Hospice & Palliative Care

The Fast Scale in Hospice

When hospice care providers talk about the Fast Scale, they usually mean the Reisberg Functional Assessment STaging (FAST) scale. This is a 16-level scale designed to help doctors, patients, and their loved ones talk about and understand the progress of Alzheimer's disease and dementia. 

The FAST Scale is divided into seven categories. The first five are:

  1. No cognitive impairment, normal functioning
  2. Possible mild cognitive impairment
  3. Mild cognitive impairment, interfering with complex tasks
  4. Mild dementia, where everyday tasks like cooking and banking are affected
  5. Moderate dementia, needing help choosing appropriate clothing.

Categories six and seven are divided into sub stages. Stage six is all about difficulties with the most basic everyday activities like getting dressed, bathing, and going to the toilet independently. The sub-stages are:

  1. Difficulty dressing
  2. Serious difficulties with bathing
  3. Inability to toilet properly without help
  4. Urinary incontinence
  5. Fecal incontinence.

At stage seven, the patient begins to lose speech and movement. The FAST sub-stages are:

  1. Severely limited speech, just a handful of words a day
  2. Little to no intelligible speech
  3. Unable to walk
  4. Unable to sit up without help
  5. Unable to smile
  6. Unable to hold head up without help.

How long does each stage last?

Alzheimer's Disease always progresses through the FAST scale in order, although there are other dementia conditions that do not, and where patients might skip stages. We're often asked how long late stage dementia or Alzheimer's disease last, but the speed at which a person moves through the scale can vary. The FAST scale gives doctors average expected durations for each stage, but these are for untreated Alzheimer's. Treatment can significantly extend the time it takes to move from one stage to the next. 

How quickly a patient moves through the scale depends on their treatment and their particular condition- every person is different. 

The FAST scale as a criteria for hospice care

Normally, patients in hospice care for Alzheimer's are in stage seven, experiencing profound levels of difficulty communicating and moving independently, but this isn't always the case. Often, those with Alzheimer's disease can also be suffering from other conditions, for example coronary heart disease. Those are also taken into account when doctors decide whether or not a person qualifies for hospice or palliative care. 

If you are or someone you love is moving through the FAST scale, it's never too early to talk it through with a local hospice. Hospice providers like us can those with earlier-stage dementia make decisions about their care while they are still able, and help us make sure those wishes are honored when the time comes.



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