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The Fast Scale For Testing Dementia In Older Adults

The FAST (Functional Assessment Staging Tool) Scale is a tool designed to evaluate the progression of dementia in individuals, particularly those with Alzheimer’s disease.

It provides a structured framework to assess changes in a person’s functional abilities and activities of daily living.

The FAST Scale is divided into seven major stages, which are further subdivided into smaller steps, providing a detailed assessment of the decline in cognitive and functional abilities.

Here’s a brief overview of the stages:

  1. Normal Adult: No functional decline.
  2. Normal Older Adult: Personal awareness of some functional decline.
  3. Early Dementia: Noticeable deficits in demanding job situations.
  4. Mild Dementia: Requires assistance in choosing proper clothing.
  5. Moderate Dementia: Requires assistance in dressing, bathing, and toileting. Significant confusion is present.
  6. Moderately Severe Dementia: Requires extensive assistance with activities of daily living. May be unable to speak more than a few words.
  7. Severe Dementia: Loss of verbal abilities. Needs help with eating and toileting. Essentially, non-ambulatory.

The FAST Scale is useful for healthcare providers and caregivers to determine the level of care needed by individuals with dementia, plan for the progression of the disease, and communicate more effectively about the condition’s stages.

Detailed Understanding Of The FAST Scale

Since hospice is most often used for end of life care, dementia patients who have a prognosis of six months (or less) are the best candidates.

Hospice Dementia FAST Scale

Dr. Barry Reisberg created the Global Deterioration Scale (GDS), a broad overview scale, to determine how advanced a dementia patient’s disease is. The FAST scale further defines the patient’s level of decline.

The scales exclude secondary conditions and co-morbid conditions that can often develop in Alzheimer’s patients.

These could include conditions such as aspiration pneumonia, chronic obstructive pulmonary disease or COPD, coronary heart disease or CHD, congenital heart disease, and even cancer.

With 16 items on the scale in all, if a patient is in Stage 7 on the GDS / FAST Scale, then their care plan should include hospice care.

Here are all seven stages of the scale.

Stage 1

Dementia patients in this first stage are seemingly fine. They go about their lives as normal and can care for themselves and others as they have been able to do for most of their lives.

They don’t struggle in any part of their everyday lives either.

Stage 2

This is where the symptoms of dementia first manifest.

A person in the early stages of the disease will struggle to do subjective work. They might not be able to remember where they left certain things or what they were doing.

Their symptoms are not very serious now and might even be dismissed as forgetfulness if there hasn’t been a formal diagnosis of dementia yet.

Stage 3

By the third stage, the patient’s functioning continues to decline.

If they still work at this stage, their work performance will have decreased. This will be noticeable to their colleagues and even their boss.

If the patient travels somewhere they haven’t been to before, they might experience confusion and other difficulties that make their travels less enjoyable.

Stage 4

Once the dementia patient is in Stage 4, their lives are becoming decidedly more difficult.

Even at home, they’ll find it hard to do the everyday activities they once did such as balancing their checkbooks or cooking a full meal.

Other complex tasks might elude them as well.

Stage 5

A patient in Stage 5 of the FAST Scale is now in the later stages of their dementia decline.

They cannot pick out clothing appropriate for occasions anymore. You might have to assist them.

They should still be able to dress themselves, but the other issues as evidenced in the prior stages have not disappeared either.

Stage 6

Reisberg breaks down Stage 6 into five substages:

  • 6a: The dementia patient cannot dress themselves easily.
  • 6b: They might be unable to bathe themselves or will avoid doing it due to newly developed anxiety.
  • 6c: Going to the bathroom becomes hard. The patient either doesn’t wipe well or will leave the toilet unflushed. 
  • 6d: This is followed by urinary incontinence, which makes the above bathroom troubles even more pronounced.
  • 6e: The last substage of Stage 6 is fecal incontinence.

It is usually somewhere in Stage 6 when the family decides it is time to move the person into memory care. Read our tips on how to ease this transition.

Stage 7

As you’ll recall, by the time a person is in Stage 7, they are in the final stages of dementia and usually meet the criteria to be admitted for hospice care.

Like Stage 6, Stage 7 has several substages:

  • 7a: The patient’s speech abilities decrease to a huge degree. They might say a single word all day or five words in total.
  • 7b: By Substage 7b, a dementia patient cannot speak intelligibly, which makes communicating with them next to impossible.
  • 7c: Patients in this stage are non-ambulatory and cannot walk of their own volition.
  • 7d: The patient cannot sit up on their own.
  • 7e: The patient has reduced facial movement by this point and cannot physically smile.
  • 7f: By substage 7f, the patient can’t keep their head up without support.
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