What is the FAST Scale?

By Seasons | March 03, 2021

family with dementia patientUsing this tool can help identify the stages of Alzheimer’s dementia in your patients or residents and how much help they may need 

The Functional Assessment Staging Tool (FAST) was developed by Dr. Barry Reisberg, an expert in dementia and Alzheimer’s disease. The scale is an aid to track the progression of Alzheimer's dementia and determine appropriate care plans 

The progression of dementia can be distressing to patients and families because it is not possible to predict the timeline of the disease. Each individual’s disease progression is different, with some patients dementia increasing over months, while others can take years or decades. 

While timeline may be uncertain, the FAST scale helps because it refers to the every-day behavior and functions of an individual to determine their stage. Since patients with Alzheimer’s dementia do not skip stages but progress through them, the scale is useful in identifying how the disease will progress and what the patient and family should expect next. By fully understanding where a patient is at on the scale, healthcare professionals can determine the most appropriate treatment and care for the individual.  

The Stages of the FAST Scale     

Stage 1 

Normal Adult 

Normally functioning/no cognitive impairment 

Stage 2 

Normal Older Adult 

Subjective/common decline typical for the elderly 

Stage 3 

Early Stage Dementia 

Difficulty with complex tasks and concentration, and some forgetfulness  

Stage 4 

Mild Dementia 

Frequent trouble with forgetfulness and task execution 

Stage 5 

Moderate Dementia 

Can no longer live independently, and have trouble performing daily tasks such as meal preparation or making a phone call 

Stage 6 

  1. Inability to dress without help 
  2. Inability to bathe without help 
  3. Inability to toilet without help  
  4. Experience urinary incontinence 
  5. Experience fecal incontinence 

Moderately Severe Dementia 

Need 24/7 supervision/assistance and require assistance with tasks listed as sub-stages  

Stage 7  

  1. Limited ability to speak, typically 1-5 words a day
  2. Loss of intelligible vocabulary  
  3. Inability to self-ambulate (walk) 
  4. Inability to sit up independently 
  5. Inability to smile 
  6. Inability to hold up head independently  

Severe Dementia 

The final stage, which consists of near-total loss of ability to communicate and perform any tasks independently.  


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When is a dementia patient eligible for hospice?  

As you’re tracking the progress of your dementia patients or residents, it’s essential to understand when they are eligible for the comforts that hospice care can provide. Because a patient may live with dementia for years, it can be difficult for families to determine when they should start preparing for the end of life. To be eligible for hospice, a patient must be in stage 7 or greater on the FAST scale. Stage 7 is broken down into smaller stages as laid out in the table above: Limited ability to speak (typically 1-5 words a day,) loss of intelligible vocabulary, inability to self-ambulate (walk), inability to sit up independently, inability to smile, and inability to hold up head independently. A patient must present at least 7a (limited ability to speak, typically 1-5 words a day), as well as the symptoms of Stage 6 (in particular difficulty with dressing, bathing, and continence), to be considered appropriate for hospice.   

Hospice care can provide support to patients, families, and caregivers for patients with severe/final stage dementia. Services include sensory-based care designed to soothe and calm (such as the Seasons Namaste Care program), respite care (for when caregivers need a break from caring for their loved one), and access to 24/7 support. Hospice care is designed to provide an end-of-life experience that best fits the needs of patients and families.

Learn more about hospice eligibility and additional conditions for Alzheimer’s disease patients  

In addition to being in stage 7 of dementia, a patient must also have specific additional conditions to be eligible for hospice care. In this 3-minute video, Seasons Chief Medical Officer Dr. Balu Natarajan, MD lays out what to look for while determining when to recommend a patient for hospice. If you've identified that a patient is approaching or in Stage 7 dementia and you have questions, you can reach out to us at any time.







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