hospice guidelines for determining prognosis, dementia

Introduction

Guidelines:

• functional assessment staging (FAST)
  • even severely demented patients may have a prognosis > 2 years
  • progression past FAST stage 7c
  • dependency for all activities of daily living*
    • inability to ambulate without assistance
    • unable to dress without assistance
    • unable to bathe
    • urinary & fecal incontinence
  • inability to speak or communicate meaningfully
    • FAST criteria depend on quantity of words, not quality of speech
• presence of medical complications*
  • survival dependent upon comorbidities
  • comorbid conditions associated with dementia
    • aspiration pneumonia
    • pyelonephritis or other upper urinary tract infection
    • septicemia
    • decubitus ulcers, multiple, stage 3 & 4
    • recurrent fever after antibiotics
  • difficulty swallowing food or refusal to eat
  • impaired nutritional status
    • unintentional progressive weight loss > 10% over the prior 6 months*
    • serum albumin < 2.5 gm/dL
• the need for around-the-clock care does not fulfill Medicare criteria for hospice eligibility for patients with a diagnosis of dementia

*dependency for all activities of daily living, presence of medical complications, & unintentional progressive weight loss identifies FAST stage 7c

* Note that this may not be correct. Neither presence of medical complications, or unintentional progressive weight loss is a component of functional assessment according to other sources

More general terms

• hospice guidelines for determining prognosis

Additional terms

• functional assessment staging (FAST)