A Look at the Hospice Dementia FAST Scale

Every September marks World Alzheimer’s Month, an annual international campaign designed to raise awareness and challenge the stigma that surrounds dementia. In honor of World Alzheimer’s Month in general and World Alzheimer’s Day specifically on September 21, we explore the importance of the Fast Scale, or Reisberg Functional Assessment STaging (FAST) scale which helps doctors, patients, and their loved ones discuss and understand the progress of Alzheimer’s disease and dementia. If your loved one is in hospice and suffering from dementia in San Mateo and elsewhere, chances are you will hear mention of this scale at some point within meetings with the care team.

FAST includes a seven-stage system that is based on the person’s level of functioning and daily activities. However, FAST focuses more on an individual’s level of functioning and activities of daily living rather than cognitive decline. So, it’s possible for someone to be at a different cognitive stage (referred to as Global Deterioration Scale for Assessment of Primary Degenerative Dementia or GDS) and have different functionally (FAST stage), according to Dementia Care Central.

The FAST scale happens to be the most well-validated measure of the course of Alzheimer’s disease in published scientific literature.

What is the FAST Scale?

The FAST Scale is comprised of the following seven categories, with the first five being:

1. No cognitive impairment; normal function
2. Possible mild cognitive impairment
3. Mild cognitive impairment; interference with complex tasks
4. Mild dementia, affecting everyday tasks such as cooking and banking
5. Moderate dementia, whereby the person needs assistance choosing appropriate clothing, for example.

Category six is divided into sub-stages and involves difficulties with everyday activities such as dressing and bathing. Those sub-stages include:

1. Difficulty dressing
2. Difficulty bathing
3. Inability to use the toilet without assistance
4. Urinary incontinence
5. Fecal incontinence

Once stage seven hits, the patient starts to lose the ability to speak and move. Those sub-stages are:

1. Severely limited speech
2. Little to no intelligible speech
3. Inability to walk
4. Inability to sit up without assistance
5. Inability to smile
6. Inability to hold head up without assistance

Length of Each Stage

Alzheimer’s disease always follows a clear progression through the FAST scale, with all steps typically occurring in order, although some stages may overlap. This isn’t always true about other forms of dementia, however, where patients can skip stages. For Alzheimer’s patients, the FAST scale provides doctors with an average expected duration for each stage, but there’s no exact science to the timing of it all. Treatment can extend the time it takes for a person to move through stages. How quickly they navigate the scale will depend on treatment received as well as the patient’s particular condition. On average, though, a person with Alzheimer’s lives about four to eight years post-diagnosis, but can live as long as 20 years, according to the Alzheimer’s Association.

There may be many years of subtle changes in the brain before a person even shows sign of the disease, known as pre-clinical Alzheimer’s disease. Today, 5.7 million Americans live with Alzheimer’s. By 2050, this number is expected to increase to 14 million. It’s the sixth leading cause of death in this country, killing more than breast cancer and prostate cancer combined. In fact, every 65 seconds, someone in the United States is diagnosed with Alzheimer’s disease.

The FAST Scale: Criteria for Hospice Care

Patients in hospice care suffering from Alzheimer’s are usually in stage seven. This is where they experience significant difficulty with communication and independent movement. On top of that, many people with Alzheimer’s also suffer from other conditions, such as coronary heart disease. All of these factors are taken into account when physicians are deciding whether or not the patient qualifies for hospice care. Typically, when admitted into hospice care, Alzheimer’s patients are in the final stages of the disease. They usually:

• Require round-the-clock assistance with daily activities and personal care
• Lose awareness of recent experiences and surroundings
• Experience changes in physical abilities, with difficulty walking, sitting and swallowing
• Have more difficulty communicating
• Are vulnerable to infections, particularly pneumonia

Within the final stages, individuals have trouble responding to their environment, carrying on conversations and controlling movement. They may still utter words or phrases, but communicating the pain they’re in or the needs they have can become very difficult. As memory and cognitive skills decline, big personality changes can occur, with patients requiring extra help with daily activities.

Contact Pathways Home Health and Hospice

If someone you love is moving through the FAST scale, our hospice care team can help you make decisions about their care while they still have the ability for input. It’s our goal to ensure those wishes are honored when the time comes. Contact us at 888-755-7855 to learn how we can help you and your family navigate and understand the FAST scale as it pertains to your loved one’s hospice journey.