The Functional Assessment Staging Test (FAST) is designed to understand the patient with dementia’s level of functioning and ability to perform activities of daily living. It is an invaluable tool for healthcare professionals to monitor functional decline, track disease progression and anticipate next steps. It’s also a key indicator of hospice eligibility for patients diagnosed with dementia.
Functional Assessment Staging Tool (FAST) Scale vs. Global Deterioration Scale (GDS)
To understand disease progression for a patient diagnosed with dementia, physicians commonly use two scales to help identify the stage of dementia the patient is exhibiting: the Functional Assessment Staging Tool (FAST) scale and the Global Deterioration Scale (GDS).
The FAST scale primarily focuses on the functional abilities of patients with dementia. Each stage identifies specific milestones related to activities of daily living and the patient’s functional status. The patient’s functional status is affected by disease progression of dementia as cognitive status declines.
The GDS scale focuses more on cognitive ability, gauging patients’ memory deficits, language problems or disorientation to time and place.
Since the FAST and GDS measure different components of patients’ overall well-being and functional status, healthcare professionals often use both to gain a comprehensive understanding of the patient’s disease progression.
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What Are the Stages of the FAST Scale?
The FAST scale is divided into 7 stages and subsequent substages from normality to the end stages of the disease process. The FAST stages are optimally complementary of GDS; however, an advantage of the FAST scale is that it delineates five functional sub-stages corresponding to GDS stage 6 and six functional sub-stages corresponding to GDS stage 7.
The 7 stages of functional decline under the FAST scale include:
Stage 1
No difficulty either subjectively or objectively.
Stage 2
Complaints about forgetting location of objects. Subjective work difficulties.
Stage 3
Decreased job functioning evident to co-workers. Difficulty traveling to new locations. Decreased organizational capacity. *
Stage 4
Decreased ability to perform complex tasks (planning dinner, guests, personal finances, etc.).
Stage 5
Assistance required in choosing proper clothing to wear for the day, season, or occasion (a patient may wear the same clothing repeatedly unless supervised).
Stage 6
Stage 6 is divided into five sub-stages. This can be the longest stage of the disease process lasting 4-8 years:
- Difficulty putting on clothes properly without assistance or prompting (may put shoes on wrong feet or have difficulty putting on clothing). *
- Unable to bathe properly; may develop fear of bathing (requires assistance adjusting bathroom water temperature). *
- Inability to handle mechanics of toileting (forgets to flush the toilet, not wiping properly or properly disposing of toilet tissue). *
- Urinary incontinence occasionally or more frequently. *
- Fecal incontinence occasionally or more frequently. *
Stage 7
Stage 7 is divided into six sub-stages and is considered the end-stages of the disease process:
- Ability to speak limited to approximately a half-dozen words in an average day. Can say short sentences but unable to make needs known.
- Speech ability is limited to using a single intelligible word on an average day. The patient may say 10 different words, but only says one word at a time (ex: no, no, no, no).
- Ambulatory ability is lost (cannot walk without personal assistance).
- Cannot sit up independently.
- Loss of ability to smile.
- Loss of ability to hold head up independently.
*The FAST is scored on information obtained from a knowledgeable informant, patient history and patient assessment.
Can You Skip Stages of the FAST Scale?
The FAST tool is used to determine if changes in a patient’s condition are due to dementia or another medical condition. A patient diagnosed with Alzheimer’s type dementia will always follow the progression of the FAST scale as the disease progresses. They will not skip any steps or revert backward once a step is met.
Patients with other types of dementia (Lewey Body, Parkinson’s, etc.) may not follow the same disease progression. However, patients with any type of dementia will have the same disease progression at the end stages of the disease (7a or greater on the FAST scale).
Using the FAST Scale for Hospice Admission
In determining hospice eligibility for a patient diagnosed with dementia, individuals who score a 7a or greater are considered to be in the end-stages of dementia and may be appropriate for hospice care depending on patient status and needs.
To be eligible for hospice a patient with a diagnosis of dementia will also exhibit comorbidities such as CAD/COPD/CHF, pyelonephritis, sepsis/septicemia, progressive weight loss of more than 10% in the past 6 months, etc.
If you are a healthcare provider caring for a patient with dementia, refer a patient to hospice care today or learn more about our Dementia Specialty Program.
