functional assessment staging (FAST)

Indications

• component of hospice guidelines for determining prognosis, dementia
• progressive functional deterioration scale.
  • note progressive sub scales 6 a-e & 7 a-f.
  • score the highest consecutive level of disability.
• score of 7 qualifies patient for hospice (GRS11); 7c or higher

Contraindications

• need for around-the-clock care does not fulfill Medicare criteria for hospice eligibility for patients with a diagnosis of dementia

Procedure

• stage 1: No difficulty either subjectively or objectively
• stage 2: Complains of forgetting location of objects. Subjective work difficulties.
• stage 3: Decreasing job functioning evident to co-workers. Difficulty traveling to new locations. Decreased organizational capacity.*
• stage 4: Decreased ability to perform complex tasks, e.g. planning dinner for guests, handling personal finances (such as forgetting to pay bills), difficulty marketing, etc.
• stage 5: Requires assistance in choosing proper clothing to wear for the day, season or occasion, e.g. patient may wear the same clothing repeatedly, unless supervised*
• stage 6: occasional or more frequent changes characterizing progressive deterioration, noted over a period of weeks
  • a: improperly putting on clothes without assistance or cueing (e.g. may put street clothes on over night clothes, or put shoes on wrong feet, or have difficulty buttoning clothing)
  • b: unable to bathe properly (e.g. difficulty adjusting bath temperature)*
  • c: inability to handle mechanics of toileting (e.g. forgets to flush toilet, does not wipe properly or properly dispose of toilet tissue)*
  • d: urinary incontinence*
  • e: fecal incontinence*
• stage 7: further progressive deterioration characterized by
  • a: ability to speak limited to < 6 intelligible words
  • b: ability to speak limited to 1 intelligible word (word may be repeated over & over)
    • FAST criteria depend on quantity of words, not quality of speech
    • dysarthric speech limited to single words would seem to qualify
  • c: ambulatory ability is lost (cannot walk without assistance)
    • presumably loss of basic activities of living which includes needing ' assistance with transfers in & out of bed would imply loss of ambulation
  • d: cannot sit up without assistance (individual will fall over if there are not lateral arm rests on chair)
  • e: loss of ability to smile
  • f: loss of ability to hold up head independently

* scored primarily on the basis of information from informants

More general terms

• functional assessment

Additional terms

• hospice guidelines for determining prognosis, dementia