Recognizing & Managing Behavioral Changes in Aging Shih Tzus

Shih Tzus are affectionate, alert, and often stubborn companion dogs. As a [brachycephalic](https://seniorpet.org/knowledge/persian-cat-brachycephalic-airway "Brachycephalic Syndrome Guide") toy breed with a long coat, prominent eyes, and a small, often crowded mouth, they develop a characteristic pattern of age-related health problems that can directly affect behavior. At 9–10 years old Shih Tzus are entering the senior life stage (typical lifespan 10–16 years), and owners commonly notice changes in activity level, sleep-wake cycles, house-training, social interactions, and responses to handling. Because many behavioral changes in seniors are driven by medical conditions, a careful, breed-specific approach helps owners and veterinarians separate cognitive and emotional causes from treatable physical disease.

This article covers common behavioral signs in senior Shih Tzus, the breed-specific medical causes to rule out, practical diagnostics and home strategies, and medical/rehabilitative treatments that preserve [quality of life](https://seniorpet.org/knowledge/siamese-cat-quality-of-life "Quality of Life Assessment").

Common behavioral changes in senior Shih Tzus

Shih Tzus may show one or more of the following as they age:

• Reduced activity or reluctant to climb stairs, jump on furniture, or go for walks
• Increased sleep or daytime napping, with nighttime restlessness or vocalization
• House-soiling or loss of previously reliable housetraining
• Increased startle, irritability, or snapping when handled around the head or mouth
• Disorientation in familiar rooms, bumping into furniture or failing to find food bowls
• Reduced interest in play or social interaction
• Changes in barking pattern — louder, more frequent, or different triggers

Because Shih Tzus are a small, clingy breed, owners often notice subtle changes quickly. The key is determining whether behavior change arises from pain, sensory decline, [cognitive dysfunction](https://seniorpet.org/knowledge/siamese-cat-cognitive-dysfunction "Cognitive Dysfunction in Senior Pets"), systemic disease (e.g., kidney disease), or breed-specific problems like brachycephalic airway syndrome or ophthalmic disease.

Breed-specific medical causes of behavior change

Below are the major medical contributors to behavioral change in older Shih Tzus, focusing on the breed’s predispositions.

1) Eye disease (proptosis, keratoconjunctivitis sicca, progressive retinal atrophy)

Shih Tzus have large, prominent eyes in a relatively shallow orbit. This anatomy increases the risk of:

• Proptosis (forward displacement of the globe) after minor trauma — an emergency that causes pain, blinking, and reluctance to be handled around the head.
• Dry eye (keratoconjunctivitis sicca, KCS) — leads to chronic discomfort, reduced eye closure, squinting, discharge, and avoidance of bright light or handling.
• [Progressive retinal atrophy](https://seniorpet.org/knowledge/siamese-cat-progressive-retinal-atrophy "Progressive Retinal Atrophy Guide") (PRA) — a degenerative retinal disease that causes night blindness progressing to daytime vision loss; affected dogs may become disoriented, bump into objects, or hesitate on stairs.

Vision loss commonly precipitates anxiety, increased startle, and house-soiling in senior Shih Tzus. Ophthalmic disease should be high on the differential when you see visual or disorientation signs.

(See ACVO resources and veterinary ophthalmology literature for breed-related risks.)

2) Periodontal disease and dental pain

Small-breed dogs like Shih Tzus have crowded teeth and early, severe periodontal disease. Chronic oral pain commonly presents as:

• Reduced interest in chewing or toys
• Head shyness or aggression when the mouth is touched
• Dropping food or preferring soft food
• Behavioral withdrawal or decreased play

Because periodontal disease is extremely common in small breeds and can begin in adult life, [dental disease](https://seniorpet.org/knowledge/siamese-cat-dental-disease "Dental Disease in Senior Pets") is a frequent, under-recognized cause of behavior change in senior Shih Tzus (see WSAVA dental guidelines).

3) Chronic kidney disease (CKD)

CKD prevalence increases with age across breeds. In dogs, CKD can cause:

• Increased thirst and urination (but paradoxically accidents if incontinence or cognitive change occurs)
• Appetite changes and weight loss
• Lethargy, reduced tolerance for activity, and irritability
• Nausea-related behavioral signs (drooling, lip-licking)

Because CKD affects medication choices (NSAIDs often contraindicated) and cognition, screen senior Shih Tzus for renal disease during behavioral workups (follow IRIS staging recommendations).

4) Brachycephalic airway syndrome (BOAS)

Shih Tzus are brachycephalic and may display varying degrees of BOAS. Chronic upper airway obstruction causes exercise intolerance, sleep-disordered breathing (snoring, restless sleep), and hypoxia. Behavioral sequelae include:

• Reduced activity and reluctance to play
• Increased anxiety related to breathing difficulty (e.g., panting in mild stress)
• Nocturnal restlessness or vocalization from sleep-disordered breathing

BOAS also increases anesthetic risk, which affects decision-making for diagnostic or dental procedures (discussed below). See peer-reviewed literature and veterinary consensus on BOAS management for details.

5) Intervertebral disc disease (IVDD) and spinal pain

While classic chondrodystrophic breeds (e.g., Dachshunds) are at highest risk, small-breed dogs including Shih Tzus can develop degenerative disc disease and spondylosis with age. Disc disease and spinal pain manifest as:

• Reluctance to jump, climb, or be lifted
• Altered gait, stiffness, or decreased activity
• Vocalization when handled or petted over the back
• Sudden behavior changes with acute herniation (e.g., yelping, reluctance to move)

[Obesity](https://seniorpet.org/knowledge/golden-retriever-weight-management-obesity "Weight Management for Senior Pets") and repetitive jumping increase risk. IVDD-related pain is often mistaken for “old age” behavior but is treatable.

6) Canine cognitive dysfunction (CCD)

CCD (also called cognitive dysfunction syndrome, CDS) is a degenerative brain disorder causing disorientation, altered sleep-wake cycles, house-soiling, and social changes. Small older dogs, including Shih Tzus 9–10 years old, can develop CCD. However, CCD is a diagnosis of exclusion after medical causes above are ruled out. Evidence supports environmental enrichment, dietary strategies, and medications (e.g., selegiline) to ameliorate signs (see veterinary neurology and behavior literature).

Diagnostic approach — what your vet will evaluate

A structured clinic workup reduces the chance of missing treatable causes:

Thorough history focused on onset/timing, environment, appetite, sleep patterns, and triggers.

Complete physical and neurologic exam with careful oral and ophthalmic assessment.

Baseline bloodwork: CBC, chemistry panel (including renal values), and thyroxine if indicated.

Urinalysis and blood pressure (hypertension can worsen retinal disease and CKD).

Dental exam under sedation or anesthesia if needed — but discuss BOAS-related anesthesia risk and airway planning.

Ophthalmic evaluation (Schirmer tear test for KCS, fluorescein stain, fundic exam). Referral to a veterinary ophthalmologist if PRA or complex disease suspected.

Thoracic radiographs or airway evaluation if BOAS suspected; reference images and experienced anesthetic planning if surgery considered.

Advanced imaging (spinal radiographs, CT, MRI) if IVDD or neurologic deficits present.

Behavioral screening for CCD after medical causes excluded; consider referral to a veterinary behaviorist.

Regular re-assessment is crucial because multiple problems commonly coexist in an aging [Shih Tzu](https://seniorpet.org/knowledge/breed/shih-tzu "Senior Shih Tzu Health Guide").

Practical, actionable home care and environmental modifications

Many behavior problems in senior Shih Tzus improve with relatively simple changes at home. Below are breed-specific, practical interventions.

Daily care and monitoring

• Schedule biannual (every 6 months) senior wellness checks starting at 9 years; do bloodwork yearly or more often if CKD or other issues present.
• Keep a daily log for 2–4 weeks noting activity, sleep, appetite, accidents, vocalization, and mobility changes to share with your veterinarian.
• Maintain a lean body condition: small weight gains in Shih Tzus can markedly worsen IVDD risk and BOAS symptoms.
• Use a well-fitted harness instead of a neck collar to reduce neck and cervical spine stress and to avoid exacerbating airway issues.

Manage vision and hearing loss

• Keep furniture and bowl placement consistent; avoid rearranging rooms.
• Use night-lights for dogs with decreased vision and place tactile cues (non-slip mats) near steps.
• For partially blind dogs, allow them to sniff and explore at their own pace; guide around obstacles rather than startling.
• For hearing loss, use visual cues like hand signals or lights; maintain predictable routines.

Breathing and heat safety (BOAS)

• Avoid strenuous exercise, hot/humid weather, and stress. Walk during low-temperature parts of the day.
• Reduce exposure to kennels with poor ventilation.
• If panting or respiratory noise worsens, rest the dog, move to a cool place, and seek veterinary assessment.
• Discuss surgical corrections (nares resection, staphylectomy) with your vet if quality of life affected.

Dental care

• Daily tooth brushing with dog toothpaste and mechanically appropriate toothbrushes is highly effective.
• Offer dental chews or water additives if brushing not possible, but confirm safety for small breeds.
• Plan professional dental cleaning intervals with pre-anesthetic assessment specific to BOAS risk.

Mobility and pain management

• Place ramps or pet stairs for trusted furniture to avoid jumping.
• Use non-slip rugs on hardwood and tile floors.
• Consider physical rehabilitation: controlled water therapy, gentle range-of-motion exercises, and low-impact walks.
• Talk to your vet about analgesia: NSAIDs are effective for osteoarthritis but require renal function monitoring (avoid or use cautiously with CKD). Gabapentin can help neuropathic pain; opioids and other adjuncts vary.

Cognitive enrichment

• Daily scent games (hidden treats in safe toys), short training sessions using food rewards, and puzzle feeders to stimulate cognition.
• Maintain routine feeding and walking schedules.
• Rotate toys to keep novelty without overwhelming a Shih Tzu with cognitive limitations.

Medical and surgical management options

When behavioral changes arise from identifiable medical disease, targeted treatments often improve behavior.

Ophthalmic treatments

• Proptosis: immediate veterinary emergency; globe replacement or enucleation may be necessary. Quick action reduces pain and infection risk.
• Dry eye (KCS): topical cyclosporine or tacrolimus, frequent lubrication, and sometimes lacrimal stimulants; treatment reduces pain and blinking-associated anxiety (see ACVO guidance).
• PRA: no cure; environmental adaptations, predictable routines, and night lighting help. Discuss low-vision aids and safety strategies.

Periodontal disease management

• Professional dentistry with tooth scaling and extrasctions as needed. Because Shih Tzus may have BOAS and small airways, discuss anesthetic plans with your vet or a specialist (premedication, short-acting anesthetics, careful airway management).
• Post-dental analgesia and home tooth care will reduce mouth pain and related behavioral signs.

CKD management

• Follow IRIS guidelines for staging CKD and managing diet, hydration, phosphorus control, and medications.
• Treat nausea and appetite loss (antiemetics, appetite stimulants).
• Avoid or use caution with nephrotoxic or renally cleared drugs; coordinate analgesia plans with nephrology needs.

BOAS surgical options

• For selected Shih Tzus with significant airway compromise, surgical correction (corrective nares resection, soft palate resection) can markedly improve exercise tolerance and sleep quality and thus reduce anxiety or sleep-related behaviors. Discuss realistic expectations and anesthetic risk.

IVDD and spine care

• Medical management for mild/moderate pain includes rest, anti-inflammatories (if renal function permits), muscle relaxants, and rehabilitation.
• Acute severe neurologic signs (e.g., paralysis) require urgent imaging and often surgical decompression.
• Long-term strategies include weight management and lifestyle modifications to reduce recurrence.

Cognitive dysfunction treatments

• Behavioral modification: structured play, environmental enrichment, consistent schedules.
• Diets enriched in antioxidants and medium-chain triglycerides may benefit cognition in some studies.
• Medications: selegiline has been used for CCD; discuss risks, benefits, and monitoring with your veterinarian (Landsberg and colleagues have summarized treatment approaches in veterinary behavior literature).

Communication checklist for owners: what to tell your vet

When you book an appointment for behavioral changes, bring:

• A timeline of behavior changes and any triggers
• A video of the behavior (especially nocturnal vocalization, gait changes, or disorientation)
• A list of current medications and supplements
• Any recent weight changes or new household stressors
• Notes on dental habits, breathing noises, or changes in sleep

Video is particularly helpful for nocturnal behaviors or transient events.

Table — Behavioral signs, likely medical causes, and initial owner actions

| Behavioral sign | Likely medical causes (breed-specific) | Immediate owner actions | |---|---:|---| | Night restlessness / loud snoring / daytime panting | BOAS, sleep apnea, cardiac disease | Keep cool, limit exercise, record episodes, schedule vet airway exam | | Bumping into furniture / disorientation | PRA, advanced cataracts, CCD | Add night-lights, keep layout unchanged, video episodes, see ophthalmologist | | Refusal to jump, yelping when moved | IVDD, [arthritis](https://seniorpet.org/knowledge/golden-retriever-arthritis-pain-management "Arthritis Management in Senior Pets") | Provide ramps, limit jumping, leash walks, vet exam for pain control | | Head shyness, dropping kibble | Dental pain, periodontal disease | Offer soft food, avoid mouth handling, schedule dental assessment | | Increased thirst/urinates more / accidents | CKD, endocrine disease, cognitive decline | Collect urine sample, record water intake, get bloodwork/urinalysis |

When to seek immediate veterinary care

• Sudden blindness or acute change in vision (rapid vet/ophthalmology referral)
• Proptosis, severe eye pain, or uncontrolled ocular discharge
• Sudden onset paralysis or severe back/neck pain
• Severe respiratory distress or collapse
• Repeated vomiting, inappetence, or seizures

Prognosis and quality-of-life considerations

Many age-associated behavior changes in Shih Tzus are manageable. Surgical correction of BOAS can improve energy and reduce sleep disturbance; dental treatment eliminates chronic oral pain; appropriate CKD management slows progression and improves comfort. Cognitive dysfunction is progressive, but enrichment and certain medications can improve function and reduce caregiver burden.

Discuss realistic goals with your veterinarian: the aim is to preserve enjoyment of life, reduce suffering, and keep a safe, predictable environment. Frequent re-checks, proactive dental and eye care, weight control, and gentle enrichment go a long way.

Bottom line — an owner’s action plan for a senior Shih Tzu (9–10 years)

Book a senior wellness visit every 6 months with baseline bloodwork and urinalysis.

Start or maintain daily tooth care and plan professional dental scaling with an anesthetic plan tailored to BOAS risk.

Watch for visual deficits and get an ophthalmic exam for any squinting, discharge, or disorientation.

Reduce jumping; install ramps; maintain lean body condition to reduce IVDD and BOAS burden.

Create a consistent home routine, add enrichment, and use environmental aids (night-lights, non-slip mats).

If breathing, swallowing, sudden pain, or paralysis appear — seek urgent veterinary care.

Recognizing behavioral change early and using a breed-specific lens makes a major difference for Shih Tzus. With attentive veterinary screening, home adjustments, and timely interventions, many causes of behavior change in senior Shih Tzus are treatable or manageable — preserving the comfortable companionship these dogs are known for.

References and resources

• ACVO (American College of Veterinary Ophthalmologists) clinical resources on proptosis, KCS, and PRA.
• WSAVA Dental Guidelines for Periodontal Disease prevention and treatment.
• International Renal Interest Society (IRIS) guidelines for CKD staging and management.
• Veterinary literature on brachycephalic airway syndrome and management; consult current reviews and consensus statements for surgical indications and anesthetic protocols.
• Landsberg, G. (2012). Clinical approaches to cognitive dysfunction in dogs; see veterinary behavior literature for evidence-based management strategies.