If we’re lucky, our dogs live a long, healthy life and, when their bodies wear out, they close their eyes and make that journey to the bottom of the Rainbow Bridge, where they romp with others until we arrive to cross the bridge with them into heaven. Unfortunately, a simple death like that is rarely the case, even in an ill dog, leaving owners with the agonizing decision about euthanasia and judging quality of life.
What Is Quality of Life in a Dog?
Veterinarians don’t have crystal balls that say it’s time to let your frail, elderly dog go, but they do have the education and experience to offer advice. Dr. Alice Villalobos, a renowned veterinarian, created a widely accepted way of judging your dog’s qualify of life using the “HHHHHMM Scale.” The letters stand for Hurt, Hunger, Hydration, Hygiene, Happiness, Mobility, and More good days.
The HHHHHMM scale uses a scoring system to assess the dog. It’s still subjective, but it gives you a score. Some veterinarians advise that you score an ill dog every month, or every few weeks, to watch the dog’s progression. Quality of life is a tough thing to judge, and this scale, with its numerical final score, helps.
Judging Frailty in a Dog
So, what does “frail” really mean? It’s not a measure of age. I believe it’s a subjective measure of thriving. According to the Morris Animal Foundation: “Frailty is a physical state in which health reserves are limited, decreasing response to stress, and increasing death rate.” In other words, a frail dog’s overall health and mental response to life are worsening. The likelihood of recovery is nonexistent, and the decision about euthanasia is no longer a matter of “should we?” but a decision about when. Pain is most certainly a factor in that decision.
A study funded by the Morris Animal Foundation and published September 24, 2024, in Frontiers in Veterinary Science, offers veterinarians a way to predict mortality within a six-month range using frailty. The North Carolina State University researchers hope to provide a way for veterinarians and dog owners to make decisions about what to do or not do to prolong a dog’s life. “Frailty is a well-defined clinical syndrome in humans caused by accumulation of impairments which result in loss of reserve capacity and increased vulnerability to disability, dependence, and death. Dogs are of particular interest in studies of frailty due to the similarities they share with people in their environment, lifestyles, and age-related diseases,” say the researchers.
They developed a frailty phenotype that is predictive of all-cause short-term mortality regardless of age, sex, and weight. Interestingly, the study found that breed was a significant factor in the analysis, with purebred dogs having 1.85 times higher mortality than mixed breed dogs. It does ask veterinarians to assess the dog’s body and muscle condition, which they routinely do at every veterinary visit.
“The tool—when coupled with simple assessments of body and muscle condition by the veterinarian—can predict the likelihood of short-term (within six months) mortality and provider important data to owners faced with treatment and quality of life decisions for their aging dogs,” says the news release from North Carolina State University.
No Desire to Stay Alive
The timing of this study’s release was tough for me. Some years ago, in the early fall, my frail husband was confined to a nursing facility due to a long illness. We both knew his time was short. We had four dogs, and I had finagled a way so I could bring one dog for a short visit. I expected my husband to choose the puppy we bought before he became ill, as he had never seen her. He didn’t. He asked for Draco, who was battling an inoperable tumor. I told him I would bring Draco on my next visit, hoping the visit would cheer them both up. Unfortunately, he never got to see Draco, as my husband died the next day.
Less than two weeks later, Draco, at age 16, indicated it was time to go. It was agonizing. I believe my husband arrived at the Rainbow Bridge and, after looking around, said, “Draco, come!” It’s comforting to think they are together.
So, while it’s still no crystal ball, frailty matters. Happiness matters. Pain matters. And sometimes, maybe, the timing matters. Meanwhile, this frailty study is another good tool we can use to help make the best decision for our beloved dogs.
Thank you for this article. It’s such an agonizing decision to make and I’ve faced making it three times. The first was the worst. It came not long after my dad died—much like your situation with your husband. I felt guilty about the decision and then felt guilty that maybe I was crying more for my sweet dog than for my Dad!
Condolences on both your losses.