Signs that the suffering outweighs the joy

I know I'm the wrong person to ask about this, I mostly deal with Mochi's teething and getting him to eat his wet food, but I'm trying to help out DonnaR here. She has a 16-year-old cat who is really struggling with mobility and naps all day. I read her previous thread Assessing QoL for my 16-year-old where she went through the vet visit and history, but I want to make sure I'm not missing anything on the "bad" side of the scale.

What are the specific clinical signs that show a senior cat is suffering more than they are enjoying life? Like, beyond just "they look sad"? I know Mittens, her other cat, has arthritis Arthritis meds that actually work, so I know pain is a big factor, but is there a point where the treatment just becomes torture? I feel like I'm asking a lot, but I want to be a good friend to her and not just tell her to keep trying.

@mcruz It is very kind of you to ask this, even if it is outside your usual area. DonnaR is a sweet lady and she is going through a lot, especially after losing Pepper.

When I managed Cleo's arthritis, the biggest sign wasn't crying out; it was the refusal to jump up onto her favorite window perch. If a cat stops doing the things they used to love because it hurts, that is a big red flag. You can look at Subtle signs of feline pain for a list of behaviors like grooming less or hiding. But for a 16-year-old, it is often about the balance. If the cat is eating, drinking, and using the litter box, they are usually okay. If they stop doing those things, it is time to talk to the vet about comfort care Palliative care at home.

Straight up. If the cat is in pain, they will act weird. My Tigers are young and destructive, so I'm not the expert on the old ones, but I've seen a senior cat at work that just stopped eating.

Check if they are drinking too much. That's a kidney thing Tracking CKD in older cats. If they are peeing a lot and losing weight, the body is shutting down. Don't get attached to the idea that you can fix it with meds. Sometimes the "suffering" is the side effect of the treatment. If the cat is sedated all the time and not awake to interact, is that life or just waiting to die? I say if they aren't happy, stop the aggressive stuff. Go to Renal diet options to see if food helps, but don't force it.

I'm so sorry DonnaR is dealing with this. I'm new to the cat world, Leo is only a year old, and I can't even imagine a cat this old being in pain.

Does the cat still try to play? I read somewhere that if a kitten stops playing, it's sick, but what about a senior? Is it normal for a 16-year-old to just nap all day? I worry that if I ask DonnaR if her cat is playing, I'll make her feel bad if she says no. I just want to know what the "joy" part of the equation looks like. Is it enough if they just purr when you pet them? Or do they have to be active?

@LauraB I think purring is a good sign, but it's not the whole picture. DonnaR mentioned in her earlier post that her cat still greets her at the door, which is a good thing.

@tigersdad I agree that sedation can be a bad sign. I was looking at Grieving a senior cat and it mentioned that sometimes the stress of vet visits and medications outweighs the benefit if the cat is in the final stages. It’s hard to know where that line is without a specific checklist. I don't want to tell DonnaR to give up if her cat is still enjoying small moments, but I also don't want her to feel guilty if the suffering is real. Is there a specific metric we use, like a score out of 10?

There is no perfect metric, @mcruz. It is very personal. DonnaR knows her cat best. The vet can tell you the clinical side, like blood work and kidney values, but the emotional side is up to the owner. If the cat is still seeking comfort and interaction, that is joy. If they are in constant distress, that is suffering. I would encourage DonnaR to keep a log for a few days. Note when the cat eats, when they are in pain, and when they seem happy. That data might help her decide if the quality of life is still worth the treatment. It is a very heavy decision, but she is not alone in it.