A dementia diagnosis is a journey with unique challenges for patients and their families. As the symptoms of dementia progress, it becomes more and more important to have reliable tools to evaluate the condition and have an appropriate care plan.
One valuable tool that we use in hospicare care is the FAST (Functional Assessment Staging Tool) Scale for Dementia. Let’s talk about how healthcare professionals use the FAST Scale to determine a patient’s stage of dementia — and how this affects hospice eligibility and your loved one’s care plan.
What Is the FAST Scale?
The FAST Scale is a detailed, seven-stage framework that measures the functional decline in patients with Alzheimer’s disease (and other forms of dementia). Because it was developed by Dr. Barry Reisberg of New York University, it’s also sometimes called the Reisberg Scale. This scale is a sort of roadmap for understanding how dementia progresses — so that healthcare providers can facilitate appropriate care interventions at the right time.
The Seven Stages of the FAST Scale
So what are the stages of the FAST Scale?
Each stage has characteristics and signs that can be seen in a patient’s current condition. The scale also provides ways to prepare for the care required at each level.
Here’s a look at each of the seven stages.
Stage 1: Normal Adult Functioning
Characteristics: In stage one, individuals don’t show any obvious symptoms of cognitive decline. They are able to function normally throughout their daily activities.
Signs to Recognize: No noticeable dementia symptoms.
Tips for Care: Help your loved one continue to support a healthy lifestyle and promote brain health with cognitive activities.
Stage 2: Normal Age-Related Forgetfulness
Characteristics: Individuals might notice minor lapses in memory (like forgetting the location of everyday objects or mild difficulty with work).
Signs to Recognize: Misplacing items, minor difficulty with recall.
Tips for Care: Caregivers might encourage their loved one to use memory aids (such as lists or calendars). It’s important to stay alert for any signs of dementia progression.
Stage 3: Mild Cognitive Impairment
Characteristics: At this stage of the FAST Scale, a patient’s cognitive decline becomes more obvious. Individuals may have difficulty at work and struggle with traveling to new places.
Signs to Recognize: Frequent forgetfulness, difficulty organizing tasks, noticeable performance issues at work.
Tips for Care: You might offer to help your loved one with planning and organizing tasks. It might also be time to consider a medical evaluation to determine if these cognitive issues are due to dementia.
Stage 4: Mild Dementia
Characteristics: In stage four, patients begin having difficulty performing complex tasks (like managing finances, planning events, or performing detailed work).
Signs to Recognize: Trouble with financial decisions, difficulty following sequences, becoming withdrawn in social situations.
Tips for Care: Your loved one will likely need support with financial management and complex chores. Start discussing future care plans with the family and healthcare providers.
Stage 5: Moderate Dementia
Characteristics: In stage five of the FAST Scale, patients require assistance with choosing appropriate clothing and may struggle with more complex daily activities.
Signs to Recognize: Repeatedly wearing the same clothes, needing help with dressing.
Tips for Care: Your loved one will probably require daily assistance with dressing and other activities. It is a good time to explore in-home care options and begin preparing for more intensive care needs. If you have questions about when to consider hospice care, Envision Hospice is here to answer your questions.
Stage 6: Moderately Severe Dementia
Characteristics: In stage six, the patient needs significant assistance to perform daily activities. This stage is divided into substages 6a to 6e, which cover various signs of decline in their personal care abilities.
Signs to Recognize:
– 6a: Difficulty dressing.
– 6b: Trouble with bathing.
– 6c: Issues with toileting.
– 6d: Urinary incontinence.
– 6e: Fecal incontinence.
Tips for Care: When a patient reaches stage six of the FAST Scale, it’s time to develop a comprehensive care plan (including professional caregiving support). If the patient is at home, make sure their environment is safe. A hospice partner (like Envision) can provide emotional support to both the patient and family members. If you have questions about hospice qualifications, please reach out.
Stage 7: Severe Dementia
Characteristics: In stage seven, patients require extensive care. Individuals lose the ability to speak, walk, and engage in daily activities. This stage is broken down further into substages 7a to 7f.
Signs to Recognize:
– 7a: Limited speech.
– 7b: Single-word communication.
– 7c: Loss of ability to walk.
– 7d: Inability to sit up independently.
– 7e: Inability to smile.
– 7f: Inability to hold up the head.
Tips for Care: At this stage of dementia, patients require intensive caregiving (often in a hospice setting). At Envision Hospice, we focus on a patient’s comfort, quality of life, and dignity during this final chapter.
The FAST Scale in Hospice Care
The FAST Scale is a powerful tool for healthcare providers to recommend hospice at the right time. By recognizing the stages of dementia, we can make sure that patients with advanced dementia receive the tailored support they need. Because hospice care focuses on comfort and quality of life (rather than curative treatments), recognizing a patient’s stage of dementia is important for management, emotional support, and assistance with daily activities.
The FAST Scale also empowers care teams and families to communicate clearly about treatment goals and quality of life interventions. It helps families make informed decisions, ensure that the patient’s wishes are respected, and prepares families for the journey ahead.
By understanding the stages of dementia and the corresponding care needs, families can better navigate the steps ahead. At Envision Hospice, we’re committed to supporting families through every stage of this challenging journey. We’re here to provide compassionate and personalized end-of-life care.
Do you have questions about how the FAST Scale guides care planning and hospice eligibility? Please feel free to reach out to our team. You don’t have to walk this journey alone.