FAST Scale

No skipping allowed!

Your patient would fit 6E.

We had been using the FAST for anyone with a "Dementia" diagnosis, but just recently have been differentiating between the dementia and a true Alzheimer's diagnosis. We only use the FAST on Alzheimer's diagnosis. If the doc says "dementia" we don't use the FAST. Which is what I had been taught for many years, as the FAST was developed to stage only Alzheimer's disease.

thanks, that is what I thought!! I am stubborn (even more so when I am right)! I am looking for documentation that states how to use the scale!

It is true that the FAST scale was developed to stage the progression of Alzheimers victims, however, over time it has become apparent that the form can provide valuable insights into the decline of a number of dementias.

FAST can be used for Alzheimer's and 'generic' dementia. Alzheimer's disease pts must be ordinal. However, other dementias do not have to be ordinal. One very important thing to be sure of though, is the pt unable to ambulate due to dementia processes, or other reasons, such as weakness. There are lots of articles on the internet about it's use. Reisburg (the creator of the tool) has several articles on it's proper use.

Good question and comments. I wondered myself about some of this. I've come to the conclusion that this scale is mostly utilized by the hospice certifying physician (when typing the report that goes to Medicare). We call admission information into a report line for the doctors and they're aware we don't have records in front of us at the patients home. The doctors don't seem to be particularly concerned about the type of dementia/alzheimers anyway. The focus is more about whether the patients dementia/alzheimers has advanced to the point that speech is diminished significantly (or is more a "word salad"). But each hospice is different in their instructions. And one thing I've learned is that those instructions change all the time!

You are correct that the type of dementia does not necessarily affect the FAST or the certification/recertification of the patient. However, the type of dementia most certainly can affect the POC.

I have nurses that will check off 7A, 7B, then also 7E. I am trying to explain that they can't skip and they have to choose the stage that the pt meets and also meets all the stages above. Is that correct?

Also, do they need to check off multiple stages they meet or just the lowest stage and it's inferred that they meet all stages above that?

Sounds like you and yours could benefit from an inservice on using some of these tools. We recently had one that also covered administering the PPS vs Karnofsky.

Typically speaking, the FAST is determined by interview of the caregivers and observation of the patient. You score the patient where they are now. If they are scored at 7A it is understood that the patient already demonstrates the features of 6 A-E.

Clear as mud? Try google.

Good luck.