Assessment of Alzheimer’s Dementia – FAST Scale

Seek Additional Help When You Start To See A Decline.

Lenity Light Hospice of Texas (LLH of TX) remains focused to improve care and treatment for our beloved patients. During this difficult and vulnerable time, we strive to be the foundation for the needs of our patients and their families. Hospice is just one of many services available to you and your loved one. Start somewhere and make a call, get information. You are not alone.

Activities of Daily Living

One of the ways to assess need for additional assistance for a patient is by looking at their Activities of Daily Living. What Activities are they able to perform that are absolutely necessary to live?

As patients get weaker or more confused, they will need increasing assistance with activities of daily living. The 6 listed are the most basic. Patients who require assistance with ADLs, especially when they need assistance with 2-3 ADLs are starting to show signs of decline. It is at this stage that if proper intervention is provided with proper support services that patients can respond well. Decline can be slowed (even while on hospice – as hospice is the one providing these services) to allow patients to live longer, live better as well as giving caregivers assistance in caring for the patient.

Activities of Daily Living:

  • Transfer (Is patient able to get in out of a chair or bed)
  • Ambulation (Is patient able to walk without assistance)
  • Continence (Is patient able to get to bathroom without accidents – Urinary Incontinence comes first, then Bowel Incontinence)
  • Bathing (Is patient able to shower/bathe without assistance. Able to perform self-care and personal hygiene)
  • Dressing (Is patient able to dress/undress self as needed without assistance)
  • Feeding (Is patient able to feed self if given a prepared meal. Can patient use utensils, can they pick up food and put in their mouth – Usually the last function to go)

Safety Issues

One of the most important determinations of what recommendations to make regarding self care/placement of patient into a facility is safety. The social workers and nurses are evaluating the patient to make sure they can safely take care of themselves.

These recommendations are made with great care as we all realize patients want to stay home, and actually do better when they are in familiar surroundings. If the patient situation allows and care can be provided at home safely, this is the best place for the patient to be. Otherwise, other options include Assisted Livings, Group Homes, and Nursing Homes.

This discussion is usually very charged with patients usually refusing or getting angry at suggestion of moving out of their homes. Keeping the focus on allowing for the patient to retain as much freedom as possible and allowing them to direct their own care is of paramount importance.

Agency staff, families and patients should understand that this is a discussion for the best interest of the patient to improve quality and length of life by focusing on basic addressable factors.

Safety Issues To Monitor:

  • Focus on Safety – Can patient maintain balance, transfer, carry out ADLs without minimal assistance?
  • Can the patient take medications safely and without forgetting?
  • Can the patient open the door, use the phone, call 911 or family in case of emergency?
  • Does the patient have any sensory impairments (hearing/vision, etc.)
  • Can the patient leave the home if there is an emergency (ie fire, natural disaster, etc.)
  • Can the patient obtain needed supplies/food for home (or have someone deliver them)?
  • Is the home a safe environment? Can it be made safer (remove rugs, grab bars, lighting, etc.)?
  • Overall health condition and mental condition of the patient. How confused i the patient? Can they be taken advantage of by others coming to the home, will they remember to eat, will they remember to turn off the stove, etc.?

Functional Assessment Staging Tool (FAST) for Alzheimer’s Dementia

The Functional Assessment Staging Tool (FAST Score) is a common tool used by practitioners to assess and evaluate the level of functional ability and cognitive decline in patients living with Alzheimer’s Dementia. It is important to note that this is just a tool and must be taken in context with overall patient condition by a trained healthcare professional.

The tool is very specific to Alzheimer’s Dementia and does not apply to other forms of dementia.

The scoring is divided into 7 stages. Individuals with dementia progress down these stages to level 7. The unique thing about Alzheimer’s Dementia is that it follows the stages in sequential order. If you note that things are out of order, than there is likely another diagnosis or another process affecting cognitive impairment in addition to Alzheimer’s Dementia.

Functional Levels

  • Level 1 – No functional or cognitive impairment
  • Level 2 – Early Changes – hard to notice
  • Level 3 – Mild functional losses noted
  • Level 4 – Moderate functional losses noted
  • Level 5 – Moderate to severe functional losses noted
  • Level 6 – Severe impairment of functional status. Needs assistance from caregivers
  • Level 7 – Total dependence on caregivers – Prognosis is guarded and at this stage usually starting to get to less than 1 year. Patient likely is becoming hospice eligible.

Functional Assessment Scale Tool (FAST Score):

Stage:Level of Functioning:
Stage 1No deficits noted – No difficulty noted subjectively or objectively
Stage 2Complaints of forgetting. Forgets locations, objects. Subjective work/activity difficulties.
Stage 3Decreased job functioning noted by coworkers. Difficulty getting to new locations. Decreased Organizational Activity
Stage 4Decreased Ability to perform complex tasks (planning dinner parties, handling personal finances, forgetting events, forgetting to pay bills, etc.).
Stage 5Requires assistance in choosing proper clothing for day/season. May wear same clothes over and over. Needs supervision with tasks. Needs redirection.
Stage 6Needing more assistance with needs.
A – Improperly putting on clothes without assistance
B – Unable to bathe properly (can’t choose water temperature, use of soap, etc.)
C – Inability to handle mechanics of toileting (forgets to flush/wipe, forgets to dispose of tissue, etc.)
D – Urinary Incontinence
E – Fecal Incontinence
Stage 7A – Loses ability to speak (Speaks less than 6 words, does not answer questions, no longer able to converse. Speech limited to same repeated words or set phrases.
B – Speech limited to one word. No longer speaking. If tries to speak, unintelligible.
C – Loses ability to walk. Cannot walk without personal assistance.
D – Loses truncal support. Patient loses ability to sit in a chair and support themselves. They fall over in a chair or need to be propped up by pillows.
E – Loses the ability to smile.
F – Loses ability to hold up head.
Psychopharmocology Bulletin, 1988 24:653-659

Get assistance early. Having proper support, getting correct equipment, improving nutrition, having close medical monitoring, continuous care plan adjustments, promptly treating infections and addressing acute issues will lead to slowing of decline, prolonging life and improving quality of life.

A FAST Assessment can help you understand your loved one’s decline and help you in obtaining the correct support. The scale allows caregivers adn healthcare providers to track functional progress and help determine appropriate goals of care for the patient. The score can help offer unique understanding of decline and lead to problem solving approach care tailored to patient care needs. Most importantly, using the score with other assessments can help caregivers and healthcare providers quickly adjust patient care plans when a change is noted. This ability to understand and act quickly will lead to improved patient care outcomes.