Head to Hoof: Senior Horse Health Concerns

Help your horse age gracefully by understanding the most common issues facing senior equines.

Many senior horse health problems are often managed with early detection. Stay vigilant with your daily care and schedule regular vet exams to give your aging equine the best chance to enjoy his golden years. Photo: Dusty Perin

Thanks to improvements in veterinary care, nutrition and management, horses today live longer than ever. Your favorite equine might easily celebrate birthdays into his 20s or even 30s. Still, most horses start showing some signs of aging in their mid to late teens. And, unfortunately, some studies report that 70 percent of horses 20 years old or older have some type of health problem requiring veterinary care or changes in management.

Maybe that’s not surprising, since a 15-year-old horse is roughly equivalent to a 50-year-old human. At age 20, your horse is like a 60-year-old and at 25, like a 70-year-old.

But senior horse health problems don’t have to mean the end of your horse’s happy days. The key is early detection, says Lisa Kivett, DVM, MS, DACVIM, of Foundation Equine Clinic in Southern Pines, North Carolina. “When we can identify a problem very early, when it’s just getting started, it’s usually fairly easy and inexpensive to treat,” she says. “This also keeps the horse from experiencing pain or discomfort since we’re able to tackle his issue before he really knows he has one.”

With that in mind, Dr. Kivett and Jaime Lehfeldt, DVM, cVMA, CVMMP, DACVIM, of Montana Equine in Billings, Montana, provide a head-to-hoof look at some key issues your older horse might face—plus some tips to help you keep your horse feeling comfortable during those senior years.

An older horse can often suffer from dental issues such as missing or sensitive teeth, which could contribute to weight loss. Offering him a complete senior feed or chopped forage can make it easier for him to chew, digest and absorb nutrients from his food. © Amy K. Dragoo/AIMMEDIA


“Dental problems are one of the most widely recognized complications of aging in a horse,” says Dr. Kivett. “Though modern horse management and advances in veterinary medicine have dramatically increased a horse’s projected life span, the teeth often wear out before a domestic horse reaches the end of his natural life.”

As a horse ages, teeth not only become worn, but can also fall out or develop sharp points on the outside of the upper cheek teeth and inside of the lower teeth, simply from normal chewing, adds Dr. Lehfeldt. The horse may develop sensitivity due to wear and exposure of the roots of the teeth. Other dental issues that may develop later in life, she says, include “improper alignment of the jaw and teeth, arthritis in the temporomandibular joint [TMJ], which is the joint that makes the jaw move, and ulcerations and abscessed teeth.”

Dr. Kivett adds that horses, like humans, can even get cavities, tartar and gingivitis. “The older a horse, the more likely it is that he will be suffering from one of these dental diseases and they’re often quite painful,” she says. Unfortunately, many owners discount the possibility of dental problems if their horses haven’t lost weight and appear to be eating normally. “This is problematic since horses frequently don’t show any outward signs of a dental problem until there is severe pain and major problems,” she says.

What you can do: Keep up on regular dental exams—every six months is the typical recommendation for older horses. This can help your vet spot trouble early. Also be prepared to call the vet between exams if your horse loses weight, has difficulty chewing, chokes, routinely drops food while eating or has long fibers or grain in his manure—all signs of potential dental issues.


While age-related eye problems aren’t as common in horses as in other species, older equines are still more prone to difficulties than younger ones.

“They can develop cataracts and problems with the retina and other structures in the back of the eye,” says Dr. Kivett. On the bright side, Dr. Lehfeldt notes that cataracts “rarely result in complete cloudiness of the lens” and horses can typically compensate well for changes in vision.

Older horses are commonly affected with equine recurrent uveitis, also known as moon blindness. In this disease, the body’s immune system attacks its own tissues—in this case, the tissues of the eye. Over time, this can lead to scarring, cataracts, pain and even blindness.

What you can do: Watch for any changes in the appearance of your horse’s eyes, such as tearing, squinting or alterations in the color of the cornea. “If the eye appears cloudy, has a bluish tint anywhere, has a spot on it or is otherwise different from its normal appearance, have it seen by a vet,” says Dr. Kivett. “Recognizing symptoms of eye problems quickly can lead to faster diagnosis and treatment, which reduces the risk for permanent damage.”

Once a horse has uveitis, treatment is aimed at decreasing inflammation, controlling pain and minimizing further damage to hopefully delay blindness.

Endocrine diseases such as PPID (Cushing’s)are common problems for senior horses. Horses with Cushing’s typically exhibit a long, curly coat and show signs such as weight loss, diarrhea, laminitis and other serious health issues. © Paula Da Silva/arnd.nL

Endocrine System

The endocrine system involves the glands that make and secrete hormones. Endocrine diseases rank alongside dental problems as a leading cause of senior horse health trouble—and the most often overlooked in the early stages, says Dr. Kivett. Probably the most common of these diseases is pituitary pars intermedia dysfunction (PPID), also known as Cushing’s Disease.

PPID results from a benign tumor in the pituitary gland at the base of the brain, leading to a reduction in dopamine production. PPID can affect many hormones and thus create “a plethora of clinical signs, such as weight loss, chronic recurring infections, lethargy, diarrhea, foot abscesses, laminitis and overall malaise,” says Dr. Lehfeldt.

Many horse owners are skeptical that their horse could have PPID if he doesn’t exhibit the disease’s characteristic long, curly hair coat, says Dr. Kivett. “Unfortunately, by the time a senior horse has this coat, his condition is often so out of control that it’s very difficult to regulate with medication,” she adds.

Dr. Lehfeldt agrees, noting, “I will have horse owners state that their old horse isn’t acting the same anymore, and they chalk it up to just ‘being older,’ when in fact it could be PPID, which is manageable, especially when identified early in the course of the disease process.”

What you can do: Your best offense is spotting the early signs of PPID. These include “changes in body weight or loss of topline, a slight bulging appearance to the eyes—which is a result of fat being deposited behind the eyes—recurrent skin infections or hoof abscesses, or changes in exercise tolerance or sweating patterns,” says Dr. Kivett. In addition, your horse may exhibit lethargy, decreased athleticism and fatty deposits on the crest of the neck and tail head. Your vet can run blood tests to look for changes in the horse’s hormone levels.

Unfortunately, there’s no cure for PPID, but it can be managed with pergolide, a medication originally used for human patients with Parkinson’s disease. “The medication can help reduce the size of the pituitary gland and therefore affect the hormones produced by the gland,” explains Dr. Lehfeldt. It can improve the horse’s symptoms and quality of life, although it must be given for the rest of the horse’s life.

Dr. Lehfeldt notes that other management strategies may come into play depending on the horse’s clinical signs. “For example, a horse that has foundered should have lower sugars in his diet and may have restricted intake if he is obese,” she says. “A thin horse will need a more calorically dense feed with smaller fiber size to digest it more efficiently to aid in weight gain.”


A swayback is a classic old-horse stereotype. While the abnormal hollowing may have a genetic component or may develop due to conformation, pregnancy and strain, age can certainly be a contributing factor. In addition, a general loss of topline muscling—even if it doesn’t lead to a swayback—is often seen in older horses, says Dr. Kivett.

“[It] can be related to metabolic disease like PPID that weakens the tendons and ligaments. It can also be due to decreasing fitness and exercise intensity if an older horse isn’t being worked as consistently as he was when he was younger,” she explains.

Arthritis—a common older-horse concern—can also affect the vertebrae of the horse’s spine.

What you can do: “Regular exercise, including working over poles, can help maintain a horse with a swayback or one with spinal injuries,” says Dr. Lehfeldt. “Modalities such as acupuncture and spinal manipulation [chiropractic] can be very helpful to maintain motion in the musculoskeletal system, reducing the formation of arthritis and making [the horse] more comfortable.”

Dental trouble, poor gut health, parasites and chronic pain are a few reasons that a senior horse could exhibit significant weight loss. © Frank Sorge/Arnd.nL

Digestive System, Nutrition, Weight

Gut health, nutrition and weight are, not surprisingly, intertwined. All can cause health concerns for senior horses and may be related to other older-horse health issues. For instance, seniors may be at higher risk for impaction colic, says Dr. Lehfeldt. This can be due to dental trouble that makes chewing difficult, leading to longer food fibers reaching the large colon, where they can become impacted. Another cause, she adds, could be decreased gut motility if a horse isn’t moving as much due to arthritis, injury or other discomfort.

Poor gut health can also contribute to weight loss, a common occurrence in older horses. “Some will become less efficient at absorbing nutrients from the gastrointestinal tract and may not be able to utilize the nutrients the same due to underlying illnesses,” says Dr. Lehfeldt. In fact, some research shows that horses age 20 and older are less able to digest protein, fiber and some minerals than younger horses.

Other underlying causes of weight loss can include dental problems, parasites, chronic pain leading to decreased appetite and inflammatory bowel disease.

On the other hand, says Dr. Kivett, some older horses will suddenly become “’air ferns’ and gain weight despite being on a diet.” This could be caused by a metabolic disease or simply be a result of less activity. It’s a concern because an overweight horse adds more stress to feet, muscles and joints that may already be worn from years of use.

What you can do: Switching feeds may make it easier for your horse to chew, digest and absorb his food, helping to minimize colic risk and weight loss. For instance, you can switch from regular hay to forage that’s chopped, cubed or in pellet form, and grain that’s rolled, crimped, extruded, pelleted or flaked.

Complete senior equine feeds are typically designed with these formulations in mind. In addition, while they should contain enough fiber to keep the digestive tract working, they may provide energy more from carbohydrates and fat than from fiber.

You may also find that it helps to increase your horse’s total feed intake, but to provide it through more frequent and smaller meals throughout the day. If your horse’s teeth are extremely worn, you might consider wet food, such as mashes. This also helps ensure that your horse takes in enough water, as thirst perception can sometimes wane in senior equines, leading to dehydration concerns.


Lameness is the most common problem of older horses and often among the first signs of aging. Arthritis is frequently the underlying cause of the unsoundness. “It is often simply the result of wear and tear over time. Any horse that lives and works long enough will inevitably develop some arthritis,” says Dr. Kivett. Arthritis, of course, can lead to pain, stiffness, reduced range of motion and lowered performance ability.

What you can do: “Looking for the signs of stiffness and soreness after work or when [the horse is] not worked regularly is important,” says Dr. Lehfeldt. Acupuncture and chiropractic work may help prevent arthritis or reduce discomfort for an already arthritic horse, she adds.

Joint supplements also abound, offering the possibility of pain management. “Every individual is different with how he responds to these products because of the variation in absorption from the gastrointestinal tract,” says Dr. Lehfeldt. “More direct products, such as Adequan[polysulfated glycosaminoglycan], Legend [hyaluronate sodium] and intra-articular injections are also available for treating arthritis.”


Metabolic conditions such as PPID can predispose your horse to laminitis and increase the risk of recurrent hoof abscesses, say Drs. Lehfeldt and Kivett.

What you can do: Keep an eye out for early signs of PPID so you have a better opportunity to manage the disease and its repercussions. In addition, keep up with regular farrier visits. “When horses get older, they still require foot care,” reminds Dr. Lehfeldt. “Due to arthritis that may have developed over time and with an athletic career, taking care of their feet is critical for comfort. The saying, ‘No hoof, no horse’ applies at any age.”

Also, if your horse shows signs of weakening hoof walls (such as cracking, chipping or flares), talk with your veterinarian or farrier about causes and solutions, including the potential benefits of a biotin feed supplement.

Gray hairs around a horse’s eyes and muzzle are a common sign of aging. © Arnd Bronkhorst

Read the Signs

Age is just a number and simply because your horse turns 15, 20 or even 25, doesn’t automatically mean he’s old. Instead of relying on the calendar, watch for these telltale signs that indicate it’s time to start thinking of and treating your horse as a senior citizen.

  • Graying hair, particularly around the eyes and muzzle
  • Deepening hollows above the eyes
  • Slackening or drooping of the lower lip
  • Elongation of incisors
  • Difficulty eating
  • Weight loss (or, less commonly, weight gain)
  • Poor coat condition and/or delayed shedding
  • Loss of muscle tone, particularly over the topline
  • Loss of ligament and tendon strength, which could lead to lower, more sloping pasterns
  • General stiffness and reduced overall flexibility
  • Reduced energy level

Exercise Tolerance

As the experts noted, typically with age comes arthritis—and that can mean your horse isn’t able to perform as he did in his younger years. Additional problems, such as other lameness issues, weight loss or breathing trouble can force a horse into decreased use or retirement, says Dr. Kivett.

When and whether you’re forced to scale back on exercise depends on your horse because every equine ages differently. “Some won’t be able to do everything they did as a younger horse, whereas others will be able to go strong until the day they die,” says Dr. Lehfeldt.

What you can do: “Let your horse tell you what he can handle as far as workload goes,” says Dr. Lehfeldt. If the regular workload gets harder, then cut back on intensity or duration. As a general rule, try to keep at least some exercise in your horse’s routine.

“I am a huge proponent of exercise for older horses,” adds Dr. Kivett. “If a horse is sound enough and healthy enough to continue some form of exercise—and most are, even it’s just at a walk—frequent, low-intensity exercise is the best thing an owner or rider can do for an older horse.” It can help maintain tendon, ligament and muscle strength, keep blood flowing to the feet and help increase insulin sensitivity. “Older horses who stay active are proven to be more sound and often just seem happier by keeping a routine,” she notes.

Routine Matters

“I often hear horse owners say, ‘My [senior] horse doesn’t need any more vaccines. He’s had enough in his life,’” says Dr. Kivett. “This is completely wrong!” In fact, she adds, keeping up with a regular vaccination routine is even more important for older horses, who have decreased immune function and decreased immune response to vaccinations. That leaves them more susceptible than younger horses “to the diseases that we vaccinate against, like influenza, West Nile virus and eastern equine encephalitis,” she says.

Some owners also have told her they’re less worried about vaccinating because if their horse gets one of the diseases, they’ll have the horse euthanized. “But dying of eastern equine encephalitis is a horrible way to go for a horse,” cautions Dr. Kivett. “And an emergency call and humane euthanasia will cost more than several years’ worth of vaccines.”

Likewise, plan to maintain your older equine on a good deworming program. “The declining immune system of an older horse may leave him more susceptible to parasitism,” explains Dr. Kivett. “It isn’t uncommon for us to see a horse that has routinely had negative fecal egg counts suddenly begin to shed high numbers of parasite eggs.” 

Age and Reproductive Ability

Both mares and stallions can remain reproductively sound well into their senior years—with some caveats. For instance, mare fertility typically starts to decline around age 15 and decreases with every passing year. Older maiden mares, in particular, will be harder to get in foal. In general, you may need to breed your mare during more heat cycles to get a confirmed pregnancy. Pregnancy loss also increases with age.

For stallions, arthritis that prevents them from mounting a mare (or a breeding dummy) is a top factor limiting longevity in the breeding shed. However, semen production can also fall off with age. Owners of senior stallions will probably need to begin limiting their books, particularly for live covers.

If you’re thinking of breeding an older horse, be sure to have your veterinarian or an equine reproductive specialist evaluate him or her for any obvious issues. And talk with her about potential management strategies that could increase your chances of putting healthy foals on the ground.

What About Cancer?

While cancer can strike at any age, and horses are less affected than many other species, the risk does increase with age. “Gray horses are particularly prone to developing melanoma as they age and horses with pink skin (especially of the eyelids, lips and genitals) are prone to squamous cell carcinoma,” says Dr. Kivett.

If you see any “areas of irregular skin or masses, call your veterinarian,” says Dr. Lehfeldt. “One of the benefits to having yearly health exams done by a veterinarian is to ensure these are identified early in the course so they can be treated sooner versus later.”

Benign but Serious: Strangulating Lipoma

While not cancerous, Drs. Kivett and Lehfeldt note that older horses can be at higher risk for another type of tumor—a condition called a strangulating lipoma. While the lipoma itself is a benign fatty tumor, it can develop a stalk or stem that wraps around part of the horse’s intestine, cutting off blood flow and leading to severe colic, explains Dr. Lehfeldt. Unfortunately, there is no way to detect this tumor early and it usually isn’t discovered until the horse is in colic surgery.

Preparation Is Key

Ultimately, every horse, like every human, will age and most will experience health challenges in the process. By understanding common issues and knowing what you can do to prevent, treat or manage them, you can put the odds in your horse’s favor for a longer, healthier, happier life. 

This article was originally published in the February 2018 issue of Practical Horseman. 

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