What is the FAST Scale?
Dr. Barry Resiberg, an expert in dementia and Alzheimer’s disease, created the Functional Assessment Staging Tool (FAST) to help track the progression of Alzheimer’s dementia and decided on the best care plan. The disease progresses differently in each person, with some cases advancing rapidly over months and others taking years or even decades to progress. This unpredictability of dementia can be stressful for patients and their families.
With this uncertainty though, the FAST scale can help because it focuses on day-to-day behavior, making it easier to track and decide on a stage. Alzheimer’s patients do not skip stages, but progress through them differently depending on their situations. Because of this, tracking their individual stage and how they are advancing helps the family and healthcare professionals know what they should expect next and what the best healthcare plan is for the patient.
The Stages of the FAST Scale
Stage One (Normal Adult) – No difficulty either subjectively or objectively.
Stage Two (Normal Older Adult) – Complains of forgetting location of objects and subjective word finding difficulties.
Stage Three (Early-Stage Dementia) – Decreased job functioning evident to people around them, difficulty traveling to new locations, and decreased organizational capacity.
Stage Four (Mild Dementia) – Decreased ability to perform complex tasks like handling personal finances or planning dinner for guests.
Stage Five (Moderate Dementia) – Requires help in choosing clothes for the day, for example, patient may wear the same clothes repeatedly unless supervised.
Stage Six (Moderately Severe Dementia) – Needs constant supervision and assistance with multiple tasks.
6a. Putting on clothes improperly without assistance
6b. Inability to bathe properly
6c. Inability to handle mechanics of toileting
6d. Urinary and fecal incontinence occasionally or more frequently
Stage Seven (Severe Dementia) – The final stage of dementia that includes almost complete loss of ability to communicate and perform any tasks independently.
7a. Limited speech ability
7b. Inability to walk without personal assistance
7c. Cannot sit up without assistance
7d. Loss of ability to smile
7e. Loss of ability to hold head up independently
When is a dementia patient eligible for hospice?
Patients are eligible for hospice when they have severe dementia in the seventh stage or greater on the FAST scale. Stage Seven includes limited speech ability, inability to walk without personal assistance, inability to sit up without assistance, loss of ability to smile, and loss of ability to hold head up independently.
Services for these patients includes care designed to soothe and calm, respite care, and access to constant support.