As a nurse who has cared for many terminally ill individuals with Alzheimer’s disease over the years, I understand the importance of accurately assessing their functional decline using the Functional Assessment Staging Tool (FAST). The FAST scale provides valuable information about the progression of Alzheimer’s disease, helping to guide appropriate care planning for patients and their families. In this guide, I will walk you through the process of assessing patients on the FAST scale, starting from stage 1 and discussing when to stop reading the scale for determination. I will also provide three examples of patients at various stages of the FAST scale.
If you are more of a visual-audio person, please see the first link in the resource section below for a YouTube video that explains how to read the scale.
Understanding the FAST Scale
The FAST scale, or the Functional Assessment Staging Tool, is a reliable and widely used measure to assess the functional status of patients with dementia. It was developed by Dr. Barry Reisberg, a leading expert in Alzheimer’s disease, in the 1980s. The FAST scale helps nurses, doctors, and caregivers to understand, communicate, and monitor the progression of dementia and its impact on the patient’s ability to perform daily tasks.
The FAST scale consists of seven stages, with the first two representing the functional ability of an adult without dementia and the last one representing the disease’s final and most severe stage. Each stage describes the patient’s level of functioning and activities of daily living (ADLs), such as dressing, bathing, eating, speaking, and walking. The FAST scale also indicates the patient’s eligibility for hospice care, usually recommended when the patient reaches stage 7.
It is essential to note that the FAST scale emphasizes functional abilities and activities of daily living (ADLs) rather than cognitive decline, which can vary from patient to patient. Therefore, the FAST scale should be used with other tools and tests that measure the patient’s cognitive and behavioral changes, such as the Mini-Mental State Examination (MMSE) or the Neuropsychiatric Inventory (NPI). The FAST scale should also be used with caution and sensitivity, as it may not capture the patient’s individuality, preferences, and quality of life.
The Assessment Process
Using the FAST scale, the nurse should interview the patient and their caregiver and observe their behavior and performance. Based on the guidelines and examples provided by the FAST scale, the nurse should identify the highest consecutive level of disability the patient exhibits. The nurse should document the patient’s score on the FAST scale and compare it with previous scores to track the changes over time.
The FAST scale is a quick and straightforward tool used during each office or home visit. However, the nurse should be aware of its limitations and challenges, such as the subjective nature of some items, the variability of the patient’s condition, and the influence of environmental factors. The nurse should also be respectful and empathic when communicating the results of the FAST scale to the patient and their caregiver and providing them with appropriate information and support.
Examples of Patients at Various Stages
Here are some examples of patients at various stages of the FAST scale, along with some nursing interventions and recommendations:
Stage 3: Early dementia. The patient has decreased functioning at work, difficulty traveling to new locations, and reduced organizational capacity. The patient may also have memory problems, such as forgetting names or appointments. The nurse should educate the patient and their caregiver about the diagnosis and prognosis of dementia and provide them with resources and referrals to support groups, legal services, and financial planning. The nurse should also encourage the patient to maintain their social and physical activities and to use memory aids and reminders.
Stage 5: Moderate dementia. The patient requires assistance choosing proper clothing for the day, season, or occasion. The patient may also struggle with personal hygiene, grooming, and toileting. The nurse should assist patients with activities of daily living (ADLs) and provide them with adaptive clothing and equipment to enhance their independence and dignity. The nurse should also monitor the patient’s skin integrity, nutrition, hydration, and elimination to prevent complications such as pressure ulcers, infections, and constipation.
Stage 7: Severe dementia. The patient is dependent on others for their care and has severely impaired functional abilities. The patient may also have limited or no verbal communication and may be bedridden or wheelchair-bound. The nurse should provide the patient with palliative or hospice care, focusing on their comfort and symptom management. The nurse should also communicate with the patient using nonverbal cues like touch, eye contact, and music. The nurse should also support the caregiver and the family and help them cope with end-of-life care’s emotional and spiritual aspects.
Assessment Process
Start by observing and interacting with the patient to gather information about their functioning and ADLs. Consider involving family members or caregivers familiar with the patient’s day-to-day activities.
Assess the patient’s abilities in various domains, including personal hygiene, dressing, eating, bladder and bowel continence, mobility, and communication. Use specific examples and observations to determine the level of assistance the patient requires for each activity of daily living (ADL).
Compare the patient’s abilities to the descriptions provided in each stage of the FAST scale. Based on the patient’s performance in the assessed domains, determine the stage that best represents the patient’s current level of functioning.
Document the assessed stage of the FAST scale in the patient’s medical records and communicate the findings to the healthcare team and family members. This information will help guide the development of a personalized care plan.
Continuously reassess the patient’s functional abilities to monitor disease progression and adjust the care plan accordingly.
Example 1: Patient at FAST 5
FAST Stage 5 represents moderately severe functional losses. Here’s an example of how to assess a patient at this stage:
Personal Hygiene: The patient needs assistance with bathing, grooming, and toileting.
Dressing: The patient requires assistance with selecting and putting on appropriate clothing.
Eating: The patient can still feed themselves independently but may require assistance with cutting food or using utensils.
Continence: The patient may experience occasional urinary or fecal incontinence and requires reminders to use the bathroom.
Mobility: The patient can walk independently but may exhibit difficulties with balance and coordination.
Communication: The patient’s speech may be limited, and comprehension may be impaired.
Example 2: Patient at FAST 6D
FAST Stage 6D indicates severely impaired functional abilities. Here’s an example of how to assess a patient at this stage:
Personal Hygiene: The patient requires complete bathing, grooming, and toileting assistance.
Dressing: The patient is unable to dress independently and requires assistance with all aspects of dressing.
Eating: The patient requires assistance with feeding and may have difficulty swallowing or chewing.
Continence: The patient is incontinent and requires frequent toileting and changing.
Mobility: The patient is wheelchair-bound or bedridden and requires assistance with transfers.
Communication: The patient’s speech is severely limited or absent, making it challenging to understand verbal instructions.
Example 3: Patient at FAST 7C
FAST Stage 7C represents total dependence, indicating the most advanced stage of Alzheimer’s disease. Here’s an example of how to assess a patient at this stage:
Personal Hygiene: The patient entirely depends on caregivers for all aspects of personal hygiene.
Dressing: The patient is unable to participate in dressing and relies entirely on caregivers for this task.
Eating: The patient requires full assistance with feeding and may need a modified diet.
Continence: The patient is incontinent and requires constant attention to manage urinary and fecal incontinence.
Mobility: The patient is bedridden and requires extensive assistance with repositioning and pressure ulcer prevention.
Communication: The patient has limited verbal communication ability and may exhibit non-verbal cues to express needs or discomfort.
Remember, these examples provide a general idea of the functional abilities at each stage, but each patient is unique, and their progression may vary. Assessing individuals holistically and considering their specific needs and abilities is crucial.
Conclusion
The Functional Assessment Staging Tool (FAST) is a valuable instrument for assessing the functional decline of individuals with dementia, particularly Alzheimer’s disease. It provides an efficient and comprehensive evaluation of functional ability and the potential for functional decline over time, enabling healthcare professionals, caregivers, and family members to monitor the patient’s capabilities. The FAST scale consists of seven stages, with the first two representing the functional ability of an adult without dementia and the last one representing the disease’s final and most severe stage. It focuses on functional abilities and activities of daily living (ADLs), making it a valuable tool for care planning and determining eligibility for hospice care.
When using the FAST scale, nurses should interview the patient and their caregiver, observe the patient’s behavior and performance, and identify the highest consecutive level of disability exhibited by the patient. Using the FAST scale in conjunction with other tools and tests that measure cognitive and behavioral changes is essential, as it communicates the results respectfully and empathetically to the patient and their caregiver.
The FAST scale should be completed on the admission of any patient with Dementia/Alzheimer’s Disease as the primary or secondary diagnosis for each re-certification period, any time a patient’s cognitive function would be considered a prognostic indicator for survival, or any time there are significant status changes.
In conclusion, the FAST scale is a valuable tool for assessing the functional decline of individuals with dementia. Its proper use can significantly contribute to developing personalized care plans and providing appropriate support for patients and their families.
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📚 This site uses Amazon Associate links, which means I earn a small commission when you purchase books or products through these links—at no extra cost to you. These earnings help me keep this website running and free from advertisements, so I can continue providing helpful articles and resources at no charge.
💝If you don’t see anything you need today but still want to support this work, you can buy me a cup of coffee or tea. Every bit of support helps me continue writing and sharing resources for families during difficult times. 💙
Compassion Crossing Academy — Free and paid online courses are available to teach caregivers, nurses, social workers, chaplains, end-of-life advocates, and educators, including death doulas, how to confidently coordinate complex care.
Currently, there is no official organization regulating end-of-life doulas (EOLDs). Keep in mind that some listed EOLDs in directories might no longer be practicing, so verifying their current status is essential.
End-of-Life Doula Schools
The following are end-of-life (aka death doula) schools for those interested in becoming an end-of-life doula:
Compassion Crossing Academy: While it’s not a dedicated death-doula school, it offers distinctive classes that can help a death doula expand their business. It’s a valuable resource for those eager to grow and deepen their knowledge in this meaningful field.
Remember that there is no official accrediting body for end-of-life doula programs. Certification only shows you’ve completed an unaccredited program and received a graduation certificate. It’s advisable to have discovery sessions with any death doula school you’re considering — regardless of whether it’s listed here — to see if it meets your needs. Also, ask questions and contact references, such as former students, to assess whether the school gave you a solid foundation to start your own death doula practice.
