact with the family? If the animal is a cat, is it able to purr and enjoy being on the bed or in your lap? Is there a response to a bit of catnip or a favorite toy? Can your pet’s bed be moved close to the family’s activities and not left in an isolated or neglected area? Is your pet depressed, lonely, anxious, bored, or afraid?

Mobility

You should determine whether your pet is able to move around on its own or with help in order to satisfy its needs. Does your pet feel like going out for a walk? Does your pet have central nervous system problems, such as seizures or stumbling? Can your pet be taken outdoors or helped into the litter box to eliminate with assistance? Will a harness, sling or cart be helpful? Is medication helping? The need for mobility seems dependent on the species and breed. You should bear in mind that cats and small lap dogs can and do seem to enjoy life with much less mobility than large and giant-breed dogs.

More Good Days Than Bad

When there are too many bad days in a row or if your pet seems to be “turned off” to life, quality of life is compromised. Bad days are filled with undesirable experiences such as vomiting, nausea, diarrhea, frustration, and seizures. Bad days could be from profound weakness caused by anemia or from the discomfort caused by an obstruction or a large, inoperable tumor in the abdomen. When a healthy human-animal bond is no longer possible, the caregiver should be aware that the end is near. Making the decision for euthanasia is a kindness to pets that are suffering.

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Adapted from Villalobos, A.E., Quality of life scale helps make final call, Veterinary Practice News, September 2004.

End-of-Life stage: Assessing Quality of Life

Quality of Life Scale: The HHHHHMM Scale

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