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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) [2]; 7c or higher [1]
Contraindications:
- need for around-the-clock care does not fulfill Medicare criteria for hospice eligibility for patients with a diagnosis of dementia [2]
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 [2]
- 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
Related
hospice guidelines for determining prognosis, dementia
General
functional assessment
References
- Medical Guidelines for Determining Prognosis in non-Cancer
Diseases, 2nd edition, Stuart et al (eds), National Hospice
Organization, Arlington, VA, 1996
- Geriatric Review Syllabus, 8th edition (GRS8)
Durso SC and Sullivan GN (eds)
American Geriatrics Society, 2013
- Geriatric Review Syllabus, 11th edition (GRS11)
Harper GM, Lyons WL, Potter JF (eds)
American Geriatrics Society, 2022