Avian Geriatrics

Growing Old Gracefully

Icarus, a Double yellow-headed Amazon parrot, came to me for his yearly examination. He was a large, handsome bird, with sleek, shiny feathers. He would flare his tail and ruffle up his head feathers, saying "hello" and "here" while pacing back and forth in his travel cage. This healthy bird represents a new class of birds being seen more and more frequently in avian practices today. Icarus is 24 years old and considered a middle-aged bird.

Through advances in avian medicine and improved husbandry practices, avian patients are living longer. It is not unusual in my practice to routinely see cockatiels well into their twenties, and large birds in their teens. Little documented evidence of the actual life-span of psittacines has been reported in the literature. Macaws have been documented to live into their late forties, one was 52 years, another was 57. In the collection that I maintain, I have a Blue and Gold macaw hen that is a documented 51 years of age, at this time. Even more surprising, she laid a fertile egg this season that hatched. I have a cockatiel patient that is 27 years old, and still going strong. Amazons can be very long-lived. I have another Double yellow-headed Amazon patient, Rocky, that is over 36 years old. The owners still have the bill of sale, and Rocky was purchased with adult head coloration, in 1962. Budgies, due to their propensity to develop tumors, usually only have a life-span of 7-10 years, although they have been known to live into their late teens. Of course, with leg banding and accurate breeder records, it is possible to often know the exact age of a domestically hatched pet bird. Many aviculturists will use closed leg bands stamped with identification letters and a two digit number, indicating the year of hatch. But, be aware that, on occasion, a band from an earlier year may be used, which may confuse an owner, who may think that a bird is actually older than it is.

Although it may be difficult or impossible to pin down an older bird's age, there are some clues as to the age of birds. Old birds may suffer from muscle wasting and weight loss. Range of motion may be limited in limbs. In birds with bare facial skin, changes may occur with age, including wart-like blemishes, cysts and wrinkling. The skin of the feet may become depigmented in spots. Feather luster may diminish with age. Degenerative opthalmologic changes may occur, including cataracts and lid laxity. Iris atrophy may occur, evidenced by a darkening of the normally light colored iris. Lenses may show nuclear sclerosis. Rapidly developing cataracts may lead to phacogenic uveitis, which left untreated, may result in blindness.

Birds are no longer imported, however, many imported birds are still kept as pets or breeder birds, but, in most cases, it is impossible to ascertain the age of these birds with any degree of accuracy. Imported birds are identified by an open stainless steel band, usually stamped with three letters and three numbers (unless the band has been removed).

On occasion, I will examine an imported bird, and the owner will state with confidence that the bird is x number of years old. It may be that the owner was told the age of the bird when it was purchased. Some birds were imported as hand-feeding babies, or shortly after weaning, and in those birds, it was possible to determine the approximate age. But other birds, imported as adults, cannot be assigned a numerical age, as in most birds, age changes are not predictable. But, since birds have not been commercially imported for several years, all imported birds can reasonably be considered adult birds, age undetermined.

Many aviculturists have set up imported pairs of birds for breeding, and since it is impossible to accurately ascertain the age of these birds, it would be a good idea to have breeders begin holding back some parent-raised offspring for future breeders. Since these imports are aging, and we have no way to know exactly how old they are, far-sighted aviculturists will begin keeping back some birds as replacements.

There are certain health concerns that are more common in geriatric avian patients. Unfortunately, malnutrition and nutritional disorders are still common in pet birds. Too many owners continue to feed a seed based diet. We know that this type of diet will result in long-term health problems, including hypovitaminosis A, calcium deficiency, hepatic lipidosis and secondary infections, for example. Birds may be maintained on very deficient diets for long periods of time, with few outward signs of malnutrition. However, this will take a toll on the bird over time. Even though the owner may offer healthful foods, the bird may continue to choose just the food items it enjoys, and ignore the foods that may help balance the diet.

The geriatric pet bird should receive a complete work up and physical exam periodically. Although a yearly check-up may suffice, older birds with problems will benefit from more frequent veterinary visits, perhaps as often as two to six times per year. Unless there is a specific need for general anesthesia, this should probably be avoided in geriatric patients for common procedures, due to the greater risk of complications. A thorough physical exam should be performed at each visit, and the avian vet should use some means of magnification when examining the patient. Eyes, ears, nares, oropharynx, choana, tongue and glottis should be carefully and closely examined. The heart, lungs and air sacs should be auscultated. The ingluvies (crop) and abdomen should be palpated. The limbs should be put through a full range of motion. The skin should be closely examined. The feathers should be scrutinized for evidence of depigmentation (which may indicate a delayed molt), lack of preening (as evidenced by dirty, ratty, unzipped feathers), feather picking or chewing, or other abnormalities. The cloacal mucosa should be gently everted with a moistened cotton-tipped applicator, and 5% acetic acid applied to the tissue. The uropygeal gland, when present, should be visually examined, and gently massaged to milk out the secretion. The feet, toes and nails should be examined and palpated. In addition to the physical exam, the bird should be weighed, its band (if present) recorded, and the bird should be scanned for a microchip.

Once the physical examination has been quickly and efficiently performed, the samples for the lab tests should be procured. Older birds may have already been screened at some point in their lives for chlamydiosis (psittacosis), Psittacine Beak and Feather Disease (PBFD), and polyomavirus, so, some repeat testing may be redundant and unnecessary, unless there has been recent risk of exposure. (Note: adult birds are quite resistant to the PBFD virus. Most birds acquire the infection while young, when the Bursa of Fabricius is still open). Chlamydia testing is not always 100% reliable in a live bird, so if warranted, testing may be repeated. The University of Georgia now offers a new chlamydia panel, consisting of a DNA PCR test of a choanal/cloacal swab, DNA PCR test of blood, and the IFA titer. This panel evaluates the bird for presence of the organism and also antibodies, so it is more thorough than just running one individual test. Polyomavirus is most dangerous to unweaned psittacines, however, any bird that is not vaccinated or that is not immune, is at risk for acquiring the disease at any age. Although research is on-going, it seems that most birds that acquire this virus as adults will develop mild signs of disease, shed the virus for a period of time (up to 6 months) and then become immune to the virus. It has been my experience that some adult birds (caiques, eclectus and scarlet-chested parakeets, most commonly in my practice) will die if infected as adults. Some researchers feel that adults won't die from polyomavirus unless concurrently infected with some other immunosuppressive organism, however, this has not been my experience. So, adult birds that have had no risk of exposure within a year should not usually need to be tested. Birds at risk for exposure should be vaccinated periodically.

Blood work should be performed on geriatric avian patients during the exam. Remembering that older birds may not be as flexible as young birds, they should be handled gently, but firmly, for venipuncture. I usually use the medial metatarsal vein for venipuncture, however, if there are any abnormalities to the feet, hocks or toes, another site should be chosen. A CBC and chemistry panel, including bile acids, should be run.

A Gram's stain of the choana and cloaca may be run. However, remember that this is just a screening test, and any abnormalities should lead to bacterial culture and sensitivity being performed.

Radiographs may be very diagnostic in the geriatric patient. Rads can show organ abnormalities, space-occupying lesions, bone or joint problems and other changes. It is important to remember that the geriatric patient should be handled gently during radiography.

Other tests or procedures may be performed during the examination. Endoscopy may be used as a diagnostic procedure, and it is possible to biopsy organs to procure samples for cytology, microbiology or histopathology. Any masses discovered may be fine needle aspirated or biopsied. Skin scrapings, microscopic feather exam or other tests may be performed. Fecals may be evaluated for parasites. Direct saline mounts are often helpful. Fecal flotations may be unrewarding. Recent research from the University of Georgia has backed up what I have known for some time now; that fecals often correlate poorly with worm load in parasitized birds. Perhaps due to the quick gut transit time, or because ascarids may be in aberrant hosts, few or no eggs may be seen on fecals. Birds at risk, or those that have never been dewormed should probably be dewormed at least once for ascarids. If ascarids have been diagnosed, the bird should probably be dewormed periodically for the rest of its life, since encysted forms of the ascarids may act as a source for reinfestation. Imported birds should probably receive an injection of praziquantel at least once, for tapeworms. I examined an older, imported Orange-winged Amazon parrot that had lived with a family for 12 years. This bird had been seen by an avian vet every year, and had a fecal performed. As the history indicated that the bird had never been dewormed, I gave it an injection for cestodes. Within hours, the bird had passed a tangle of the nasty parasites. So, don't overlook the risk of internal parasites in the geriatric patient. Pyrantel pamoate and praziquantel have been very safe and efficacious in the geriatric patient, in my practice.

Geriatric birds may develop atherosclerosis, most commonly seen in African Greys and Blue-fronted Amazons, diagnosed on post-mortem most often. The fungal infection, aspergillosis, may occur in older birds, especially those housed in poor conditions. Old birds may suffer from chronic liver disease, chronic heart disease or chronic renal disease. Urinalysis, ECG, aspergillus titer, electrophoresis or ultrasound may prove diagnostic. Strokes may occur in geriatric birds. Neoplasia may occur in older birds, and is more common in certain species (with budgies at the top of the list).

Older birds on a poor plane of nutrition will usually be suffering from some degree of hypovitaminosis A. The choana may be swollen, and the choanal papillae may be blunted or absent. Sheets of sloughed epithelial cells may be seen on a Gram's stain. Chronic sinusitis may occur, and is often complicated by secondary bacterial or fungal infections. Correction of the diet is important, even for older birds that might have spent decades eating an improper diet. It is extremely important that dietary changes not be undertaken until the bird has been carefully examined, tested and consequently treated for any problems uncovered, as stressing a bird during diet conversion can create an acute illness from sub-clinical disease.

Older birds may have a problem with obesity. Obesity in birds may be defined as a weight that exceeds optimum by 15% or greater. Because a bird may become more sedentary as it ages, and the owner may have settled into a routine, perhaps not playing with the bird as often, the lower activity level may result in weight gain. Also, the older bird may have a slower metabolic rate, and may not require as many calories. If it continues to eat as it did in its younger days, it may put on weight. Although hypothyroidism is not well-documented in psittacines, it may also play a role in weight gain in some older birds. Hepatic lipidosis is common in overweight birds, especially Amazons, cockatiels, rose-breasted cockatoos, quaker parrots and budgies, in my practice. On radiographs, the liver shadow will be enlarged. The enlarged liver may be seen though the skin, and it may be palpable. If visualized through endoscopy or laparoscopy, the liver will have rounded edges, be friable, and have a mottled yellowish color. Birds with hepatic lipidosis may not clot properly, so the avian vet must be very careful when performing any procedures where hemostasis may be an issue. Geriatric birds with hepatic lipidosis require a weight loss program that drastically reduces fat from the diet, and close monitoring by the avian vet. Long-chain complex carbohydrates and fructose may be given by gavage. Vitamins, minerals and amino acids should be supplemented, as well. Lactulose is helpful in treating avian liver disease.

Arthritis, bone and joint problems may occur in older birds. Some older birds may suffer from a limited range of motion in one or more joints. This may occur as a result of old injuries sustained when the bird was initially captured out of the rainforest, in old, imported birds.

Cataracts are evident in most macaws over 35 years of age and they may also develop in other species of birds. Cataracts may have a rapid onset, which may lead to uveitis and blindness. Cataract surgery may be attempted.

As avian veterinarians are doing such a good job of prolonging quality life in avian patients, and as owners become more knowledgeable regarding proper husbandry, nutrition and preventative health care, more and more birds will be living to a ripe, old age. We must begin addressing the issue of geriatric care in pet birds. Owners should be educated about the special needs and requirements of the older avian patient. This is best accomplished by the avian vet during the annual check-up. Geriatric medicine can become a lucrative, exciting and challenging area of avian medicine that has not been adequately explored in most practices.

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