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.
|
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
|
Moderately Severe Dementia |
Need 24/7 supervision/assistance and require assistance with tasks listed as sub-stages |
|
Stage 7
|
Severe Dementia |
The final stage, which consists of near-total loss of ability to communicate and perform any tasks independently. |
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.
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.
References:
https://www.who.int/news-room/fact-sheets/detail/dementia
https://www.alz.org/alzheimers-dementia/
http://www.ec-online.net/Knowledge/Articles/latealz.html